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


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
  • Single parenthood

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  • DOI: 10.1007/978-3-319-89429-4_6
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  1. 1.

    Although we will not discuss the ethical issues surrounding surrogacy, it is important to note that heterosexual couples who meet the current clinical definition of infertility may also benefit from surrogacy coverage. For instance, a woman who underwent a hysterectomy due to endometrial carcinoma may wish to start a family after she is cancer free. Even if she has the foresight, opportunity, and means to preserve her eggs, she cannot carry a pregnancy due to her surgery and will need to seek the assistance of a surrogate.

  2. 2.

    The 15 states that currently require health insurers to offer coverage for infertility diagnosis and treatment are Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia.

  3. 3.

    Although the Massachusetts infertility mandate has the most extensive ART coverage in the United States, it still does not include surrogacy. Single men and gay couples therefore will not receive coverage for all of the technologies and services they need to build a biological family.

  4. 4.

    Male infertility care is often overlooked in discussions of infertility. Although almost half of the infertility cases among heterosexual couples are caused by male factors, only six states (California, Connecticut, Massachusetts, New Jersey, New York, and Ohio) mandate coverage for male infertility care. Two other states (Montana and West Virginia) mandate undefined infertility services only for health maintenance organization plans. Among these states, Massachusetts once again provides the most comprehensive coverage for male infertility treatment, including sperm procurement, processing, banking, as well as reversal of elective sterilization (Dupree 2016). However, the Massachusetts coverage plan is designed only for males in heterosexual relationships.


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Correspondence to Lisa Campo-Engelstein .

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Lo, W., Campo-Engelstein, L. (2018). Expanding the Clinical Definition of Infertility to Include Socially Infertile Individuals and Couples. In: Campo-Engelstein, L., Burcher, P. (eds) Reproductive Ethics II. Springer, Cham.

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