DESCRIPTION (provided by applicant): 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 ...