Army Staff Sgt. Matt Kiel was shot while on patrol in Iraq just six weeks after his wedding. Doctors said he would be on a ventilator for the rest of his life and would never again move his arms or legs — dashing his hopes of raising a family.
But within months of his injuries five years ago, Kiel was breathing on his own and had regained enough function in his left arm to operate a motorized wheelchair. Doctors said he and his wife, Tracy, could start a family through in vitro fertilization.
The couple were overjoyed, until they discovered that the Department of Veterans Affairs does not cover the costly procedure.
"The war takes away so many things from us," Matt Kiel said. "I don't think it should take away our ability to have a family."
Kiel, 31, of Parker, Colo., is among a growing population of veterans whose war wounds make it difficult for them to have children. Advances in battlefield medicine mean troops are surviving catastrophic wounds in Iraq and Afghanistan that might have killed their predecessors in earlier wars. The use of homemade bombs to target foot patrols has left them particularly vulnerable to injuries that can damage their reproductive systems.
More than 1,900 service members have suffered such injuries since 2003, according to Pentagon data provided to U.S. Sen. Patty Murray ( D-Wash.). Most are men, but they include a growing number of women. Many could benefit from in vitro fertilization, which is why Murray is pushing for the VA to cover the procedure.
"Providing this service is a cost of war," Murray said. "There is absolutely no reason we should make these veterans, who have sacrificed so much, wait any longer to be able to realize their dreams of starting or growing their families."
The VA does cover fertility counseling, diagnostic tests and some procedures for veterans with service-connected injuries. For men, that can include the retrieval of sperm, and for women, intrauterine insemination, in which semen is inserted into the uterine cavity through a catheter. Those treatments do help some veterans conceive, although the VA generally won't cover the care provided to veterans' spouses or surrogates.
But for the most severely wounded, more advanced treatments are needed, said Dr. Lori Marshall, medical director at Seattle-based Pacific Northwest Fertility and IVF Specialists. The sperm retrieved from injured men may be of too poor quality for successful intrauterine insemination.
In IVF, egg and sperm are combined in a laboratory, and the resulting embryo is transferred into a woman's uterus. The procedure bypasses the fallopian tubes and is the treatment of choice for many women with badly damaged or missing tubes, Marshall said. If the uterus is incapable of sustaining a pregnancy, the woman may need a surrogate.
"Most of the men and women who suffer these injuries are young and should have very high success rates," Marshall said. But the cost can be prohibitive. A complete cycle of IVF typically costs between $12,000 and $20,000, and it can take several attempts to achieve a successful pregnancy.
Murray, chairwoman of the Veterans' Affairs Committee, introduced legislation that passed the Senate by unanimous consent Thursday directing the VA to make advanced fertility techniques like IVF available to disabled veterans, their spouses or surrogates. But prospects for similar legislation are uncertain in the House, where spending cuts to avoid the fiscal cliff are dominating discussion.
The Congressional Budget Office estimates the cost of providing the services at $568 million over five years. Murray proposes paying for it with savings from the drawdown of troops in the Iraq and Afghanistan wars.
The VA has not taken a position on the bill. Department spokesman Mark Ballesteros said officials are "carefully considering" the needs of a new generation of patients with new traumas. "VA's goal is to restore veterans' physical and mental capabilities to the greatest extent possible," he said.
Monique, a Southern California veteran who did not want her full name published, is among the veterans hoping for a swift resolution. She is wondering whether she should shelve plans for a beach wedding in Marina del Rey in favor of an inexpensive ceremony at a government office — because the price tag for her dream wedding is $11,000, nearly what it would cost for a cycle of IVF.
Doctors say her fallopian tubes are too damaged from the injuries she sustained in a 2005 ambush in Iraq to conceive naturally. Surgery won't help. Her best chance is IVF.
Monique never thought she would get married. "Now that I am.... I want the big fluffy dress," she said.
But she said she won't feel whole again if she can't have a baby. "I'm a woman," she said. "I should be able to do this."
The Department of Defense does cover IVF for injured active duty service members. The policy, announced in 2010, allows for three full cycles of treatment for service members and their spouses, said Cynthia Smith, a department spokeswoman.
But by the time some service members have sufficiently recovered from their wounds to start planning a family, they are no longer on active duty and no longer qualify for the coverage. Many insurance plans don't cover IVF. Their best hope may be the VA.
Dr. Ajay Nangia, clinical director for andrology at the University of Kansas Medical Center, would also like the government to pay for male troops to freeze their sperm before they deploy. He acknowledged that this might not be a subject commanders want to raise as troops ready for combat, but he said the consequences of an emasculating injury can be psychologically devastating.
"The most normal thing for people to do, ultimately, is to have a baby," he said. "When you can't … it just gnaws into your soul."
When Kiel first learned the extent of his disabilities from his neck wound, he looked at his wife and asked if she still loved him.
"I just said, 'Baby, you're stuck with me,'" Tracy Kiel said.
She formed a group of military spouses dubbed the "In Vitro Girls" to lobby Congress and was in the audience for Thursday's Senate vote, even though the couple had already had children. With the help of a nonprofit and contributions from strangers who sent checks through the mail, the couple scraped together more than $30,000 to pay for IVF.
Tracy got pregnant on the first attempt. Children Matthew and Faith are now 2 and have just learned to ride on the back of their dad's wheelchair.
"She jumps up there and says, 'Go daddy, go,' " Tracy Kiel said.
"We got our dream," she continued. "We get to be like everyone else."