One of the most frustrating parts of family building is discovering how limiting insurance coverage can be. With the recent announcement of an updated definition of "infertility," LGBTQ+ parents-to-be are finally included. Here's what that means for you.
In this article:
- How ASRM Impacts Access to Fertility Care
- How is infertility defined?
- Advocating for Change
- Redefining Infertility: The New Guidelines
- Hope for the Future of Family Building
- Our Physicians Respond
- Will insurers adopt the new definition of infertility?
- Who else will benefit from these changes?
- When should I seek fertility treatment?
- Will employer-based coverage be impacted?
- Increasing Access to Essential Healthcare
What is ASRM?
Since 1944, those working in reproductive health have looked to the American Society for Reproductive Medicine (ASRM) as an industry leader on social and ethical issues in the field. ASRM also helps to establish guidelines for laboratory and clinical practice and serves as a leading resource and advocate for public policy concerning reproductive health issues.
As a result, the way ASRM defines infertility (and how insurance companies choose to interpret that definition) can have a big impact on who is able to access coverage for fertility treatment.
According to RESOLVE: The National Infertility Association, "In the case of infertility, the majority of patients bear the responsibility of covering the costs of treatment. No one expects that their insurance company will deny them coverage for this medical condition, but most do." As a result, essential fertility and family-building assistance is often inaccessible.
Sadly, with the out-of-pocket costs of fertility treatment out of reach for most, particularly LGBTQ+ couples with little to no insurance coverage, many hopeful parents have delayed their family-building plans, taken out loans, or given up on having children altogether.
How is infertility defined?
With infertility affecting 1 in 6 couples globally, the need for family-building assistance has become increasingly common. Yet the official definition of infertility has long been outdated, excluding millions in the LGBTQ+ community, single individuals, and others who desperately want to become parents.
Up until October 2023, infertility was defined by ASRM 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."
As a result, those in same-sex relationships, those who need the help of a donor to grow their families, or those who didn't quite fit within the confines of the official definition received little to no fertility coverage from their insurers.
Advocating for Change
At Gay Parents To Be and our partner clinic, Illume Fertility, we have a longstanding history of advocating at both the state and national level for increased access to fertility care for all. We are proud to have been a part of supporting many policy changes and new bills that focus on family building for the LGBTQ+ community.
Patient Advocate Lisa Rosenthal, along with Illume's eight physicians and hundreds of team members, remain committed to raising awareness, decreasing barriers to care, and pushing for progress in the family-building space. One of the ways we do this is by participating in RESOLVE's Advocacy Day each year.
"Having ASRM formally update the definition of infertility to reflect the medical, scientific, and societal realities that make up infertility brings them into line with what patients, not-for-profit organizations, and professional communities have been asking for and using for years," says Lisa.
Redefining Infertility: New Guidelines
On October 15, 2023, the American Society for Reproductive Medicine (ASRM) Practice Committee issued a new definition of infertility.
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.
Most importantly, ASRM adds, "Nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation."
In simpler terms: The official definition of infertility has now been expanded to include anyone needing medical interventions "in order to achieve a successful pregnancy either as an individual or with a partner," according to ASRM.
How will this impact the LGBTQ+ community?
Gay Parents To Be Founder Dr. Mark Leondires, who is a parent through egg donation and surrogacy himself, also attended ASRM's 2023 conference. He feels optimistic about the recent changes and how they will impact his community:
"Everyone who desires to be a parent is included in this new definition of infertility," he says. "This will likely pressure corporations that offer infertility benefits to include single individuals and LGBTQ+ parents-to-be; it should lead to change across the country and improve overall access to care."
Hope for the Future of Family Building
Dr. Ilana Ressler, one of Illume Fertility's physicians who attended the ASRM Scientific Congress & Expo in person, says that the reception to this news was overwhelmingly positive.
"There was great excitement at ASRM 2023 regarding the announcement of the new definition of infertility," says Dr. Ressler. "The new definition is more inclusive and progressive - it will hopefully have a great impact financially, providing broader coverage by insurance."
These long-awaited updates signal a significant shift in the family-building space. But what does this news really mean for patients? And how will the new definition actually impact who is able to access the fertility treatment they need to become parents?
Your FAQs, Answered
In response to ASRM's announcement, Illume's reproductive endocrinology team share their perspectives on the updated definition of infertility and explain the impact they expect it to have on the LGBTQ+ community:
Will insurers adopt the new definition of infertility?
"We would hope that individuals with coverage for fertility services will be able to utilize this coverage that they pay for based on this new definition," says Dr. Williams. "It is unfortunate that many insurance companies will only allow individuals to use this coverage if they have met the strict definition of infertility, which has historically been the inability to conceive after one year of intercourse with an opposite-sex partner."
This past definition has excluded many individuals from treatments that are available in their insurance contracts, as well as treatments that are required to be covered by Connecticut state law.
"So, we are hopeful," says Dr. Williams. "But we also know that many insurance companies still apply their own definition of infertility, despite professional society recommendations."
The bottom line: Insurance companies do consider ASRM's guidelines when developing their policies and plans. However, this doesn't mean that every insurer will immediately shift their criteria on who qualifies for fertility treatment.
Who else will benefit from these changes?
In addition to those in the LGBTQ+ community and individuals who wish to pursue single parenthood, there is another population of patients that will be positively impacted by the new definition of infertility - those at risk of passing on genetic disorders.
"Patients currently affected by insurance restrictions based on definition also include couples who are at risk of having a child with a severe genetic disorder," says Dr. Williams. "Many insurance companies will cover advanced testing to identify healthy embryos prior to pregnancy, but to perform this advanced testing, in vitro fertilization (IVF) is necessary."
Unfortunately, unless you meet the definition of infertility, your insurance company will deny coverage for IVF treatment - meaning you aren't able to access that treatment option (and therefore, preimplantation genetic testing) which would increase the chances of a healthy child.
Why it matters: "This requires these couples to try to conceive for a year with the significant risk that they may have a child with a severe disease," adds Dr. Williams. "We hope that insurance companies will recognize this new definition, and that the state legislature also recognizes these updates as they apply to legally-mandated coverage."
When should I seek fertility treatment?
While ASRM’s new definition now includes more people who need family-building care, one thing has remained the same: its guidelines on when to see a doctor if you're having trouble conceiving.
"There have been no changes to the medical recommendations, which include 12 months of trying to conceive for those under 35 years old, and six months of trying to conceive for those over 35," Dr. Joshua Hurwitz says.
"Of course, if there is a definitive issue precluding pregnancy, such as the need for donor gametes, then this new definition provides the pathway to immediately seek out fertility treatment," he adds.
What are donor gametes? This term includes eggs, sperm, or embryos that have been donated by an individual in order to help a hopeful parent conceive. For example, two moms-to-be will typically need a sperm donor in order to achieve pregnancy.
Increasing Access to Care
Reproductive endocrinologist Dr. Alexander Kucherov shares that the current restrictions are also frustrating and challenging for physicians who know they could help a patient achieve their goals - if only they had the insurance coverage to access treatment.
"Equity in treatment and patient care is one of the most difficult problems facing our patients," Dr. Kucherov says. "There are very few areas of medicine where patients cannot access care solely because of insurance or financial considerations - if someone has appendicitis, they can usually get an appendectomy; if someone has cancer, they can usually get surgery or chemotherapy."
Unfortunately, in the field of reproductive medicine, this is not necessarily the case.
"As a physician, it is heartbreaking when a patient is not able to obtain the necessary treatment," he says. "I am hopeful that this new definition of infertility will allow many more patients to access care and achieve their goals."
Sierra Dehmler is the Content Marketing Manager for Gay Parents To Be and its partner clinic, Illume Fertility. She is also a fertility patient herself. Combining empathy gained on her personal journey with her professional experience in marketing and content creation, she aims to empower and support other hopeful parents by providing family-building resources that educate, inspire and encourage.