The Department of Defense (DoD) announced at the end of January that it is expanding fertility benefits for active duty service members to include the cost of egg and sperm freezing. These services will be covered during a two-year pilot program designed as part of the Force of the Future Initiative, which is a move to make the military a more family friendly employer and to encourage troops, especially women, to remain enlisted.
Egg and sperm freezing will only be available to active duty service members who either request the benefit or who are anticipating a deployment.
Deployed service members run the risk of sustaining injuries that can reduce or eliminate their ability to father children or to carry a pregnancy to full term. According to Military Times, more than 1,300 veterans who served in Iraq and Afghanistan suffered injuries to their groin regions and genitalia that required advanced reproductive surgeries. These injuries are mostly from encounters with improvised explosive devices (IED’s) or shrapnel from explosions.
“We can help our men and women preserve their ability to start a family, even if they suffer certain combat injuries,” Defense Secretary Ash Carter said of the new program.
The DoD already offers in vitro fertilization (IVF), artificial insemination, sperm extraction and embryo preservation at no charge to severely wounded, active duty personnel and their spouses. Neither Tricare, the military’s civilian health benefits program, nor the Department of Veterans Affairs, which provides health care to former service members with service-connected conditions, cover the cost of IVF or other advanced fertility treatments, such as egg and sperm freezing.
After the two-year pilot program has concluded, the DoD will assess its impact and will then either continue the program or allow members to pay for the out-of-pocket costs of storage for their frozen eggs and/or sperm.
How much does egg and sperm freezing cost?
There is some data available on the internet about the costs associated with the process of egg and sperm freezing as well as storage of frozen specimens. USC Fairfax lists an initial fee of $10,000 to undergo one egg freezing cycle with one year of egg storage at no additional charge and then $500 per year for additional frozen egg storage and a $5,000 fee for egg thawing. Cryobank, Inc. lists the cost of freezing a single sperm specimen as a range between $350 and $460 with ReproTech’s fee for frozen sperm and egg storage ranging from $275 for one year to $2,858 for 10 years.
The DoD will spend $150 million for soldiers to freeze their eggs or sperm. The DoD reported that service members electing to use egg or sperm freezing services will sign consent agreements in order to indicate their preferences in the face of death or divorce. Currently, courts in the United States typically do not enforce contracts signed at the time of egg or sperm retrieval when a couple files for divorce. Frozen eggs and sperm are typically returned to their respectful owners while frozen embryos are usually destroyed.
The DoD joins Facebook and Apple among employers offering egg and sperm freezing for specific employees as part of their compensation and benefits plans.
How does egg freezing work, and what are the success rates?
Sperm is the smallest human cell while eggs are the largest human cell. It is possible to see a human egg with the naked eye, but sperm is only visible with magnification. Sperm and embryos are easier to freeze than eggs because eggs contain a large amount of water that crystalizes when frozen. This crystallization can destroy the eggs while they freeze, when they are frozen and when they thaw.
Due to the high moisture content of egg cells, eggs are typically frozen using a slow-freeze method or a flash-freezing process known as vitrification, in which a cryoprotectant can make water harden like glass without any ice crystals forming.
Egg freezing is not a simple procedure. In order to retrieve eggs for freezing, women must undergo the same hormone treatments that women who undergo IVF go through. This process includes two to four weeks of self-administered hormone injections and oral birth control pills to temporarily halt natural hormones followed by 10 to 14 days of hormone injections to stimulate the ovaries and to mature multiple eggs at once.
Once the eggs have adequately matured, they will be removed from the ovaries via a needle placed through the vagina using ultrasound guidance. The woman is intravenously sedated during the egg removal process to reduce pain and discomfort during the procedure. Immediately after removal, the eggs are frozen and then stored in a tank of liquid nitrogen.
When a woman is ready to attempt pregnancy, which can be several years later, her frozen eggs are thawed, injected with a single sperm to achieve fertilization and transferred to her uterus as embryos. The success rate of IVF varies from woman to woman with most women achieving a 20 percent to 35 percent success rate.
Women are born with an estimated 1 million to 2 million eggs. By the time a woman starts to menstruate, her egg supply has dwindled to roughly 300,000 eggs. As women age, the reproductive quality of their eggs diminish, which is why some women experience fertility problems later on in their years of reproductive potential.
An article from Parents.com reported that women under the age of 25 have a 92 percent chance of getting pregnant naturally within one calendar year if they are actively trying to conceive each month. The site listed percentages of natural conception as an 86 percent chance for women ages 25 to 34 and a 78 percent chance for women ages 35 to 39 with a mere 3 to 4 percent chance for women over the age of 45.
The same article stated, “If a 42-year-old woman has five embryos placed, there is a 10 to 20 percent chance of pregnancy.”
How does sperm freezing work, and what are the success rates?
Compared to the egg freezing process, sperm freezing is much simpler.
The man is screened for infectious diseases, such as HIV and hepatitis, before producing a fresh sample of sperm that is immediately frozen and then stored in a tank of liquid nitrogen. Not all sperm survive being frozen, but their survival rate is much higher than that of frozen eggs.
When desired, the sperm are thawed for use in one of three ways: in IVF in which many sperm are placed along with an egg inside a petri dish and fertilization occurs on its own, in intrauterine insemination in which the sperm are placed directly into a woman’s uterus to facilitate fertilization or in intra-cytoplasmic sperm injection in which the sperm are injected directly into an egg. This last procedure is one step beyond IVF in the steps medical professionals take to do everything scientifically possible for fertilization to occur.
The United Kingdom’s Human Fertilisation and Embryology Authority gives the success rates of fertilization using frozen sperm as being dependent on the woman’s age. If she is under age 35, the success rate is around 19 percent. The success rate drops to 15 percent for women aged 35 to 39 and just 7 percent for women aged 40 to 42.
The success rate of pregnancies that result from frozen eggs and sperm along with the actual financial costs of freezing eggs and sperm plus the additional cold storage fees must be considered in the cost vs. benefit analysis of the egg and sperm freezing procedures offered by the DoD, Facebook and Apple.
In addition, the health risks to women associated with the egg collection process must be considered as well in any cost vs. benefit analysis. Some women may view the egg collection process as being invasive and will therefore not choose to undergo this type of fertility procedure when other options, such as surrogate mothers and adoption, are available.
The number of our active duty soldiers and those facing deployment who choose to utilize the DoD’s new egg and sperm freezing program will be the best way to see if these new fertility benefits are an advantage to our military members and their families.