New definition of infertility opens many doors
The definition of infertility used by the American Society for Reproductive Medicine (ASRM) has long been outdated, excluding millions of hopeful parents. Now, experts are expanding that definition to be more inclusive, ultimately affecting who is able to access family-building assistance.
As a leading resource and advocate for public policy concerning reproductive health issues, ASRM helps establish guidelines for laboratory and clinical practice. While its previous definition of infertility was distinct from the some more expansive definitions used by the World Health Organization (WHO) and Resolve: The National Infertility Association, most insurance companies, employers and other entities have deferred to ASRM’s language when developing policy.
Until October, ASRM defined infertility as “the failure to get pregnant within a year of having regular, unprotected intercourse or therapeutic donor insemination in women younger than 35 or within six months in women older than 35.”
As a result, those in same-sex relationships, those who need the help of a donor to grow their families or those who didn’t quite fit within the confines of the official definition received little to no fertility coverage from their insurers.
On Oct. 15, the ASRM Practice Committee redefined infertility as “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; and
- The need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos to achieve a successful pregnancy either as an individual or with a partner.
Significantly, ASRM adds, “Nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation.”
These long-awaited updates signal a significant shift in the family-building space. But what does this news really mean for patients? And how will the new definition actually affect who is able to access the fertility treatment they need to become parents?
The new guidelines can help shape state mandates and insurance coverage for infertility. Ideally, couples and individuals whose health insurance plan includes infertility coverage will be able to take advantage of ASRM’s expanded definition to lower their out-of-pocket costs.
ASRM’s new definition doesn’t mean every insurer will immediately shift its criteria on who qualifies for fertility treatment, but it is an important first step. Some corporations already offer infertility benefits to include single individuals and LGBTQ+ parents-to-be. Now, other employers could face pressure to do the same, leading to change across the country and increasing overall access to care.
Besides hopeful parents in the LGBTQ+ community and those who wish to pursue single parenthood by choice, there is another population of patients that will benefit from the new definition of infertility – anyone at risk of passing on genetic disorders.
Some insurance companies will cover advance testing to identify healthy embryos prior to pregnancy, but to perform this testing, in vitro fertilization (IVF) is necessary. Unfortunately, unless the couple have met the definition of infertility, the insurance company will deny coverage for IVF treatment, meaning they will not be able to access the preimplantation genetic testing (PGT) they need to increase their chances of a healthy child.
The previous, more restrictive definition of infertility has long frustrated and challenged physicians who knew they could help patients achieve their family-building goals, if only they had the insurance coverage needed to access treatment. Now, ASRM’s definition of infertility reflects the medical, scientific and societal realities that make up infertility and brings them into line with what patients, nonprofits and professional communities have been asking for.
Understanding insurance policies can be difficult, but hopeful parents who ensure they have the best fertility coverage possible are able to work towards their goals sooner. Exploring every available option and taking advantage of open enrollment (generally Nov. 1 through Dec. 15) are the best ways to do this.
Infertility patients who use employer-provided health insurance should always consult their human resources department to understand what is covered under their particular policy.
Mark Leondires, M.D., is founder, medical director and partner in reproductive endocrinology at Illume Fertility – with locations in Harrison, Danbury Norwalk, Stamford and Trumbull — and Gay Parents To Be (GPTB). He is board-certified in obstetrics, gynecology, reproductive endocrinology and infertility.
Mental health tips for fertility patients in the new year
By Shaun C. Williams, M.D.
For anyone who is currently on a fertility journey and nervous about navigating the new year – with all its resolutions and expectations — here are nine helpful tips to help get you through it with the unique stressors of infertility in mind.
- Reflect on your traditions — Getting together with family and friends – February alone is chock-full of holidays — can bring comfort and happiness. But keeping up with certain traditions can sometimes add more stress. Consider starting new traditions or even just changing it up this year. For example, if it will be too difficult to attend a large family gathering, opt to have a smaller and more selective get-together with loved ones you’re confident will be supportive of you as you go through fertility treatments.
- Make time for yourself — Don’t get so caught up that you forget to make time for yourself. Remember to check in and take stock of your stress levels. Take time to rejuvenate by choosing activities that bring you enjoyment, relaxation or connection. This may be a great time to get that massage you’ve been dreaming of, go for a hike with friends, try a new winter recipe or spend time enjoying a good book. Prioritize what fills your cup and set aside time to practice whatever form of self-care feels best to you.
- Don’t compare lives — In a time where most of us are constantly connected through various apps and social media platforms, we are bombarded with a continuous stream of content. It can be easy to fall into the trap of assuming that what we’re seeing is someone’s reality.
The majority of photographs, videos and updates we’re scrolling through are highly curated posts that are meant to show only the best moments. It’s just a highlight reel. While it may look like the friends you follow are always taking relaxing vacations, they may actually be in the middle of a contentious divorce. The co-worker who just posted an over-the-top pregnancy announcement might have had multiple miscarriages. Try to remember that what you see on social media is only a fraction of someone’s reality. It’s never the full story.
- Set healthy boundaries — A lot is expected of us throughout the year. Remember you don’t have to do it all, and that your health and happiness – not the expectations of friends and family – are most important. If you’re feeling overwhelmed by a packed calendar full of events, take a moment to assess whether you need (or want) to bow out of any of these commitments. Those who love and support you will understand if you need to lighten your load a bit.
- Plan ahead for difficult conversations — Most people have good intentions but aren’t sure what to say in response to another person’s struggles with infertility. Some will offer unsolicited advice or ask invasive questions. Think about how you will address fertility-related topics if someone asks and practice your responses so you aren’t caught off-guard in the moment. Some questions that might come up:
- Are you in fertility treatment?
- What happened during your last treatment cycle?
- Do you know why you can’t get pregnant?
- When is your next transfer, test or appointment?
- Why don’t you just adopt?
If you do decide to attend a party, make an exit strategy in case any interactions become too difficult. Also, consider if there will be any pregnant relatives or friends at events. Planning ahead and thinking about how these things might affect you will help you decide which gatherings you want to attend and which you might wish to skip.
- Reach out for support — You may feel alone or feel like you’re the only one struggling to get pregnant, especially when holiday cards and letters start flooding in. Finding a community of fellow fertility patients can make all the difference. Reach out to your fertility clinic to see if they have any support groups (online or in-person) or can recommend other groups in your community.
Organizations like Resolve can point you to additional resources in your area. Social media platforms like Facebook also have fertility groups that you can join. It can be quite comforting to connect with others who understand what you are going through.
- Do what feels right to you — Keep in mind that what might feel enjoyable to someone else might not feel right for you. It is important to find your own way as you navigate your fertility journey. Some find comfort in being around family members. Others might find more enjoyment planning time with a partner or close friend. Prioritize your own mental health when choosing who to be close to this year.
- Don’t share unless you’re ready — If you’ve just gotten a positive pregnancy test after a loss, have an embryo transfer coming up, or simply aren’t sure what’s next on your fertility journey, remember that you don’t owe anyone (even close friends or family) any updates. Even well-meaning loved ones can sometimes push a little too hard for sensitive information. You might feel pressured to share updates before you’re ready, but it’s more than OK to keep some things private.
- Practice self-compassion —. If friends or family members share that they are expecting a baby and you react strongly (feeling numb or unable to congratulate them), be gentle with yourself. You’re not a bad person for needing to step away for a minute to collect yourself. If you feel blindsided by someone’s big news, share your feelings with someone else you trust and allow yourself some time to process your reaction.
What you decide you need or want to do today doesn’t have to be forever, and you can always make adjustments as needed. As you go through fertility treatment, try to keep the main focus on what’s best for you emotionally. Accept that it may mean shaking up traditions or routines. So plan ahead, set boundaries, speak up when you’re struggling and do what feels right for you so that you can find your own joy while protecting your mental health during this new year.
Shaun C. Williams, M.D., is a partner in reproductive endocrinology at Illume Fertility, a leading modern fertility practice whose team of experts help individuals and couples grow their families, and is board-certified in obstetrics, gynecology, reproductive endocrinology and infertility.