The term “fertility” is commonplace for myths, inaccurate information, and sensationalized stories to take a stronghold on the media and occupy our headspace. Unfortunately, this can sometimes lead to legislation, private policies, and cultural stigmas that create obstacles for people who require assistance to build their families.
In this blog, we’ll review the many definitions of infertility, including how social infertility affects the LGBTQ community. We’ll also cover how infertility, in general, might play a factor in your biological family building journey. Lastly, we’ll review some of the common barriers to fertility treatment for LGBTQ singles and couples, and what you can do to overcome them.
Definition of Infertility
Infertility is described for most medical purposes as sperm and egg being exposed to one another for a year without conception. While some state language includes the term “insemination” as well, by and large, this definition doesn’t take LGBTQ population into account. Further, the diagnosis of “infertility” typically refers to a couple, which also excludes single parents from pursuing biological family building.
Sadly, the medical definition of “infertility” has long been outdated -- but is often accepted as is, in black and white terms, by insurance providers. This inherently denies LGBTQ couples and single parents-to-be from equal coverage.
LGBTQ Couples & Social Infertility
Social infertility is a relatively new term that accounts for the family building dreams of LGBTQ couples and single parents-to-be. In both instances, biological family building will require assistance from a donor and will most likely also require a fertility professional, legal counsel, and mental health professional.
Aside from social infertility that affects essentially all cisgender couples in the LGBTQ community, there are additional infertility issues that may affect the LGBTQ population.
For LGBTQ dads-to-be, men make sperm every 90-days or so, but that doesn’t exclude them from experiencing infertility, too. Potential causes of male-factor infertility could be steroid/hormone usage, a past STD, age, smoking and/or drinking, or some combination of any of these factors.
For LGBTQ moms-to-be, this includes 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 STD could also hamper the reproductive system’s function.
Another possible cause of infertility for moms-to-be is advanced maternal age. 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 decline with age. To illustrate this point with actual figures, at birth, there might be around 2 million or so 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. By 37 or so, that number is down to 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 pregnancy.
Need a full refresher on the female reproductive system?
At this point, if you’re a mom-to-be, you might be thinking, “What?! Men make sperm every 90-days, meanwhile, we’re losing 10K eggs a month? That’s not fair!” And you’re right, it’s not fair, but that is why fertility testing is so important.
Baseline Fertility Testing for the LGBTQ Community
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.
For moms-to-be, baseline fertility testing includes AMH testing, Cycle day 3 blood testing, and day 21 testing.
For dads-to-be, baseline fertility testing includes going for a semen analysis to evaluate your sperm quality.
For all LGBTQ singles and couples, genetic carrier screening is available and can help screen for a variety of genetic conditions. Additionally, genetic counseling is an important part of the process and is a major factor when it comes to choosing an egg donor or selecting a sperm donor.
Want more information on Fertility Testing for the LGBTQ community?
LGBTQ Infertility and Insurance
As mentioned above, too often are LGBTQ individuals excluded from insurance coverage on the basis of the medical definition of “infertility.” Thankfully, there are many organizations out there that 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 singles 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. In order to accomplish this and for ways to inquire about your own benefits, we created a resource with 4 LGBTQ Family-Building Questions to ask HR.
As our Founder, Dr. Mark Leondires, says, “It takes a village, but the village is out there.”
If you’re a member of the LGBTQ community, you have the advantage of knowing that there are resources out there. While many hetero patients experience grief, shame, sadness at the prospect of talking to a fertility provider, LGBTQ community has the unique experience of approaching it with a different outlook. How’s that for positivity?! Choosing a provider who has the resources and, most importantly, the experience building LGBTQ families is key.
For more information on the biggest factors to look-out for when choosing your clinic, check out this article.