Infertility Definition Expanded to Be More Inclusive

Infertility is no longer restricted to just women in heterosexual partnerships. Now, circumstances common among LGBTQ people and single women trying to get pregnant can meet the official definition for infertility.

The new clinical definition, put together by the American Society for Reproductive Medicine (ASRM), establishes infertility as a disease, condition, or status that meets one or more of these characteristics:

Not being able to get pregnant, with or without a partner, for any reason related to the patients’ medical, sexual, or reproductive history, or their age, physical findings, or diagnostic testingRequiring donor gametes or embryos, or other medical intervention, to achieve a successful pregnancy, with or without a partnerEvaluation should begin at 12 months of regular unprotected intercourse with no pregnancy (for female partners under 35) or at 6 months (for female partners older than 35) when there is no known etiology for either partner that suggests impaired reproductive ability

Infertility was previously defined by ASRM and the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice as failing to get pregnant from unprotected intercourse or therapeutic donor insemination within one year of trying (for women younger than 35) or within 6 months (for women older than 35).

Jared Robins, MD, ASRM’s chief executive officer, said in an ASRM press release that the new 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,” Robins said.

In the press release, ASRM specified that “[n]othing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation.”

Elizabeth Fino, MD, a reproductive endocrinologist at NYU Langone Health in New York City, said this updated definition is how a lot of doctors have been viewing patient care for a while.

“We’re looking at using reproductive medicine to kind of build families and that looks so different for so many people,” Fino told MedPage Today, adding that she’s not sure how insurance companies will interpret the new definition.

Fino also explained that LGBTQ people and single women have been at the forefront pushing for more inclusive reproductive care. When it’s nearly impossible to meet clinical and insurance criteria for infertility based on their experiences trying to get pregnant, they have had to jump through hoops — for instance, lying to their doctor about what they’ve been trying in order to meet the definition. Fino said this “leads to poor medical care if people aren’t being open about what their real goals are.”

Fino said even beyond this updated definition, she’d like to see the field move forward to not require everyone to fit into a particular definition of infertility, but rather to look at all patients through the lens of family building and procreative management.

Aimee Eyvazzadeh, MD, MPH, a reproductive endocrinologist in California, told MedPage Today that families have become more fluid and “we as a medical society have to catch up with what our patients’ needs are.”

Eyvazzadeh also pointed out that infertility is inevitable — and sometimes it happens before people’s desire to have kids runs out.

“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 said. “My hope is that we would see changes in coverage for patients with this new definition since more people have insurance with fertility coverage now than they did 10 years ago.”

ASRM’s updated definition of infertility has been affirmed by its board of directors and will be published in the journal Fertility and Sterility next month.

Rachael Robertson is a writer on the MedPage Today enterprise and investigative team, also covering OB/GYN news. Her print, data, and audio stories have appeared in Everyday Health, Gizmodo, the Bronx Times, and multiple podcasts. Follow

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