Infertility has a new definition in the U.S. — one that could make a big difference to would-be parents who are single or LGBTQ+.
Last week, the American Society for Reproductive Medicine (ASRM) issued an expanded description of the condition, stating that infertility involves “the need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner.”
Before this update, the ASRM officially described infertility as a condition in which heterosexual couples weren’t able to conceive after a year of unprotected intercourse. The new, more inclusive definition may help more same-sex couples and single people gain access to assisted reproductive technologies, since some insurance plans rely on the ASRM definition of infertility.
“What we’re really trying to do is to acknowledge the reality that there are multiple reasons why patients may need medical intervention in order to build their families,” said ASRM chief advocacy and policy officer Sean Tipton. “It could be a tube problem. [It] could be the lack of sperm … It also could be that someone is single or is partnered with someone who is of the same sex as they are, and those people deserve access every bit as much as anybody else.”
The decision, he said, is intended to support same-sex couples and single patients who currently see their fertility treatment claims declined. “Sometimes we were having our own definitions thrown back in our faces to justify that denial,” said Tipton.
The new definition also reflects a change in the conversation around infertility. The ASMR’s previous definition, said Tipton, was meant to recognize infertility as a disease and help to diminish stigma. Since then, “the target has moved, and we are working harder to expand access to care for everyone,” he said.
Mia Cooley, the founder of xHood, an organization supporting Black queer people through family-building, welcomed the change.
“Black LGBTQIA+ families, in particular, encounter a disproportionate array of challenges as we navigate the path to parenthood,” she said. The fact that the new definition explicitly points to assisted reproductive technologies as indispensable to addressing infertility, she said, has the potential to greatly expand access and understanding of the specific needs of various communities requiring fertility treatment.
“I foresee the updated infertility definition as a catalyst for increased research into the distinct needs and hurdles faced by same-sex couples and single individuals in their journey to parenthood. Ideally, this will drive the development and support of specialized treatments and comprehensive support systems,” she said.
Whether the updated description will suffice to ensure LGBTQ+ and single people receive insurance coverage for their fertility needs, however, is out of ASRM’s hands. “We understand insurance companies are highly motivated to deny people coverage and they’ll probably come up with another excuse, but at least it takes this one off the table,” said Tipton.
In states such as Illinois and Massachusetts, coverage of infertility is already mandatory for all people trying to conceive. New York also passed a law in 2021 requiring insurers to cover infertility treatments for same-sex couples, without having them undergo unnecessary testing. In a retrospective analysis presented at the ASRM summit in New Orleans this month, Samantha Estevez, a doctor with fertility practice RMA of New York, showed the impact of the legal change: Among 285 records from same-sex couples undergoing treatment at the clinic, the median length between first consultation to starting IVF shortened from 292 days prior to the 2021 law to 173 after the law.
While the updated ASRM definition doesn’t have an immediate effect on state regulations, in many states, provisions for infertility treatments are linked to the “official” definition, said Cooley. “An extended definition holds the potential to exert influence over policy adjustments, paving the way for enhanced legal and financial support for individuals and couples in pursuit of reproductive assistance,” she said.
The ASRM update comes amid other efforts to expand access to fertility treatments. In August, veterans filed a lawsuit against Veteran Affairs to demand it cover fertility treatments for all members who may need it. Currently, the VA limits treatments to heterosexual, married couples.
Expanding fertility coverage has important business implications, too: The fertility industry is booming, and projected to reach $41 billion globally by 2026. In the U.S., the industry has grown exponentially as more employers have started offering fertility treatment services. In the wake of ASRM’s announcement, the nonprofit National Infertility Association (known as RESOLVE), shared a model benefit package meant to encourage employers to make their current fertility benefits more inclusive.