Infertility Has a New, More Inclusive Definition

Key Points

• The interest in infertility services has increased in recent years, for several reasons.
• The actual definition of infertility has now changed as well.
• The American Society for Reproductive Medicine altered the definition to include single and LGBTQIA+ people.

One of the United States' leading reproductive health organizations has redefined "infertility" to be more inclusive of single and LGBTQIA+ people, among others.

Previously, the American Society for Reproductive Medicine (ASRM) defined infertility as the inability to become pregnant after one year of having unprotected heterosexual sex or undergoing intrauterine insemination for women under age 35, or after six months for women over age 35.

That diagnostic guideline remains the same for heterosexual couples, but the now-expanded definition states that infertility is a disease, condition or status affecting anyone needing medical intervention—regardless of gender, sexual orientation or relationship status, according to the ASRM.

This includes single and partnered people unable to achieve pregnancy due to medical, sexual and reproductive history; age; physical findings and diagnostic testing; and those requiring donor eggs or sperm.

"This revised definition reflects that all persons, regardless of marital status, sexual orientation or gender identity, deserve equal access to reproductive medicine. This inclusive definition helps ensure that anyone seeking to build a family has equitable access to infertility treatment and care," said Jared Robins, M.D., the chief executive officer of the ASRM, in a news release.

"I thank the practice committee, our board, and other ASRM leaders and staff for diligently and deliberately establishing a definition of infertility that acknowledges the reality of all seeking infertility care. We look forward to working with our members, policymakers and others to normalize this definition," Robins said.

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The new definition more accurately reflects diverse patient populations, said Sue Ellen Carpenter, M.D., the founder of Bloom Fertility in Atlanta.

"Fertility care has long been involved in helping single individuals and members of the LGBTQIA+ community in building their families," said Rachael Jones, M.S.N., A.P.R.N., the vice president of clinical client strategy at WINFertility in Greenwich, Connecticut. "This updated definition of infertility is a great step in recognizing the inclusion of all individuals needing fertility treatment to build their families, no matter what that family looks like."

The expanded guidelines could help to enact positive changes, including broader insurance coverage for fertility treatments, as many companies and employers rely on bodies like the ASRM to define diagnostic criteria, according to Jones and Carpenter.

The interest in infertility services has mushroomed in the past several years—partly because an increasing number of people are waiting longer to have children—and more employers have begun offering fertility benefits.

However, infertility treatments remain expensive.

Costs vary by city and specific services, but just one cycle of in vitro fertilization (IVF) typically costs $12,400 in the U.S., according to the ASRM.

Some state legislatures determine who can access certain benefits, so it may take some time for policies to reflect the change, Jones said. Still, it's a move in the right direction.

"Insurance companies followed the old standard, making access to coverage impossible for those who would never meet the criteria of frequent heterosexual intercourse," Carpenter said. "The new definition shows growth and an open-mindedness for giving those on a path to parenthood the means to pursue their goals.

"Even when insurance coverage is not a driving issue, this definition is a real representation of who my patients are and the ways they go about building their families."

The new definition will be published as a report of the ASRM Practice Committee in the society's flagship journal, Fertility and Sterility, per the release.