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What Does LGBTQ+ Infertility Look Like?

Exploring social infertility vs physiological infertility and access to fertility care for LGBTQ+ couples and single parents-to-be.

November 17th, 2023 | 9 min. read

By Sierra Dehmler

For decades, the definition of infertility has restricted access to essential medical care for LGBTQ+ couples and single parents-to-be who need the help of fertility treatment to build their families. But what does "infertility" really look like in the LGBTQ+ community? 

Many in the LGBTQ+ community don't struggle with physiological infertility, but still need fertility treatment or donors to help build their families.

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Who gets access to fertility care?

The world of "fertility" is full of myths, inaccurate information, and sensationalized stories portrayed by the media - which historically exclude LGBTQ+ families from the narrative.

This has unfortunately led to layers of exclusionary legislation, private policies, and cultural stigma that create additional obstacles for people who require fertility treatment and/or a donor to help build their families.

Let's take a closer look at the medical definition of infertility, how insurance companies interpret it, and how archaic perspectives on fertility negatively impact LGBTQ+ couples and single parents-to-be in need of assistance, 

What is the definition of infertility?

For medical purposes, infertility has traditionally been defined as sperm and egg being exposed to one another for a year without conception. While some state language included the term "insemination" as well, this definition was never fully inclusive of the LGBTQ+ population.

Furthermore, a diagnosis of "infertility" typically refers to a couple, which also excludes single parents from pursuing biological family building. 

The good news? On October 15, 2023, the American Society for Reproductive Medicine (ASRM) Practice Committee finally issued a new, more expansive definition of infertility. 

Breaking Down the New ASRM Guidelines 

ASRM's new definition of infertility acknowledges that it can be 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.

Why does all of this matter?

Because insurance providers look to the medical definition of "infertility" to decide which policy holders should have coverage for fertility treatment, this has historically resulted in denials of equal coverage to LGBTQ+ couples and single parents-to-be. 

Let's explore how social infertility affects the LGBTQ+ community, how physiological infertility might play a factor in your biological family-building journey, and finally, review some common barriers to fertility treatment and what you can do to overcome them.

What is social infertility?

Many in the LGBTQ+ community don't struggle with physiological infertility, but still need fertility treatment or donors to help build their families. This is sometimes referred to as "social infertility."

Social infertility is a term that accounts for the family-building dreams of LGBTQ+ couples and single parents-to-be, in an effort to increase awareness and access to care.

In both instances, biological family building will require assistance from an egg and/or sperm donor and will most likely also require a fertility doctor, legal counsel and a mental health professional. While insurance companies traditionally only recognized physiological infertility, the new definition from ASRM shows a shift towards acknowledging social infertility as well.

Hope for Families

Learn how the updated definition of infertility will help increase access to family-building care for LGBTQ+ folks.

Learn More

Understanding LGBTQ+ Infertility 

Aside from social infertility, which affects the majority of cisgender couples in the LGBTQ+ community, you may also have physiological fertility challenges working against you.

Let's explore the most common issues hopeful parents encounter:

For LGBTQ+ Dads-to-Be

Men may make sperm every 90 days or so, but that doesn’t exclude them from experiencing infertility too! Male factor infertility accounts for a significant portion of fertility issues in opposite-sex couples, and can be an issue for same-sex couples as well.

In some cases of infertility, a man produces less sperm than normal. The most common cause of this condition is varicocele, an enlarged vein in the testicle. Varicocele is present in about 40% of men with infertility problems.

Potential causes of male factor infertility could be steroid or hormone usage, a past sexually-transmitted infection (STI), age, smoking, drinking, or a combination of any of these factors.

For LGBTQ+ Moms-to-Be

Infertility may be caused by hormone disorders, such as PCOS and endometriosis. Additionally, physical issues with the reproductive system could occur, which might include fibroids or other uterine abnormalities. A previous STI can also impede normal reproductive system functioning.

Another possible cause of infertility for moms-to-be is advanced maternal age. 

Ovarian Reserve 101: How long will you be fertile?

While the “biological clock” concept is overplayed, it is also often misunderstood. The reality is that women are born with a set number of eggs, and unfortunately, quantity and quality do decline with age.

To illustrate this point with actual figures, at birth, there might be around 2 million eggs. However, that number drops by about 75% once puberty hits, leveling somewhere around 500,000. And though only one dominant egg is produced every month during adulthood, approximately 10,000 total eggs are lost each cycle.

Note: By age 37 or so, that number decreases to around 25,000, and likely far less than that when you factor in viability (quality), which is the likelihood that an egg is genetically/chromosomally normal and could result in a healthy pregnancy.

At this point, you might be thinking, “What?! Men make sperm every 90 days and we’re losing 10K eggs a month? That’s not fair!” And you’re right, it’s not fair, but that's why having as much information as possible about your fertility is key.

The Importance of Fertility Testing

Fertility testing empowers you with information that can be used to map out your family-building journey. It also enables you to plan for family-building costs for services like IUI, IVF and/or surrogacy.

With this knowledge in mind, you can also reach out to your insurance provider to determine what services and procedures are covered under your policy. Here's what to expect.

  • For moms-to-be, baseline fertility testing usually includes anti-Mullerian hormone (AMH) testing to assess ovarian reserve, Cycle Day 3 blood tests, and Day 21 testing.
  • For dads-to-be, baseline fertility testing includes a semen analysis to evaluate the quality and quantity of your sperm and ensure no underlying issues exist.

Did you know? For all LGBTQ+ singles and couples, genetic carrier screening is available to help screen for a variety of genetic conditions. Genetic counseling is also an important part of the process, especially when it comes to selecting an egg or sperm donor.

LGBTQ+ Infertility & Insurance

Too often, LGBTQ+ individuals are excluded from insurance coverage on the basis of the long-held medical definition of "infertility." With ASRM's recent announcement, we are hopeful that insurance providers will soon be pressured to update their policies to more fully cover those in the LGBTQ+ community.

Thankfully, there are many organizations who are helping to move this conversation forward in addition to providing funding and resources, such as Family Equality Council. There are also fertility benefits-focused companies like Progyny that offer expanded coverage for LGBTQ+ individuals and couples.

While there is a growing number of family-building grants and resources available, you can also be a part of moving this conversation forward by advocating for change on a policy level.

Take action: To push for progress and inquire about your own benefits, we created a resource for you: What to Know About LGBTQ+ Family-Building Insurance Coverage

The Challenges & Joys of Family Building

As our founder, Dr. Mark Leondires says, “It takes a village, but the village is out there.” 

While many non-LGBTQ+ patients experience grief, shame, and sadness at the prospect of talking to a fertility provider, the LGBTQ+ community has the unique experience of approaching it with a different outlook. How’s that for positivity?!

So, while family building can undoubtedly be challenging for the LGBTQ+ community, it is often an exciting process too. Choosing a provider who has extensive experience helping LGBTQ+ families grow and provides inclusive support throughout your journey is key to your success.

Advocate for yourself, ask lots of questions, and take advantage of every resource available to you. You deserve the chance to become a parent, and your dreams are achievable.

Get Inspired & Empowered

Looking for more support on your LGBTQ+ family-building journey? We've got you covered! Explore a variety of family stories, treatment guides, and other helpful resources below.

Real Family Stories

For Moms-to-Be

For Dads-to-Be

Sierra Dehmler

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.

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