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

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.

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