Expanding the Clinical Definition of Infertility to Include Socially Infertile Individuals and Couples

  • Weei Lo
  • Lisa Campo-EngelsteinEmail author
Conference paper


In the United States, single individuals and LGBTQ couples who wish to conceive biological children are considered to be “socially infertile” due to their relationship status. Due to the high cost of infertility treatments and inadequate insurance coverage, the socially infertile has minimal access to assisted reproductive technology (ART). Under the current medical definitions of infertility, even in states with infertility insurance mandates, only heterosexual couples with physiological infertility are covered for ART. It is well documented that infertility interferes with many aspects of the human experience and reduces the quality of life for involuntarily childless individuals regardless of whether the infertility is physiologically or socially based. Physiological infertility was initially considered to be a private issue before being recognized as a medical diagnosis and has since legitimized heterosexual couples’ access to ARTs. The medical diagnosis of infertility not only affirms that their intention to conceive biological children is justifiable but also confirms that it is a condition that can and should be treated with current medical interventions. Expanding the current definition of infertility to include social infertility will elevate it to a treatable medical condition, justifying the use of ART for such individuals and potentially alleviating the negative impacts of infertility. Thus, states with infertility insurance mandates should provide the same infertility coverage to socially infertile individuals as physiologically infertile heterosexual couples.


Social infertility Assisted reproductive technology Infertility mandate LGBTQ Single parenthood 


  1. Amato P, Patterson S, Beattie B. Single-parent households and children’s educational achievement: a state-level analysis. Soc Sci Res. 2015;53:191–202.CrossRefPubMedPubMedCentralGoogle Scholar
  2. American Psychological Association. Answers to your questions: for a better understanding of sexual orientation and homosexuality. Washington, DC; 2008. Available at: Accessed 15 July 2017.
  3. American Society of Reproductive Medicine. Infertility: an overview (booklet). 2012. Available at: Accessed 17 Aug 2017.
  4. Baram D, Tourtelot E, Muechler E, Huang K-E. Psychosocial adjustment following unsuccessful in vitro fertilization. J Psychosom Obstet Gynaecol. 1988;9(3):181–90.CrossRefGoogle Scholar
  5. Basco D, Campo-Engelstein L, Rodriguez S. Insuring against infertility: expanding state infertility mandates to include fertility preservation technology for cancer patients. J Law Med Ethics. 2010;38(4):832–9.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Bell A. The margins of medicalization: diversity and context through the case of infertility. Soc Sci Med. 2016;156:39–46.CrossRefPubMedGoogle Scholar
  7. Bodkin H. Single men will get the right to start a family under new definition of infertility. The Telegraph, Oct 20; 2016. Accessed 19 Dec 2017.
  8. Bos HMW, van Balen F, van den Boom DC. Lesbian families and family functioning: an overview. Patient Educ Couns. 2005;59(3):263–75. Available at: Accessed 27 Aug 2017.CrossRefPubMedGoogle Scholar
  9. Centers for Disease Control. Infertility FAQs. Accessed 7 Nov 2017.
  10. Chachamovich J, Chachamovich E, Ezer H, Fleck M, Knauth D, Passos E. Investigating quality of life and health-related quality of life in infertility: a systematic review. J Psychosom Obstet Gynaecol. 2010;31(2):101–10.CrossRefPubMedGoogle Scholar
  11. Chambers GM, et al. The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril. 2009;91(6):2281–94.CrossRefGoogle Scholar
  12. Child Welfare Information Gateway. Planning for adoption: knowing the costs and resources. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau; 2016. Available at: Accessed 19 Feb 2017.Google Scholar
  13. Clarke V. What about the children? Arguments against lesbian and gay parenting. Women’s Stud Int Forum. 2001;24(5):555–70.CrossRefGoogle Scholar
  14. Clemons R. Frankly my dear... gay men marry straight women! Here’s why! Huffington Post. 2016. Available at: Accessed 15 Oct 2017.
  15. Davenport D. So you’re infertile, why not just adopt? Creating a family: the national infertility & adoption education nonprofit. 2016. Available at: Accessed 17 Aug 2017.
  16. Davison N. Gay marriage with Chinese characteristics. Slate. 2011. Available at: Accessed 17 Oct 2017.
  17. Devine K, Stillman RJ, DeCherney A. The Affordable Care Act: early implications for fertility medicine. Fertil Steril. 2014;101(5):1224–7.Google Scholar
  18. Domar A, Zuttermeister P, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993;14(Suppl):45–52.PubMedGoogle Scholar
  19. Dupree J. Insurance coverage for male infertility care in the United States. Asian J Androl. 2016;18(3):339–41.CrossRefPubMedPubMedCentralGoogle Scholar
  20. FertilityIQ. Cost of infertility treatment. 2017. Available at: Accessed 17 Aug 2017.
  21. Golombok S, Zadeh S, Imrie S, Smith V, Freeman T. Single mothers by choice: mother–child relationships and children’s psychological adjustment. J Fam Psychol. 2016;30(4):409–18.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Greil A. Not yet pregnant: infertile couples in contemporary America. New Brunswick: Rutgers University Press; 1991.Google Scholar
  23. Greil A, McQuillan J, Slauson-Blevins K. The social construct of infertility. Sociol Compass. 2011;5(8):736–46.CrossRefGoogle Scholar
  24. Health Policy Commission Office of Patient Protection. External review for denials of coverage for infertility treatment. The Commonwealth of Massachusetts. 2013. Available at: Accessed 4 Feb 2017.
  25. Hodes-Wertz B, Druckenmiller S, Smith M, Noyes N. What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility? Fertil Steril. 2013;100(5):1343–9.e1342.CrossRefPubMedGoogle Scholar
  26. Hopkins J, Sorensen A, Taylor V. Same-sex couples, families, and marriage: embracing and resisting heteronormativity. Sociol Compass. 2013;7(2):97–110.CrossRefGoogle Scholar
  27. Illinois Department of Insurance. Insurance coverage of infertility treatment. 2014. Available at: Accessed 25 Jan 2017.
  28. Katz P, Showstack J, Smith J, Nachtigall R, Millstein S, Wing H, Eisenberg M, Pasch L, Croughan M, Adler N. Costs of infertility treatment: results from an 18-month prospective cohort study. Fertil Steril. 2011;95(3):915–21.CrossRefPubMedGoogle Scholar
  29. Kraft D, Palombo J, Mitchell D, Dean C, Meyers S, Schmidt A. They psychological dimensions of infertility. Am J Orthopsychiatry. 1980;50(4):618–28.CrossRefPubMedGoogle Scholar
  30. Livingston G, Parker K. A tale of two father. Washington, DC: Pew Research Center; 2011. Available at: Accessed 20 Dec 2016.Google Scholar
  31. Long S. 11 celebrity lesbian couples who’ve proudly given birth. July 06; 2015. Accessed 6 Sept 2017.
  32. Luk B, Loke A. The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: a systematic review. J Sex Marital Ther. 2015;41(6):610–25.CrossRefPubMedGoogle Scholar
  33. Lukes M, Vacc N. Grief, depression, and coping in women undergoing infertility treatment. Obstet Gynecol. 1999;93(2):245–51.Google Scholar
  34. Marina S, Marina D, Marina F, Fosas N, Galiana N, Jové I. Sharing motherhood: biological lesbian co-mothers, a new IVF indication. Hum Reprod. 2010;25(4):938–41.CrossRefPubMedGoogle Scholar
  35. Möller A, Fällström K. Psychological consequences of infertility: a longitudinal study. J Psychosom Obstet Gynaecol. 1991;12:27–45.CrossRefGoogle Scholar
  36. Murphy J. Should lesbians count as infertile couples? In: Donchin A, Purdy LM, editors. Antilesbian discrimination in assisted reproduction. Embodying bioethics: recent feminist advances (new feminists perspectives). Boston: Rowman and Littlefield; 1999. p. 103–20.Google Scholar
  37. Nachtigall R, MacDougall K, Davis A, Beyene Y. Expensive but worth it: older parents’ attitudes and opinions about the costs and insurance coverage for in vitro fertilization. Fertil Steril. 2012;97(1):82–7.CrossRefPubMedGoogle Scholar
  38. National Conference of State Legislature. State laws related to insurance coverage for infertility treatment. Washington, DC: National Conference of State Legislatures; 2017. Available at: Accessed 29 Jan 2017.Google Scholar
  39. New York State Financial Services. Health insurance coverage for infertility treatment regardless of sexual orientation or marital status. Insurance Circular Letter No.7; 2017. Available at: Accessed 2 May 2017.
  40. Pakizegi B. Single parent adoptions and clinical implications. 2007. Available at: Accessed 27 Aug 2017.
  41. Peterson B, Newton C, Rosen K. Examining congruence between partners’ perceived infertility-related stress and its relationship to marital adjustment and depression in infertile couples. Fam Process. 2003;42(1):59–70.CrossRefPubMedGoogle Scholar
  42. Pew Research Center. The decline of marriage and rise of new families. Washington, DC: Pew Research Center; 2010. Available at: Accessed 20 Dec 2016.Google Scholar
  43. Pew Research Center. A survey of LGBT Americans. Washington, DC: Pew Research Center; 2013. Available at: Accessed 5 Jan 2017.Google Scholar
  44. Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99(1):63.CrossRefGoogle Scholar
  45. Rank N. Barriers for access to assisted reproductive technologies by lesbian women: the search for parity within the healthcare system. Houston J Health Law Policy. 2010;10:115–45.Google Scholar
  46. RESOLVE: The National Infertility Association. Insurance coverage in your state. 2017. Available at: Accessed 17 Aug 2017.
  47. Ryan S, Pearlmutter S, Groza V. Coming out of the closet: opening agencies to gay and lesbian adoptive parents. Soc Work. 2004;49(1):85–95.CrossRefPubMedGoogle Scholar
  48. Sundby J, Schmidt L, Heldaas K, Bugge S, Tanbo T. Consequences of IVF among women: 10 years post-treatment. J Psychosomat Obstet Gynecol. 2007;28(2):115–20.CrossRefGoogle Scholar
  49. Tatlow DK. Shining a light on gay-straight marriages in China. The New York Times; 2015. Available at: Accessed 15 Oct 2017.
  50. Terry D, Hynes G. Adjustment to a low-control situation: reexamining the role of coping responses. J Pers Soc Psychol. 1998;74:1078–92.CrossRefGoogle Scholar
  51. The Ethics Committee of the American Society for Reproductive Medicine. Access to fertility treatment by gays, lesbians, and unmarried persons: a committee opinion. Fertil Steril. 2013;100(6):1524–7.CrossRefGoogle Scholar
  52. Waldfogel J, Craigie T-A, Brooks-Gunn J. Fragile families and child wellbeing. Future Child. 2010;20(2):87–112.Google Scholar
  53. Weissenber R, Landau R, Madgar I. Older single mothers assisted by sperm donation and their children. Hum Reprod. 2007;22(10):2784–91.CrossRefGoogle Scholar
  54. Whiteford L, Gonzalez L. Stigma: the hidden burden of infertility. Soc Sci Med. 1995;40(1):27–36.CrossRefPubMedGoogle Scholar
  55. Wirtberg I, Möller A, Hogström L, Tronstad S, Lalos A. Life 20 years after unsuccessful infertility treatment. Hum Reprod. 2007;22(2):598–604.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Albany Medical CollegeNew YorkUSA
  2. 2.Alden March Bioethics Institute, Department of Obstetrics and Gynecology, Albany Medical CollegeAlbanyUSA

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