In its October 2023 Committee Opinion, the American Society for Reproductive Medicine published a new, more inclusive definition of infertility, acknowledging the many reasons why patients may need medical help to build their families. This new definition expands the meaning of infertility and has the potential to improve access to care, especially to LGBTQ+ and single intended parents.
The New ASRM Infertility Definition
The ASRM defines infertility as “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.”
The ASRM continues to add that “nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation.”
New ASRM Definition: Why Does it Matter?
While the new definition retains the same cut off periods for seeking treatment (12 months when the female partner is under 35; 6 months if older), its other provisions have widely been described as ‘game-changing’:
Wider scope
The old infertility definition focused on men and women who were unable to get pregnant after a year of unprotected intercourse or intrauterine insemination. As Sean Tipton, ASRM’s chief advocacy and policy officer noted, the new definition “[makes] it explicit that lack of access to the kind of gametes you need is a condition deserving treatment”.
Inclusivity
The new infertility definition applies to anyone who needs medical help to build a family, regardless of relationship status, gender identity or sexual orientation. In his conversation with Axios, Tipton noted that it became clear that the organization had to explicitly address this as single people and people in same-sex relationships were finding it difficult to get access to treatment. As ASRM CEO Jared Robins, MD, said, this new definition acknowledges the reality of all seeking infertility care and helps ensure equitable access.
Insurance coverage
As of September 2023, 21 states, plus DC have passed fertility insurance coverage laws. Of those, only 8 states have single parent and LGBTQI+ inclusive policies. The new definition changes the status quo as a number of insurance plans rely on the ASRM definition to determine coverage.
The ASRM will now be working with members, policymakers and others to normalize the new definition.
Key Takeaway
The new ASRM definition addresses two main groups: heterosexual couples, and patients who are single or in a same sex relationship. The update promotes inclusivity, reduces stigma, improves access to care, and supports medical providers to better serve their patients.
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