Anticipated Impact on Veterans' Health Care: Veterans of OEF/OIF/OND are young, increasingly female, and include growing numbers of Veterans who have survived historically mortal injuries. These patriots face unique physical and mental health challenges that may be detrimental to future fertility; challenges include: sexual assault, blast injuries causing genito-urinary trauma and traumatic brain injury, chemical exposures, and post-traumatic stress disorder. Thus comprehensive, high-quality reproductive care, including infertility prevention and treatment, is vitally important for the post-deployment health and quality of life of this generatin of Veterans. Our goal is to better identify, understand, and treat infertility and to facilitate infertility care utilization for Veterans in order to make a positive impact on post-deployment health and quality of life for affected Veterans. Background: Responding to increased pressure from Veteran advocates and a Senate bill from December 2012, the VA recently renewed efforts to provide limited infertility care to Veterans. Very little is known about the true prevalence of infertility in Veterans, especially in the male population, or the impact of combat-related and sexual assault trauma on fertility, much less the existing disparities, barriers, and preferences regarding infertility care in the VA system. The Pentagon is monitoring the number of OEF/OIF/OND Veterans who have suffered pelvic or genital injuries that could impact reproductive capability, and traumatic injury benefits are now being paid to those affected. Sexual assault is an even more common trauma in female Veterans and a relatively overlooked issue for male Veterans; officials estimate that 26,000 military members were sexually assaulted in 2012 alone (up 35% from the previous year). Our team's study of 1,004 female Veterans suggested sexual assault is also a risk factor for infertility as well as for delay and avoidance o pregnancy. Other studies indicate duration of deployment, concurrent mental health diagnoses, and traumatic brain injury can also increase the risk of infertility in Veterans.
Specific Aims : 1. Assess infertility prevalence in a nationally representative sample of reproductive-aged male and female OEF/OIF/OND Veterans. 2. Compare prevalence of infertility in those who have and have not experienced sexual and/or combat-related trauma and quantitatively investigate how physical and psychological injury and biological and behavioral alternations mediate risk of infertility due to these traumas. 3. Use qualitative methods to further elucidate associations between trauma exposures and infertility, identify unexpected connections, and explore Veteran-identified best opportunities for VA intervention. Methods: Guided by a novel conceptual framework, we will use an explanatory mixed methods design: subject selection model for this study. To begin, quantitative data will be collected using computer-assisted telephone interviews (CATI) with nationally representative samples of male and female OEF/OIF/OND Veterans <45 years old in order to determine the prevalence of infertility. Associations between sexual assault and combat- related trauma and infertility will then be estimated using accelerated failure time and logistic regression models. Next we will qualitatively examine infertile Veterans unique experiences, exploring the complex relationships between trauma exposures, fertility outcomes and infertility care seeking. Data will be collected using semi-structured telephone interviews with a purposeful sampling of subjects identified as infertile in the CATI. This qualitative study phase will ensure that all relevant associations are analyzed in the quantitative analysis and will also extend our knowledge of Veteran preferences for infertility-related health services. Our conceptual framework will help integrate the quantitative and qualitative components coherently while emerging itself as an improved framework to guide next step interventions.
The newest generation of combat Veterans includes increasing numbers of women and Veterans who are surviving what historically would have been mortal injuries. These patriots face unique physical and mental health challenges that may be detrimental to future fertility, including: sexual assault, blast injuries causing genito-urinary trauma and traumatic brain injury, chemical exposures, and post-traumatic stress disorder. Our innovative mixed methods study is designed to: 1) accurately assess the prevalence of infertility in a nationally representative population of female and male OEF/OIF/OND Veterans, 2) explore how Veterans' sexual assault and combat-related trauma exposures affect fertility outcomes and infertility care seeking at the VA, and 3) identify Veteran-supported systems and patient-level interventions. The ultimate goal is to better identify, improve access for, and treat this under-recognized condition, ultimately optimizing quality of life for our nation's latest generation of Veterans.
