Oct 23, 2023 - Health

New infertility definition a "game-changer" for hopeful LGBTQ+ parents

Illustration of a stork holding a fountain pen in its beak.

Illustration: Lindsey Bailey/Axios

A new, more expansive definition of "infertility" could lead to more help for hopeful LGBTQ+ or single parents.

Why it matters: The decision by an influential organization of reproductive health providers to redefine the condition could lead to broader insurance coverage of fertility services like egg freezing and in vitro fertilization for all people who need help starting families — not just those in heterosexual couples.

Context: Infertility was previously defined by the American Society for Reproductive Medicine (ASRM) as when a man and woman can't get pregnant after a year of unprotected intercourse or intrauterine insemination. For women 35 and older, the time period is six months.

The group's new definition now also includes:

  • The inability to get pregnant because of the patient's medical, sexual and reproductive history, age, physical findings and diagnostic testing.
  • The need for medical intervention such as donor eggs or sperm to achieve pregnancy.

Between the lines: The updated language applies to anyone who needs help having children, regardless of relationship status, gender identity or sexual orientation.

State of play: "There's been a real issue with getting access to treatment for certain causes of infertility including for single people [and] people in same-sex relationships … so it became clear that we need to explicitly address that," ASRM spokesperson Sean Tipton tells Axios.

Despite the growing interest in fertility care — and more employers offering fertility benefits to stay competitive in the labor market — insurance coverage of the often-pricey services remains limited.

  • As of now, 21 states plus D.C. require some workplace health plans to cover at least some form of fertility coverage, and of those, only eight states have policies that are inclusive of LGBTQ+ communities and single parents, according to Betsy Campbell, chief engagement officer at infertility advocacy group Resolve.

What they're saying: A more inclusive definition of infertility — which ASRM considers a disease, condition or status — is "a game-changer," because a number of insurance plans rely on the ASRM definition of what qualifies as a disease to determine coverage, infertility specialist Lucky Sekhon tells Axios.

  • With this update, "insurance companies can't discriminate. … It gives people ammunition to fight policies for more coverage," she says.
Data: Resolve; Map: Thomas Oide/Axios
Data: Resolve; Map: Thomas Oide/Axios

Zoom out: When the ASRM stopped considering egg freezing "experimental" in 2012, and when the American Medical Association started calling infertility a disease in 2017, those changes made way for more insurance coverage for infertility.

  • "Payers look to us to provide guidance on what is a legitimate, reviewed therapeutic option [for people trying to conceive]," ASRM's Tipton says.

Although IVF is pricey the average cost of one cycle is $12,400, according to ASRM — many infertility advocates aren't worried that broader coverage of fertility services would drive up other health insurance costs.

  • Campbell pointed to studies suggesting fertility insurance coverage does not significantly increase medical plan costs, because patients without coverage "often engage in riskier decision-making [like putting] pressure on doctors to transfer multiple embryos, which leads to multiple high-risk multiple pregnancies and births which are much more costly than the birth of a single," she says.

Bottom line: The revised definition of infertility is "a sign that we as a society have become more progressive and more inclusive," says Sekhon.

Read more: What it will take to eliminate disparities in fertility care for Black women

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