from the blog.

Check Her Sperm Count

This is a piece written for us by a member of the infertility, loss, and adoption community.

Don’t get me wrong. I appreciate the efforts of the Maryland State Legislature in passing the new IVF equality law. If you’re not familiar with the legislation, the intent of the law was to guarantee equality when it comes to reproductive assistance by requiring insurers who offer IVF coverage to heterosexual couples to also offer IVF coverage to lesbian couples, like my wife and me, who want to start a family.

But if we’re being honest, the law is fundamentally flawed. The problem is that the law still requires lesbians to prove that reproductive assistance is “medically necessary” by establishing infertility before their insurance will cover IVF.

One, no form of reproductive assistance (whether it be IUI or IVF) is medically necessary. Giving birth does not cure disease. And that’s not why we do it. Sure, you could argue that some people reproduce for the sole purpose of creating organ donors. But that practice is morally/ethically questionable at best and hardly the norm. And of course, I understand that infertility can be the result of a disease or medical condition. In addition to not having a male partner, I also have an underactive thyroid and endometriosis (neither of which were a real problem until I wanted to conceive).

Two, the method by which a lesbian couple must establish infertility remains fundamentally unfair and, in some instances, far more costly by comparison. In reviewing my own policy with a major insurance company, most straight couples can establish infertility by having unprotected sex for one year without a pregnancy if the woman is under 35 years old. The wait is only 6 months if the woman is over 35. This can be done in the privacy of their own home without medical supervision. Most straight couples can also establish infertility based on the male partner’s low sperm count.

Guess what? My wife and I have been having unprotected sex for 18 years without a pregnancy. As for sperm count, test her. I’m sure you’ll find it’s low. And yet, we had to spend over $20,000 out-of-pocket and go through six unsuccessful IUI cycles to prove what everyone already knew—we (as a couple) are infertile and need reproductive assistance.

I also understand that there are straight couples who don’t qualify for insurance for equally unjustifiable reasons. For example, I know of straight couples who don’t qualify for coverage because the male partner doesn’t have sperm or the female partner does not have a uterus. Making those couples prove medical necessity would be futile and unnecessarily stigmatize them as sick. I would argue that they, too, deserve insurance coverage for reproductive assistance.

That may be what I find most insulting. I’m not sick—I’m gay. Or, fill in the blank: I’m not sick—I was born without a uterus, sperm, and so on.

If the legislature really wanted to guarantee equality, they would structure a bill that acknowledged the fact that infertility is not a disease but rather a frustrated desire to conceive. For many, this desire is inherent in our DNA, whether straight or gay. Having children is not medically necessary. It is a choice that we, as a society, have said we support and encourage in married couples as a matter of policy. Now that marriage equality is the law, infertility support should be extended to gay couples on an equal footing.

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1 Comment

  1. Thank you for bringing attention to yet another area in which the infertility community is under-served by the health industry and protection laws. We have a long way to go…

    That said, if I had to choose between defining infertility as a disease or a frustrated desire to conceive, I’d choose the former – only because there are enough people who think that if you cannot reproduce without assistance (whatever the reason) then you should pay for it out of pocket. My own brand of infertility is woven into my DNA – I’m not sick, it’s definitely not a disease, and “frustrating” doesn’t begin to cover the anguish I experienced. I’d prefer to legally define infertility as something like “needing reproductive assistance” which would cover people who do have reproductive diseases, chromosome disorders (like me), or social infertility (which, in addition to the LGBTQ community, would also cover single parents by choice).

    I do have a question though: obviously the textbook definition of infertility is very heterocentric, but there are plenty of people in the LGBTQ community who are infertile. What do you think the standard for diagnosis should be? (Specifically for women, as men can have their sperm analyzed relatively easily.)

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