IVF in the Military: Expanding Access for Service Members

In this ASRM advocacy update, leaders from the American Society for Reproductive Medicine discuss the ongoing effort to expand infertility and IVF coverage for active-duty military personnel and veterans through TRICARE and related federal programs. Sean Tipton, Chief Advocacy and Policy Officer, is joined by Dr. Micah Hill, former military physician and past SART president, and federal policy consultant Georgette Kerr to examine the clinical, personal, and legislative challenges facing military families seeking fertility care. The discussion highlights real-world patient stories, barriers created by current eligibility requirements, and the significant financial burden many service members face when pursuing treatment. Speakers also provide an in-depth overview of recent congressional activity, including bipartisan support for expanded IVF benefits, obstacles encountered during National Defense Authorization Act negotiations, and ongoing efforts to secure legislative reform. The webinar underscores ASRM’s commitment to equitable access to reproductive healthcare and outlines opportunities for members and advocates to support policies that help military families build the families they desire.

So thanks for being with us. I am Sean Tipton. I'm the Chief Advocacy and Policy Officer for the American Society for Reproductive Medicine.

We just wanted to take a few moments this evening to talk about and update people on where we are and what has been a long-term and remains an important priority for us, which is trying to get adequate infertility and specifically IVF coverage for our hardworking active duty military personnel. Now, we have been at this, I was looking today, we've been at this for 10 years. We have a poster in our office.

I don't really know if we decided we're gonna show that or not. It was a quote from Owen Davis, who was the ASRM president in 2016. When we were doing, we did a campaign.

At that point, it was really focused on veterans more than military. And so we did a set of these posters. You can see it even had the older logo on it.

We've changed our logo since then. And also at that time, 10 years ago, we worked with SART and had a number of SART clinics who were advertising discounts that they would offer to veterans. And we did that in part to try to embarrass the government and Congress, because you people are willing to take cuts to your income and they could fix it if they just pass something.

Turns out it's pretty hard to embarrass Congress. So maybe that didn't work so well, but we have been working, I think you can take that down now, Anna. We've been working on it for 10 years.

We have come close a couple of times. One thing I will say, we're gonna talk mostly tonight about coverage for TRICARE and active duty military people. That is because if we can fix that at a policy level, the VA will follow.

So they have a reg that says we'll do, we'll have the same criteria as DOD does. So if we can solve it at DOD, it's a twofer. Whereas if we just fix it at the VA, it would not fix it for active duty people.

So it's sort of more efficient this way. And we think maybe it will work better. Now, as I said, we have had a number of attempts.

We have freestanding legislation that would fix it. We have talked to the executive branch to try to get them to do it on their own. Most significantly in the last two years, and one of our speakers will explain this in more depth a little bit.

We have actually passed legislation which contained a provision that would have fixed this and would have had begun coverage for TRICARE patients to get IVF services. And that was removed at the last minute in a conference committee because the legislation was not exactly the same as what passed in the House and passed in the Senate. So they have to go to a conference committee and work that out.

And the speaker, we're gonna pull no punches here. Speaker Mike Johnson pulled that provision from the bill two years in a row, despite it having passed with bipartisan majorities two years in a row. So if you're looking for someone to blame, that's where to point your finger because that's who did it.

So what we're gonna do the rest of the evening, we're gonna talk a little bit. We have two important speakers and a couple of other people on who may get on as needed. But first we're gonna hear from Dr. Micah Hill.

Dr. Hill is at Shady Grove now. He is also the immediate past president of SART and also only recently left a long tenure in active duty working at Walter Reed and is still involved in their fellowship training there. And so Dr. Hill is gonna talk a little bit about what it's like in person to try to deal with this as an active duty military person and also now from where he sits as an ASRM leader and a SART leader and an activist.

And then we're gonna hear from Georgette Carr. Georgette, did I say Carr anyway? It's an E, not an A. Georgette is a lobbyist to ASRM employees to work with on federal issues. We started working with Georgette, I think three years ago.

It became apparent to me that myself and my colleagues in the ASRM office, we were healthcare lobbyists and we needed somebody who knew something more about lobbying with the armed services committees in the defense department. And Georgette fits that bill. And as she will also tell you, she also has experience of what it's like when you are a military spouse dependent on TRICARE and you realize you have a fertility issue and need to get coverage.

And then possibly, you may also see, and I do wanna thank Anna Hovey from our office who coordinates our advocacy activities like this and our government affairs team in-house is also online and can jump in with maybe some things that they know. And that is Jesse Loesch, our director of government affairs and Emma Behrens, who is our government affairs manager. So with that, I will turn it over to Dr. Hill.

Well, thank you, Sean. It's an incredible honor to be on with this panel and there's probably no topic that I'm more passionate about than helping our active duty and veterans build their families. I mean, we owe this to the people that sacrificed their lives so that we have this free country.

We're coming up on our 250th anniversary here in just a month. And so there's no more important time to be talking about this. I spent 25 years in the military, 16 of that at Walter Reed and a lot of that running the IVF program at Walter Reed, which is our largest in the military.

And I still train our military fellows, our NIH fellows at the NIH military, Shady Grove Fellowship Program. So I'm passionate about this and I'm sure we're gonna dive into a lot of the logistics and legal stuff. That's not my expert.

I'm just gonna sort of start with my experience. It was incredibly frustrating to be a trained professional at this and sort of be handcuffed and practice when you're seeing these people. It'd be like having an oncologist in the military and we have a lot of them who can't do surgery and can't do chemo.

Like you can treat cancer, but you can't have your two biggest guns, your two biggest therapeutics to solve that for those people. If you think about it, the US military has over a million people in it, but we do less than 2000 IVF cycles a year in the US military. 15% of people of reproductive age have infertility at least and 2000 out of a million is not 15%.

And even if everyone who's infertile doesn't need IVF, it still is not even scratching the surface of what we should be offering to these people who are serving our country. And from a personal level, the one that hits me the most, I was the IVF director, Lieutenant Colonel, and seeing this patient who was 18 years old, newly enlisted into the army, serving her country, got a diagnosis of lymphoma, like brutal diagnosis. She's 18.

She doesn't really have any family. She doesn't really have any way to pay for IVF. Technically that should be covered under current military provisions, but at that time, the administrators came and said, well, she hasn't had the insult yet to her fertility.

She hasn't had the chemo yet. So she doesn't meet the diagnosis of infertility because she's not infertile. Like, yeah, but she's gonna be in two weeks when they start her chemotherapy and they wouldn't cover it.

And this young lady did not have family. She did not have a way to be able to raise the funds that it would cost to do egg freezing at that age. And she broke down in tears.

Like, she's 18. She's literally a kid, less than a year out of high school, serving her country, and we could not support her to preserve her fertility while she's serving her country. Not only made me cry, but frankly, pissed me off.

Like, that is not how we should be treating the men and women who serve our country. Then you take it to the flip side where we've done really, really well. Like at Walter Reed, we've pioneered procedures that did not exist to treat infertility.

A lot of people don't know this, but sperm, when it comes out of the testicle, has a three-week process as it works through the body before it comes out in the ejaculate. During that time, it actually goes up inside our abdomen. We had a man who hit an IED in Afghanistan.

We evacuated him to Erev John in Kuwait, had a bilateral amputation. What you don't think about is those guys who have those bilateral amputations, those ladies who do, they also often lose their reproductive organs. Like those hits take those out as well.

They often lose their ability to urinate normally, to defecate normally. So they end up with ostomies, with tubes to urinate. The unique thing about sperm though is it comes up inside of our body and goes through this thing.

And there's a seminal vesicle gland that adds a little bit of fluid that helps with that ejaculate. And sometimes sperm gets stuck in there. So this gentleman had his bilateral amputation in Kuwait.

Got evacuated to the launch stool, was stabilized there. We got him to Walter Reed and our urologist and our reproductive endocrinologist operated on him. We got sperm out of that.

He had been married less than a year before he deployed. And imagine that, he's lost both his legs. He's lost his ability to urinate, his ability to defecate.

He's lost his ability to reproduce and have a family with his young wife, who's lost that dream of hers as well. They have a baby because of what we did at Walter Reed. We presented that new technique at ASRM.

That room was packed. And now that's used in emergency rooms and other places all around the globe to treat things that aren't just war injuries. So we have this weird dichotomy within military medicine where we're like abandoning people that are low-hanging fruit, that it's so easy to treat them, but we literally just aren't covering the few thousand dollars to preserve their fertility before they go through chemo as they're serving our country.

And yet we're also like deploying our REIs into combat situations. And we're developing techniques to preserve fertility in the most extreme of circumstances. So at our end, I feel like we're doing the best we can in the Army, the Navy, the Air Force, and the Marines to do what we can do.

But I feel like we're handcuffed with how we treat these patients because of what's placed on us mainly from Congress and the legislature. And so I'll leave it at that. I'm sure we're gonna dive deeper into that, but that's sort of my high-level personal view.

What makes me really proud to have served and also what infuriates and frustrates me about my time in the service. Yeah, you know, Dr. Hill, when we started on this, I thought, oh, this is gonna be pretty easy. This is a sympathetic crowd.

It's gonna be bipartisan. Everybody wants to take care of our military. And it turns out a lot of people like to claim they wanna take care of our military.

They don't really wanna do it. And we have not yet figured out a way to provide these services without a cost. And so one of the knocks is, gosh, that's gonna cost money.

I'm like, yeah, turns out taking care of sick people does cost money. And there's just no way around that. But so a couple of things before we move on.

One is if you all have questions, put them in the Q&A and we will do our best to get those addressed. And then, Dr. Hill, I just wonder, we have thrust you into some situations, appearing at press conferences on the Hill, going and talking to members of Congress. I wonder if there's anything, any of those interactions that have surprised you either in a pleasant way or perhaps in a way that continued to piss you off.

Yeah, both, for sure. In the pleasant way is that there appears to be bipartisan support. When you sit down and meet with the legislatures, with the people who are writing our laws, even with the lobbyists, all these other people, there's bipartisan support.

The vast majority of Americans, the vast majority of politicians support, not just IVF for the military, but IVF for everybody in our country, as would be normal for almost every other modernized nation in the world. So that's encouraging. You sit down and they're all supportive of it.

But then you get behind the scenes and they start negotiating and they start actually making decisions. And you realize that on both sides, I think both parties are guilty of this, they're more willing to leverage that for PR stunts, to say, hey, look, that other party doesn't support it. This other party doesn't support it.

But we do, rather than actually solving the problem. So yeah, if you're gonna ask me what pisses me off or makes me angry when I look at it, it's when you hear behind the scenes that both sides support it, but neither are willing to work together because they'd rather get the publicity gains. And that's not my area of expertise.

I've been military my whole life, so I don't know anything about politics. So when I see that, that makes me angry. That makes me really, really frustrated.

Appreciate that. And we do appreciate all you've done. Dr. Hill made the mistake of being SAR president, leaving the military and living close to Washington DC all at the same time.

So we have taken full advantage of him in that convergence. So I'm gonna turn now to Georgette. And if those of you didn't hear the intro at the beginning, Georgette Kerr is a lobbyist that ASRM has on contract.

Just a small point. So Emma and Jesse and I are all officially registered lobbyists on behalf of ASRM. We are full-time employees of ASRM.

We also hire contract lobbies who have specialties that maybe we don't, contacts that we don't. We do that in the States and we do that in DC as well. And Georgette has just become a stalwart part of our team.

We are grateful to her every single day and she also has an interesting personal connection to this whole issue. So Georgette, we'll talk about that a little bit and maybe try to guide you through this without losing you completely in the weeds, try to help you understand kind of where we are from a legislative process thing on this particular task. Awesome.

Hi, I see a lot of familiar faces, I guess, or names. I'm Georgette Kerr. I'm the executive vice president at Plorus Strategies, but I've been part of the ASRM team for the past almost three and a half years.

And I say this all the time, ASRM is a favorite client. The team here is amazing, doing really, really fabulous work. And this issue is near and dear to my heart.

Despite all of my jobs in Washington, I guess my most important job is mom. I am a two-time IVF mom. I'm hoping my two little IVF miracles are upstairs, getting ready for bed.

So apologies in advance if we crash. But my husband served in the Marine Corps. When we were going through IVF, we actually lived on the military base here in Washington, DC, Joint Base Anacostia-Balling.

Actually, at the time he was a veteran, but we can get to that. And honestly, we connected with a lot of our neighbors. We had a funny story.

Our neighbor next door was getting ready to PCS. That's when a military family changes duty stations. And they came over and they knocked on our door to ask if they could use our microwave.

And they came in and we had just had a transfer. And I had that lovely little ultrasound picture that only an IVF patient would see and recognize. And our neighbor said, oh my God, you did IVF? We had to do IVF too.

And it's so common and you realize it. And then you get into this conversation about how difficult it is when someone's on active duty. They're separated from their spouse a lot of the time.

That can be part of it. They have toxic exposures. Their jobs are dangerous.

They're high stress. And so it shouldn't surprise anybody that rates of infertility in the military are significantly higher than the general population. We work with a lot of the military service organizations, veteran service organizations that do all of their own research in this space.

And some of the more recent statistics, we use the one in six statistic for the general population. For military, it's closer to one in four. So I think that that again, kind of justifies from a policy standpoint, the reason why we are so committed to advocating for expanded access for this particular population.

I guess my story and the other thing to kind of set the policy kind of table here is when we got our infertility diagnosis, we had a genetic diagnosis. My husband has a balanced chromosome translocation. He's a de novo carrier.

So fortunately we knew about this before we even tried to start to conceive. And when we got serious about starting a family, my husband didn't even think of it. He said, oh, well, I'm not only a veteran, I'm a DOD civilian.

There's gotta be some help for me here. I've served my country in uniform. I was in the reserve and I'm a federal employee.

There's gotta be some help for me here. And when he called the VA, and the policy is very similar on the active duty and the VA side, we very quickly learned that IVF coverage was only accessible if you had a service connection as the cause of your infertility. So my husband was born with this genetic diagnosis.

It was not caused by his military service. And so we were left to pay out of pocket entirely to build our family. For us, that took three retrievals.

It took three transfers to have our two kids. That was about $70,000 out of pocket expense. A lot of your young reproductive age, military, active duty military families aren't making a lot of money having the disposable income.

And so those are significant costs to have to pay out of pocket. And so what we've really kind of been focused on is this service connection issue. Obviously that service connection issue doesn't cover some of the most common infertility diagnosis and thinking of things like endometriosis, PCOS, unexplained infertility, those things, if you can't prove it's connected to your military service, you can't get coverage.

Part of the thing that's challenging too, and I see Dr. Christie is on the call too, is your injury or your illness has to be so severe and documented in a certain way. In most cases, you're leaving the military at that point. And so to Sean's point, getting some expanded access on the active duty TRICARE side is also gonna help us, I think a little bit on the VA side.

And so we need legislation to get this done, to make sure that TRICARE, which is the insurance provider for active duty military can go beyond this very narrow eligibility criteria for coverage and cover a broader part of our military population. And so I can kind of walk us through quickly the legislative history where we've been for the past three and a half years on this issue. And I'll say when Sean first reached out to me, part of the reason I was brought on to the ASRM team is my first job in Washington.

I worked on Capitol Hill for someone that the folks on this call probably never heard of named Hillary Clinton. She was a member of the Armed Services Committee. And so I sort of caught the bug for the annual defense bill.

And it's a year long process. In today's political environment, there are so few pieces of legislation that actually cross the finish line. But this is one bill that is almost guaranteed to make it to the president's desk for signature because that feeling of commitment to our troops still exists in Congress.

And so I think there's an opportunity to capitalize on that a little bit as well. So when I was brought on, I was actually brought on to kill some bad language in the NDAA my very first year. I think part of this was lack of education about these issues and IVF and the process and sort of the statutory language that led to a provision that was just bad.

We had language in the bill that said, TRICARE can cover ART excluding IVF. There's a ton of problems with that. One, ART excluding IVF means gift and ZIFT.

And as many folks on this call know, there's probably about a single digit number of gift and ZIFT cycles in this country every year. So this didn't really do anything meaningfully to expand access. But two, that excluding IVF language being in statute was gonna make it even harder for us to open the aperture and expand coverage going forward.

So that was in the fiscal year 25 NDAA. We were able to get the bad excluding IVF language thrown out of the bill. We had a kind of fallback plan.

I see Barb's on the call too. We got a cryopreservation pilot so that members of the military, active duty military under certain circumstances could freeze eggs, freeze sperm before deployment. That pilot was actually supposed to be live by the end of last year.

We have not seen progress. So that is something we are actively following up on. But our hope was to launch something like that that was relatively non-controversial.

It did not involve embryos so that we could collect data on the need, the demand, the utilization and use it to build our case for broader TRICARE coverage. So fast forward to the next NDAA cycle, FY 26. We found ourselves in a real pickle.

We had great language in both the House and Senate bills but the kind of problem was, and this is pretty unusual as far as the annual defense authorization bill goes. We had two competing TRICARE coverage provisions, one led by Senator Duckworth and one led by Senator Sullivan in the FY 26 bill. Or no, that was 25.

I think 24 we got the cryopilot. So maybe we've been at this even longer than I thought. But that particular year we got both provisions in.

The Sullivan language had some things that were really, really hard for us to accept. There was another codification of anti-abortion language. There was a service commitment so that if you were in the military you had to sign up for another four years to be able to access healthcare.

Obviously we think that's a pretty crazy stipulation. And there were other things that were not as bad but not ideal like you had a dollar cap versus a cycle cap in terms of coverage. The other thing we really didn't like was they were requiring you to store indefinitely or they used bad language instead of embryo donation.

They used embryo adoption or some crazy term, your remaining embryos. So I think the fact that we had those two competing provisions is what led the provisions to ultimately fall out that year. Then we were in last year's NDA cycle, FY 26.

This was the closest we've ever gotten. We had language in both the House and the Senate NDAs passed out of the committees in their markup, passed the full House on the floor, the full Senate on the floor. And then we get to the conference committee and we were feeling pretty confident.

The language was probably about 95% the same, small differences between the House and the Senate bill but things that probably wouldn't have been in there if we held the pen. So like for example, the House bill had cost sharing and prohibitions on certain things like genetic testing. The Senate bill had a rulemaking process and some other prohibitions in it but nothing that we couldn't swallow because we really did believe it was going to meaningfully expand coverage.

And then at the 11th hour, the speaker pulled it out. I remember it was like the week before Christmas or something, I got a call at 11 a.m. from our friends on the Armed Services Committee saying that the speaker is pulling it. And thanks in large part to ASRM members who activated very quickly.

We ramped up a lot of grassroots pressure on the speaker's office and I was told we were on life support, we were resurrected but on life support by the end of that day. Within the next 24 hours, we worked with Congresswoman Jacobs' office who in a strange world has a friendship with Matt Gaetz who was able to get the Undersecretary of Personnel at the Pentagon on record as supporting our language. And at the end of the day last year, it still fell out.

But all that work was not for nothing which kind of brings us to where we are today. So today, I guess three days I think it was after the speaker pulled this language and the NDAA was signed into law in December last year. In the house led by Congresswoman Jacobs, we dropped pretty much the exact same language that the speaker pulled from the big defense bill as a standalone bill, bipartisan.

We are up to 26 co-sponsors today and I am excited to share that 14 of those are Republicans. That is a really significant number considering our margins in the house. And in fact, little wonky legislative procedure for you, it is enough if Democrats band together and those Republicans kind of stick to supporting the bill to force the speaker to hold the vote on the floor.

We're not ruling that out, we're keeping our powder dry but I think that that significantly changes the dynamic as we head into this NDAA, that's the name for the defense bill season. So that is significant and the Republicans who are on this bill are an amazing sort of cross section of the Republican conference. We have folks that are probably among the most moderate, most vulnerable incumbents that are up for reelection in the house this fall, to some folks that I almost fell off my chair when I heard they were signing onto the bill.

So I think that in itself to Dr. Hill's point speaks to the bipartisan nature of this particular issue. We know that Congressman Jacobs is going to be offering that very same language in the house NDAA markup, which actually is coming up next week, it will be on June 4th. It's an all-nighter, they stay up all night, it's usually like a 20 hour long markup and DC we all bet on what time it's going to end.

But last year and the past couple of years actually, I'm usually up till like 12, one in the morning and we're texting with the staffers in the room. And what we're expecting hopefully same as the past couple of NDAAs, is that this language will be adopted as part of a big package of amendments and it'll go through in the markup and be in the final version of the bill that goes to the house floor for a vote, hopefully sometime in June or July. So fast forward to the Senate side, we have been desperately trying to get a Senate companion, the same bill that was introduced in a bipartisan fashion in the house, introduced in the Senate as well.

We have a couple of Republicans who have expressed interest. In fact, we had some great meetings, I guess earlier this month where we had Republicans sit across the table from us and say they had no substantive issues with the bill, but they have yet to sort of pull the trigger. Our hope is that we can still get this bill introduced because just like we have this bipartisan strong showing of support in the house, I think that that would significantly change the dynamic and put us in a very strong position in the Senate.

The Senate will mark up their bill, the Armed Services Committee is gonna meet the following week, the week of June 8th, and they do all of their consideration behind closed doors. So it's a little bit challenging to kind of have a lot of insight into the process. I'm sure because ASRM, and one of the reasons I love working with ASRM is the staff comes to us to help drive the strategy behind the scenes.

So I'm sure we will be getting a lot of messages, asking questions, tips, guidance. And I think it's so important for ASRM, the leader on the sort of science and the clinical expertise is sort of driving the strategy here. So we are expecting Senator Duckworth similarly to introduce the language that the committee already agreed to, that the full Senate agreed to last year in markup.

There are rumors that we caught wind of about a week or two ago that Senator Sullivan may be up to no good again, and potentially offering his amendment that includes a lot of those things that not just we, but the military community does not like. So we were literally just signing onto this call and we got out the door today, a letter from military service, veteran service organizations to the leadership of the House and Senate Armed Services Committees, expressing support for our preferred language for the bill and raising issues with some of these red flags, the service connection in particular that we would expect to be in the Sullivan amendment. We have 15 different, some big, some small, some national, some more focused military groups on that letter.

So we're really trying to preempt what we saw with the competing language two NDA cycles ago from happening again. So that's where we are today. I can kind of talk about what the opportunities and what the challenges.

Actually Georgette, let me do that. Sure. Let me start that, because I wanna say a couple of things.

One is, so as Georgette just laid out, this is very complex. The tactics are complicated. The procedures are complicated.

And I know a lot of ASR members wanna be actively involved, and we welcome that, but sometimes it doesn't work. And we sometimes, one obvious thing we do here is like, let's send everything out and get everybody to co-sponsor these bills. Well, we're gonna end up with 7,000 Democrats and three Republicans, and that's not gonna help our cause.

So that's why we haven't like deployed that particular strategy. Now, as Georgette mentioned, when we got, to get the provision back on life support, what we did was reach out to a lot of people, a couple of them who were on this call that I, Dr. Hill, Dr. Alicia Christie, some of our ASR leaders who we know have, who we know were veterans, and particularly some who had some tie to Louisiana or something else to get that. So it's, just because you're not seeing a lot of our activity doesn't mean it's not happening.

But it requires some pretty particular sensitivity sometimes. And that's why we wanted to do this call, because we wanted to keep you informed of what's going on, even when there's not a big, massive call to action. So I didn't want you to think we weren't doing anything.

And a lot of ASR members are involved, but it's in very specific tactical ways. So I do think as this, as the NDA, the National Defense Authorization Act, which is the reason this is such a important vehicle, because it authorizes all the activities of the Department of Defense every year. So without it, our defense industry, our defense department comes to a halt, and that can't be allowed.

But so that is part of why when the speaker took it out, nobody was willing to try to put it back in on the floor, because they don't want to be responsible for holding this whole piece of legislation up. Speaker knows that, he knows he can get away with that. So that's why that happened.

But we have done and will do, and there are times when we're going to want a big public noise, and we will do that. The other thing I think that becomes important is sometimes we need some technical help, especially dealing with the budget estimates. What we see from the official sort of budget scorekeepers in Congress, the Congressional Budget Office, they like to assume that every female member of the military is going to need five IVF cycles every year.

And yeah, that's going to cost a lot of money. We also know that's a ridiculous assumption. And so, and because ASRM, we have one real asset that we bring to this to any debate, and that is the expertise that you all have.

And so we treat that very jealously. And so yeah, we will acknowledge the infertility rate of active duty military is probably higher than it is in the general population. And maybe the percentage of people who need services, maybe that will be a little.

On the other hand, most of the people in the service are under the age of 25. And unless you have something like Dr. Hill's first story, most of those people aren't going to need infertility care. So we take this very seriously, and we very jealously protect ASRM's reputation as a reputable source of information, even when sometimes tactically we might like to say something different, we don't.

The other thing I wanted to say was that, Georgette alluded to some of the restrictions and some of the deals, some of the conditions that people want to put on this. ASRM, fertility problems are a health condition and ought to be treated as such. They ought to get the same research resources, and they ought to have the same access to insurance and clinical services as any other kind of health concern.

And we will resist anything that tries to put a condition on that. In particular, and sometimes we'll make some small compromises if we have to, we will never compromise away or agree to compromise away the ability of patients to make their own decisions about their own medical care, including what happens to their own tissues. That's a very popular restriction that people want to put on there.

You can't discard your embryos. We will never agree to that kind of stipulation because it's just too important a precedent for us. So I think with that, I don't know if Jesse and Emma have anything you want to add, and then we can kind of see if there's questions that we want to deal with.

No, nothing major to add, but thank you to Dr. Hill and Georgette and Sean for laying that out so thoughtfully and comprehensively. I think just to echo Georgette's sort of thoughts, it's really exciting, I think, that we have 14 Republicans in the House on the bipartisan bill. So we're feeling hopeful, hopefully that things move over the next few months to a few years, and that I think we saw real progress after the removal in December.

So it was- I think the other reality about that, Emma, that struck me was a lot of these Republicans were pretty pissed off at the Speaker. Absolutely. That's why we got 14 to co-sponsor, because this will shock you.

Politicians have egos, and they don't like the decisions that they made and the deals that they made to get overridden by one person. And so it was not a popular action. Absolutely.

It's going to be interesting to see, just because a lot of the timing of this is such that this is probably going to be resolving itself again in November, December, that's going to be after the midterms. So we may be looking for a couple of different reasons at a lame-duck Speaker there, which may change the dynamics. Now, this bill is not going to cross the finish line, certainly until after the election.

It'll go on the floor probably in June and July, which I think is actually strategically helpful for us because I think IVF is so popular. I think anyone is going to be really reluctant to take it out at that point. But I think there's a lot of other things that make the environment different and sort of play in our favor this year.

I think one thing we haven't talked about, aside from, to Sean's point, Republicans being pissed that their will and what they voted for on the floor being overridden by their leadership, is this parity issue. Maybe for folks on the call that don't know this, members of Congress get their health insurance through the D.C. Exchange, and thanks to Jesse's work and others that work at the state level, because we had D.C. fertility mandate go into effect January 1, 2025, members of Congress now have access to IVF coverage. And the way that we wrote the language for the NDAA, it mirrors exactly the coverage that members of Congress get.

And that's a very hard talking point for a lot of these Republican members that are pro-military. They get very uncomfortable when you point that out. So I think that has also been sort of a game changer in the environment.

And to Sean's point, I think when the speaker pulled this the past few times, the polling was looking pretty good for Republicans. It didn't look like their majority was in jeopardy, and that is certainly not the case this time around. And I think there's part of me that wonders, and because we have all these Republicans on record now co-sponsoring a certain version of the language, one, I think it'll be hard for him to tweak it, but because some compromises have already been made, if we're doing the final negotiations in a lame-duck Congress, is he gonna want this to get done on his watch or potentially next year, when Republicans may not control either chamber? So that's another thing.

I mean, I think the other thing, and we're still sort of navigating this, and this is like, you need a whole nother webinar to talk about the rulemaking the Trump administration just put out on accepted fertility benefits. But the things that the president has said that at face value are very pro-IVF, for certain members who felt like they needed it, it's created some political cover for them to get behind this. So I think those are all things that we do have going on our favor as we kind of approach this year's NDA cycle.

So a couple of things, a couple of questions. I talked about we needed, we brought Georgette in partly because we needed more expertise in the DOD, but it's also, every policy community has its own set of, know well the players in the military service groups or the veterans groups. And I wonder, Georgette, could you just name drop a few of those groups so that people know kind of who we're talking about? Oh, I can pull up our letter here.

The two big ones are NMFA, National Military Family Association, and MOA, the Organization for Military Officers. We work with some of the smaller groups, Building Military Families Network. And that's something else I wanna plug before I forget.

They're gonna be sort of championing next week, it's gonna be June 3rd, a Military Infertility Awareness Day, strategically timed to coincide with NDA markup. So we're still trying to get more information and hopefully we'll be amplifying that, but that's also an opportunity, I think, for folks on this call to kind of help us get the word out as we head into this really critical legislative period. So we're working with them.

We'll probably have some social media of our own and some amplifying theirs. And so those of you who are social media folks, if you could be on the lookout for that and amplify that on that day, that would be very helpful. Yeah, but just to rattle off the groups that are on this letter, we've got Air Force Sergeants Association.

We already talked about Building Military Family Networks, Commission Officers Association of the U.S. Public Health Service, the Elizabeth Dole Foundation, Iraq and Afghanistan Veterans of America, Maternal Mental Health Leadership Alliance. We already talked about MOA, the Minority Vets, the National Military Family Association, the Naval Enlisted Reserve Association, Paralyzed Veterans of America, SWAN, Service Women's Action Network, Tragedy Assistance Program for Survivors, the Independence Fund, and the U.S. Coast Guard Chief Petty Officers Association have all been active. Thank you.

And so for those of us, like my colleagues who are full-time employees of ACERM, this is good because there's a million groups about everything. And so we have, despite the fact that I've been at ACERM forever, there are opportunities to go to work for other groups. Association work in D.C. is a growth industry, I always tell people.

I'm trying to think of what the other, so a couple other of our questions that have come in, you know, as I was talking about the cost projection, the other interesting thing is they also like to include the cost of the maternity care and obstetrical care, and even as I recall, the daycare and pediatric health costs. So again, it's like- And I was looking at these numbers- Do you count the fact that you have to keep taking care of people who need post-amputee care? It's just ridiculous. Yeah, so just to illustrate that, the CBO, the Congressional Budget Office, their estimate to cover IVF added under TRICARE was $1.8 billion over two years.

The Defense Department's estimate for, their estimate, they did it on a five-year basis, was anywhere ranging from 4.9 to 8.7 billion. About five years ago, when we did our white paper model for TRICARE benefit, we estimated 260 million with an M as opposed to billion with a B for year one, and that was only to sort of catch up with pent-up demand, and then 144 million per year after that. Obviously, that's a lot of daylight between those numbers.

And just the other thing to kind of put it for context for folks on this call, the president has requested a top-line number for defense spending of, you know, 1.5 trillion, and we're talking about what we think is more in the range of, you know, 150 million. This is a drop in the bucket as far as DOD spending is concerned, and we just have to consistently keep reminding folks of that. Okay, so thanks.

I think a couple of my staff have a couple of points they're ready to make. Yeah. So we'll let that happen.

Thanks, everyone, and thanks again to Dr. Hill and to Georgette. I think just the one announcement that Jesse and I wanted to make is that we wanted to plug sort of the legislator meetings we've been doing so these are both virtual meetings, and more recently, we've been doing some in-person, in-district meetings, which is really exciting. We've done a couple in Des Moines and then in South Florida with Representative Nunn and Representative Wasserman Schultz, who are the co-leads on the Hope with Fertility Services Act.

So I'm going to pop the Google Doc in the chat that folks can fill out if they're interested in either hosting legislators, whether they're state or federal, at their clinic and district, or if they're interested in doing virtual meetings. And you can also always feel free to email us or the Public Affairs ASRM email, which I can also put in the chat. Thanks, Emma.

I think it's important. We, as I said, we're not doing big, you know, showy everybody-call-your-congressman kind of things at this point, but these meetings, even virtual meetings, are very important and can lead to unexpected returns. One of our members in Louisiana had a meeting and it turned out one of the Senate staffers got to that and suddenly we've got a new prospect for a champion in the Senate in Louisiana.

We have set some people up in some other states where we're looking to get, we really are, we don't want to drop the bill in the Senate until we have a Republican sponsor on it. And we've gotten some good leads on that from some of these visits. So if you're at all interested in doing that, it, I get it.

It can be a pain in the ass to have a member of Congress or their staff come to your clinic. It's powerful for them though. And, you know, again, I play on the stereotype of the, you know, politicians like to kiss babies.

You present a target-rich environment for those folks to come in, you know. The next best thing to kissing a baby is kissing somebody who's making babies. So they like to do them and you can do them virtually and it's pretty valuable to do them virtually as well.

So I would encourage you to take advantage of that. We are going to be doing some other things. We have partnered with a group called Vote ER in the past to help people get registered and get their patients registered.

And with the midterm elections, we'll be doing some of that again. It looks like there's going to be enough sort of reproductive-related ballot measures out in the states that we'll do some postcard writing at our meeting in Baltimore, which I'm sure you all will be attending. So we'll be doing things like that.

So with that, I think we're going to wrap it up and try to get out of here within 45 minutes, which is pretty good. We really do appreciate Dr. Hill's activism, Dr. Christie's activism. All of our many, we have a lot of members who are very willing to drop what they're doing and go to work on this.

I think for any of our members who have been military REs, this issue just infuriates them. I don't think Dr. Hill's alone and his passion for this issue from people who have served and not been able to take care of patients when you know it's right there. And I think all of us feel that way about a lot of things, but it's particularly poignant if you're for people serving in the military.

And we're going to keep plugging at this. I keep thinking we're right there. And, you know, as an undergrad, I was maybe ironic, I was a political science major.

I remember my like congressional behavior class, professor saying significant legislation has a long gestational period. And I didn't realize how close I would get to that in the course of my career. So again, thanks, Dr. Hill.

Thanks to Georgette. Thanks to the team at ASRM. We work hard and thanks to all of you for your interest and we will keep you informed.

And trust me, we will tap you when we need you to bring this thing home.