Bilin Media

The Labels of Infertility


How can Employers be truly inclusive with their family-building benefit?

Heteronormative Definition Has Negative Effect on LGBTQ Patients

Infertility is often defined as not being able to get pregnant or carry a child to term after 12 months of regular, unprotected sexual intercourse.  A woman may be diagnosed as infertile after less than 12 months, depending on her age and diagnostic test results.

This definition assumes a heterosexual relationship, and it’s used by many insurance companies to decide when fertility treatment will be covered.  What are the implications for same-sex couples?  How can employers offer inclusive and fair fertility benefits?

Infertility Based on the Female Reproductive System

Insurance coverage for fertility treatment varies widely by state.  Most insurance companies in non-mandated states do not view fertility treatment as medically necessary and do not cover it.  Only 16 states require insurance companies to cover or offer coverage for diagnosing and treating infertility.  The laws in most of these states do not include language about same-sex couples.  Maryland mandates equal coverage for married same-sex couples, but also requires six attempts at IUI before covering IVF.  Where does this leave male same-sex couples?  A definition of infertility that is driven only by a heterosexual female partner’s reproductive system denies fertility treatment to gay couples, and may slow or deny treatment coverage to lesbian couples. And what about singles?

Changing the Definition

Scholars in bioethics and some medical practitioners have started arguing for a broader, more inclusive definition of infertility, known as social infertility, a phrase that already feels dated. Their view is that people can be “socially” infertile if they want to conceive but are not able to engage in sexual intercourse for a variety of reasons, including lack of an opposite-sex partner or being part of a same-sex partnership.  Social infertility is shaped by a person’s relationships and circumstances rather than a purely physiological diagnosis.   It’s possible to be both socially infertile and physiologically infertile.  Expanding the definition of infertility is controversial, and some fear it could pathologize homosexuality.  Others believe that if the right to reproduce is a universal right, it should be extended to all, regardless of sexual orientation.

Waive the Definition or Better Yet, Drop All Labels

Employers have the power to offer inclusive benefits that go beyond the medical policy and decide how broadly the benefits are to be offered.  They can waive the definition of infertility and cover costs of fertility treatment without preauthorization.  Inclusive, comprehensive family building benefits can include fertility preservation like egg or sperm freezing, surrogacy, and adoption benefits.  Offering comprehensive benefits is a strong recruiting tool and recognizes the importance of LGBTQ employees, single people, and heterosexual couples to your company.