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Infertility is defined by many major health groups, including the World Health Organization and the American Congress of Obstetricians and Gynecologists as being unable to get pregnant after 12 months of regular unprotected sex. But the truth is, that definition doesn’t tell the whole story — and it doesn’t fully represent the range of people who may require medical intervention to build their families. The term only applies to a specific heteronormative demographic, while also excluding people who, for a variety of reasons, may not be served at all by this definition, yet share the experience of navigating the world of assisted reproduction.
That’s why it’s such a big deal that the American Society for Reproductive Medicine recently amended their definition of infertility. The new definition feels far more inclusive, more accurately representing the range of reasons that people may require medical intervention to build their families.
The new definition of infertility from this group is as follows: ‘‘'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 6 months when the female partner is 35 years of age or older.”
For so many people — and providers in the reproductive health space — this is a massively welcomed change. A TikTok clip from Lora Shahine, MD, a reproductive endocrinologist at Pacific NW Fertility in Seattle and host of the Baby or Bust Fertility podcast, celebrates the new definition.
“It’s the most inclusive language I’ve ever seen,” says Dr. Shahine in the clip. “ASRM specifically states that they don’t want the definition of infertility to allow for denial of use of fertility treatments and benefits based on sexual orientation or relationship status. It’s going to be harder for insurance companies to deny benefits based on this inclusive language, and I think it will increase access to care.”
We spoke with Dr. Shahine about the importance of this language change and what it may mean for access to care and coverage moving forward.
Why we needed a change
Let’s face it: The previous definition of infertility didn’t serve people who were unable to try to conceive for 12 months “the old fashioned” way — this includes same-sex couples, single people, people with known health barriers that would impede conception, those with a history of high-risk pregnancies that preclude them from carrying again, those with genetics factors that make IVF with PGD a necessity…the list goes on. When you think about it, that definition excludes a lot of people.
“[The previous definition] Is narrow in scope because it excludes couples that are anything other than heterosexual couples who are able to try to conceive with intercourse over 12 cycles of trying,” says Dr. Shahine. “It excludes same-sex couples, people with irregular and unpredictable menstrual cycles for any reason including premature menopause, people with inability to have intercourse due to pain with intercourse or erectile dysfunction, and single people.”
When we wrote about the isolation gay men face on their path to parenthood, Brian Rosenberg, founder of Gays With Kids, made a similar observation. “We don’t call [what we experience] infertility,” he said. “It’s not infertility. I don’t have a womb.”
Infertility, under the new definition, can take many forms
The changed definition of infertility forces us to rethink the limiting nature of the previous definition, but the truth is, that the need for a more inclusive definition is nothing new.
“The new definition [better] reflects the people I see as a fertility doctor that needs treatment in order to have their family,” says Dr. Shahine. “People who need donor sperm, donor egg, surrogacy, treatment to ovulate, interventions to help with conception for any reason.”
A decade ago, fertility issues — all fertility issues — were heavily stigmatized. Since then, little by little people have begun sharing their experiences, initiating public and private conversations, and slowly removing the taboo around it. People whose experiences fit into the traditional definition of infertility really benefited from this normalization. Now, we have an opportunity to destigmatize all fertility issues under this new definition.
“Fertility has traditionally been ignored, hidden, full of shame but I hope this inclusive definition will lead to an understanding that there are many different ways to build a family,” says Dr. Shahine. “I hope this definition will add to the trend I’m already seeing in my [nearly 500,000] social media followers across platforms that are being more open about needing IVF, sharing miscarriage, and helping each other feel less alone.”
It’s about more than just a cultural shift, though
Because of the limiting previous definition of infertility, many people who did not try to conceive for 12 months were ineligible for fertility benefits or coverage. Under this new definition, that may change — at least potentially, according to Dr. Shahine, who believes this change could improve access to care.
“[Whether more patients gain access to coverage] depends on many factors and most importantly limitations by insurance companies and employers that dictate what they will cover and not cover,” says Dr. Shahine. “Many companies providing benefits have traditionally used the previous definition of infertility to deny coverage to people that need third party reproductive options like donor gametes, surrogacy, and more.”
“I’m hoping the new definition will increase access to care both from increased coverage for treatment from employers and insurance companies and more people seeking care to build their family now that they learn more about options available to them,” adds Dr. Shahine.
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.