Infertility gets a new, expanded definition to address ‘the reality of all’ seeking care, medical group says

Reproductive health experts are updating how they define “infertility” to be more inclusive.

The new definition, issued last week by the American Society for Reproductive Medicine (ASRM) Practice Committee, has been expanded to include anyone needing medical interventions “in order to achieve a successful pregnancy either as an individual or with a partner.”

The updated definition will be published as a report in the society’s journal Fertility and Sterility in about a week or 10 days, Sean Tipton, ASRM’s chief advocacy and policy officer, said Monday.

In the new definition, “we made it explicit that lack of access to the kind of gametes you need is a condition deserving of treatment,” Tipton said, referring to how some people who are single or in same-sex couples would fall into that category.

“That is, the reason you may need medical assistance to build your family, it can be because your fallopian tubes don’t work, or it could be because your sperm don’t swim right. But it could also be because you’re single, or because you are in a relationship with a person who doesn’t have the kind of gametes you need. Those are legitimate causes of infertility, and they need to be treated accordingly,” Tipton said. “It is our hope that this definition removes one of the excuses that insurance companies have attempted to use to deny patients coverage for the medical care they need to have children.”

The ASRM previously defined infertility as the failure to get pregnant within a year of having regular, unprotected intercourse or therapeutic donor insemination in women younger than 35 or within six months in women older than 35. That diagnostic and treatment guideline remains unchanged for heterosexual couples trying to have a baby.

But the updated definition now expands beyond that to also state that infertility is characterized by the “inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing,” or “the need for medical intervention,” such as 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,” Dr. Jared Robins, CEO of ASRM, said in a news release last week.

The new definition “acknowledges the reality of all seeking infertility care,” Robins said, and ASRM looks forward to “working with our members, policymakers, and others to normalize this definition.”

While infertility generally has been defined as not being able to conceive after a year or longer of unprotected sex for heterosexual couples, the US Centers for Disease Control and Prevention has said on its website that “these definitions of infertility are used for data collection and monitoring,” and “they are not intended to guide recommendations about the provision of fertility care services. Individuals and couples who are unable to conceive a child should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility.”

Overall, the new ASRM definition addresses two groups. It maintains a definition of infertility for heterosexual couples – being a year of trying but not conceiving for women younger than 35 and six months of trying but not conceiving for those 35 and older – and it includes patients who are single or in same-sex couples, said Dr. Rachel Ashby, director of the Donor Egg and Gestational Carrier Program at Brigham and Women’s Hospital, who was not involved in the new ASRM definition.

On one hand, “infertility is a disease state. It’s a condition that needs treatment,” Ashby said. “Then the other thing that stands out is the idea that for many people, they can’t get pregnant without the use of donor gametes. If I’m a single woman, if I’m in a same-sex relationship as a woman, or if I’m two men, I need donor gametes. This is another tenet of infertility that’s inclusive of the LGBT community.”

Dr. Aimee Eyvazzadeh, a San Francisco-based reproductive endocrinologist, called the new ASRM definition a positive step forward.

“By adopting a more inclusive and accurate definition of infertility, the medical community can better serve and support those in need of reproductive assistance. It not only promotes transparency but also helps reduce the stigma often associated with fertility problems,” Eyvazzadeh, who was not involved in the updated definition, said in an email.

“There are doctors who feel compelled to tell patients that insurance won’t cover a service because they don’t meet a ‘definition’ even if it’s unrelated to insurance coverage,” Eyvazzadeh said in the email. “The definition means a lot to fertility doctors and patients and I’m thrilled to see this change.”

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