Building a family should be a basic human right. At Family Equality, we know how important family is to people regardless of sexual orientation, gender identity, or marital status. We were thrilled when the American Society for Reproductive (ASRM) updated its definition of infertility, acknowledging that all individuals and couples deserve equal access to fertility care no matter who they are, who they love, or how they identify.
Who is ASRM?
The American Society of Reproductive Medicine (ASRM) defines itself as “a multidisciplinary organization dedicated to the advancement of science and practice of reproductive medicine.” The society was originally founded in 1944 by a group of fertility experts dedicated to studying and improving fertility. Today, ASRM engages in advocacy from its headquarters in Washington, D.C. on behalf of medical professionals and their parents. Their efforts focus on access to care, particularly, around assisted reproduction.
Redefining Infertility
ASRM previously defined infertility as the failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic insemination in women younger than 35 years or within six months in women older than 35 years. This largely aligned with the CDC’s and WHO’s definitions, focusing on infertility as a disease.
ASRM’s new definition de-centers the previous coupled heterosexual norm by defining infertility not only as a disease but also as a condition or status.
Infertility is a disease, condition, or status characterized by any of the following:
- The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
- 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.
- In patients having regular, unprotected intercourse and without any known etiology for either partner suggestive of impaired reproductive ability, evaluation should be initiated at 12 months when the female partner is under 35 years of age and at six months when the female partner is 35 years of age or older.
Source: ASRM
Essentially, ASRM’s previous definition became one of three possibilities. The new definition is expanded to include people who are single or LGBTQ+ individuals or couples who must rely on donor gametes (sperm or eggs) or donor embryos to conceive.
How does this new ASRM definition affect LGBTQ+ family formation?
Most relevant to LGBTQ+ family formation, ASRM has acknowledged that infertility can be characterized by “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.” This not only recognizes and validates how many single and partnered LGBTQ+ people create families but can lead to essential access to insurance coverage, the development of specialized treatment, or greater support systems. The change is especially important for BIPOC LGBTQ+ individuals and couples who often encounter a disproportionate number of challenges when creating a family.
ASRM’s Role in Policy Making
For single people or LGBTQ+ individuals or couples, economic factors, including costs associated with assisted reproduction, create disparities in access to fertility care. Currently, 21 states and D.C. require workplace health plans to cover at least some form of fertility coverage. However, only seven states and D.C. have policies that are LGBTQ+ inclusive. Many states have laws that rely on older definitions of infertility. These states need to update their definitions of infertility to be more inclusive, and we need to pass new laws that provide access to everyone who wants to grow their family through pregnancy. The new ASRM definition lends support to that effort.
ASRM’s new definition does not guarantee that people who are single or LGBTQ+ individuals or couples will receive insurance coverage for their fertility needs. Still, it is a step in the right direction. States often rely on the ASRM definition to determine the diagnosis and treatment of infertility in their coverage mandates, and insurance plans often rely on ASRM’s definitions to determine coverage. This inclusive definition may help more people gain access to appropriate fertility care. At the very least, insurance companies can no longer point to ASRM’s definition of infertility to deny coverage.
Change in the States
Equitable access to care is essential for LGBTQ+ family building. Legislators must actively and deliberately address barriers to fertility care by ensuring that their state offers comprehensive and inclusive fertility coverage. Organizations like Resolve have been working for decades to ensure that anyone struggling to build a family, including the LGBTQ+ community, has access to all options. Family Equality has been fortunate to partner with Resolve in supporting these efforts. ASRM’s new definition bolsters this effort.
Family Equality’s most recent in-depth research study showed that 63% or up to 3.8 million LGBTQ+ millennials are considering expanding their families in the coming years. For these and other individuals planning to grow their families through assisted reproduction, ASRM’s new definition could be a game-changer. Cost pressures influence whether people seek fertility care. If states improve their laws and insurance companies improve their coverage based on ASRM’s inclusive definition of infertility, same-sex couples and LGBTQ+ individuals will have better access to obtain appropriate, needed medical treatment. Of course, this does not mean that everyone will have equal access to care. Unless coverage is extended to people who are uninsured or who obtain health coverage through Medicaid, unjust limitations will remain. Like ASRM, Family Equality strongly supports including comprehensive fertility care in all coverage programs.
Next Steps for Hopeful Parents
Hopeful LGBTQ+ parents should engage in open and honest conversations with their providers about their desire to use assisted reproduction to grow their families and ask how ASRM’s new definition of infertility can assist in the process. They should look at the coverage currently offered through their insurance policy. Because several insurance plans rely on the ASRM definition to determine coverage, the new definition gives people footing to fight for better coverage. People should also research whether their state mandates infertility coverage. If so, they should review their insurance plans and find out whether the plans are fully insured or self-insured, whether their employer is subject to or exempted from the law based on the number of people they employ, and whether the policy was written in the governed state. Even in states without mandated coverage, LGBTQ+ people can use this definition to request their employer provide infertility treatment coverage, something more employers are doing to stay competitive. People can also join the Resolve Advocacy Network to learn about current efforts to improve fertility care through state and federal legislation and advocate for comprehensive coverage for all.
Supporting Each Other
No matter where you are in your family-building journey or where you are in the world, Family Equality provides spaces for you and your family to connect with others, find support, and build community. In fact, Family Equality hosts a biweekly TTC/Fertility Peer Support Space for LGBTQ+ folks looking for a supportive environment in which to discuss issues related to fertility and trying to conceive (TTC). We hope to see you there!
Meg York
Senior Policy Counsel, Director of LGBTQ+ Family Law and Policy
Meg was named LGBTQ+ Bar Association’s Top 40 Lawyers Under 40. Meg is committed to providing high-quality legal advocacy to the most vulnerable and to making law accessible to all. When she is not working, Meg enjoys spending time with her wife and three children in Vermont’s great outdoors.