VA Health Care: Action Needed to Improve Fertility Care Communications and Eligibility Determination Process

What GAO Found

Within the Department of Veterans Affairs (VA), the Veterans Health Administration (VHA) is responsible for providing enrolled veterans access to reproductive health care, including fertility care. From fiscal years 2022 through 2025, VHA data show that approximately 8 million veterans used some type of VHA health care. Around 30,000 veterans had an infertility diagnosis in fiscal year 2025, an increase from the approximately 19,000 veterans with an infertility diagnosis in fiscal year 2022. VHA officials said there may be several reasons for the increase, such as expansions VHA made to eligibility for fertility care in 2024.

Number of Veterans with an Infertility Diagnosis, Fiscal Years 2022-2025

VHA’s Office of Women’s Health communicates about available fertility care through various methods, such as a fertility webpage and brochures. GAO found some interested veterans may be unaware of VHA’s fertility care. For example, stakeholders said male veterans may not seek out or may find it difficult to seek out eligibility information because it comes from Office of Women’s Health. GAO determined that VHA has not implemented key performance practices related to its communication. By implementing such practices, VHA could better assess progress towards its communication goals and increase the effectiveness of its outreach to veterans about fertility care. This would allow VHA to identify and make any needed adjustments to better ensure its efforts reach veterans who may need fertility care.

VHA changed its process for determining veterans’ eligibility for fertility care in October 2024. Under the change, VA medical center fertility teams are responsible for making these decisions instead of VHA at the national level. However, GAO identified challenges with the process after October 2024. For example, GAO found fertility team composition and skill level varied at selected facilities. VHA officials from these facilities said that it can be challenging to determine veterans’ eligibility, which can affect the care they receive. GAO also found that teams at two facilities did not consistently provide written notifications of eligibility decisions to veterans as required. Federal standards for internal control state that agencies are to identify, analyze, and respond to change as part of their risk assessment efforts. Assessing the changes it made to its eligibility determination process would allow VHA to determine whether the process is working as intended or whether adjustments are needed, in turn, ensuring it is best serving veterans.

Why GAO Did This Study

Infertility—the inability to conceive or sustain a pregnancy—can affect both men and women. Research suggests veterans may experience infertility for a variety of reasons including injuries in combat, environmental exposures, or trauma sustained during military service, which impacts treatment options. To be eligible to receive certain fertility care, such as in vitro fertilization, a veteran’s infertility must be causally related to a service-connected disability—an injury or illness incurred or aggravated during military service—or to the treatment of one.

GAO was asked to review issues related to infertility among veterans. This report, among other objectives, describes (1) available data on infertility among veterans for fiscal years 2022 through 2025; examines (2) VHA’s efforts to provide information to veterans and providers about available fertility care; and (3) VHA’s eligibility determination process for fertility care.

GAO reviewed VHA documentation and data for fiscal years 2022 through 2025; interviewed VHA officials, staff involved with fertility care at four VA medical centers, and four veterans integrated service networks (selected based on presence of fertility staff, geography, and facility complexity); and interviewed eight veterans, six veterans service organizations, and two national organizations (selected based on focus on infertility and national reach).