title: Infertility care among OEF/OIF/OND women Veterans in the Department of Veterans Affairs.
abstract: BACKGROUND
  An increasing number of young women Veterans seek reproductive health care through the VA, yet little is known regarding the provision of infertility care for this population. The VA provides a range of infertility services for Veterans including artificial insemination, but does not provide in vitro fertilization. This study will be the first to characterize infertility care among OEF/OIF/OND women Veterans using VA care.
  
  
  METHODS
  We analyzed data from the OEF/OIF/OND roster file from the Defense Manpower Data Center (DMDC)-Contingency Tracking System Deployment file of military discharges from October 1, 2001-December 30, 2010, which includes 68,442 women Veterans between the ages of 18 and 45 who utilized VA health care after separating from military service. We examined the receipt of infertility diagnoses and care using ICD-9 and CPT codes.
  
  
  RESULTS
  Less than 2% (n=1323) of OEF/OIF/OND women Veterans received an infertility diagnosis during the study period. Compared with women VA users without infertility diagnosis, those with infertility diagnosis were younger, obese, black, or Hispanic, have a service-connected disability rating, a positive screen for military sexual trauma, and a mental health diagnosis. Overall, 22% of women with an infertility diagnosis received an infertility assessment or treatment. Thirty-nine percent of women Veterans receiving infertility assessment or treatment received this care from non-VA providers.
  
  
  CONCLUSIONS
  Overall, a small proportion of OEF/OIF/OND women Veterans received infertility diagnoses from the VA during the study period, and an even smaller proportion received infertility treatment. Nearly 40% of those who received infertility treatments received these treatments from non-VA providers, indicating that the VA may need to examine the training and resources needed to provide this care within the VA. Understanding women's use of VA infertility services is an important component of understanding VA's commitment to comprehensive medical care for women Veterans.
authors.affiliation: *VA Central Western Massachusetts Healthcare System, Leeds †Department of Quantitative Health Sciences, University of Massachusetts Medical School ‡Clinical and Population Health Research Program, Worcester, MA §Reproductive Health for the Women Veteran's Health Strategic Healthcare Group, VA Central Office, Washington, DC ∥VA Puget Sound Health Care System, Seattle, WA ¶VA Office of Patient Services, Office of Women's Health, Washington, DC #University of Washington School of Public Health, Seattle, WA **VA Palo Alto Health Care System, Palo Alto ††Stanford University School of Medicine, Stanford, CA ‡‡Department of Medicine, University of Connecticut, Mansfield §§VA Connecticut Healthcare System, West Haven, CT ∥∥Comprehensive Women's Health, VHA, Washington, DC ¶¶Yale University School of Medicine ##VA Connecticut ***Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Kristin
authors.initials: K
authors.lastname: Mattocks
authors.forename: Aimee
authors.initials: A
authors.lastname: Kroll-Desrosiers
authors.forename: Laurie
authors.initials: L
authors.lastname: Zephyrin
authors.forename: Jodie
authors.initials: J
authors.lastname: Katon
authors.forename: Julie
authors.initials: J
authors.lastname: Weitlauf
authors.forename: Lori
authors.initials: L
authors.lastname: Bastian
authors.forename: Sally
authors.initials: S
authors.lastname: Haskell
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D054542:Iraq War, 2003-2011; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D058014:Veterans Health; D016387:Women's Health