It’s Time to Redefine Infertility
When Erik Schramm talks to friends about starting a family, he’s heartbroken. “I watch them want to do this, then I tell them about the costs, and they say, ‘We just can’t.’ Or I see couples go into crazy debt because it’s their dream,” says the 43-year-old, who lives in Townsend, Delaware.
Schramm and his husband have two children and are about to start the process of having a third. Despite several setbacks — including three failed embryo transfers before having their first child — Schramm, a political consultant, acknowledges that he and his husband, a doctor, are fortunate to have the resources to cover the expenses of having a family. In order to have their first child, the couple spent more than $100,000 out of pocket on rounds of donated eggs, embryo transfers, travel for their surrogate and more. Still, he says, “it’s so frustrating as a gay couple that fertility treatments aren’t covered by insurance.”
Many insurance plans treat infertility as a heterosexual condition, either explicitly or implicitly. “Most medical books and medical organizations define infertility as the inability to conceive after one year of unprotected sex,” explains Lisa Campo-Engelstein, director of the Institute for the Medical Humanities at the University of Texas Medical Branch. The presumed meaning of “unprotected sex” is vaginal sex, not oral or anal, between a heterosexual couple.
Since LGBTQ+ couples are excluded from this definition, they often either receive no insurance coverage for fertility treatments or have to pay out of pocket to “prove” infertility before accessing benefits. Seeing this as an unfair burden, some reproductive health experts have promoted the concept of “social infertility.” “This refers to people who are not in the kind of partnership that is expected to lead to pregnancy on its own, such as single people and same-sex partnerships,” explains Faren Tang, a reproductive justice fellow with the Program for the Study of Reproductive Justice at Yale University. While not all LGBTQ+ advocates agree that this term is useful, most agree that LGBTQ+ couples should have access to infertility care and insurance benefits.
The challenging road to LGBTQ+ parenthood
For anyone, going through fertility treatments is a second job. “You’re researching, choosing sperm, taking out loans, being really careful with money, making humongous life decisions and crossing your fingers that they’re the right ones and will work,” says Carrie Welch, 41, a mother of two with her wife, Jannie Huang, 42. “Plus you’re trying to keep your body and your mental and emotional health in shape.”
Add to that being LGBTQ+ and having to find inclusive healthcare providers. “For trans people in particular, even the prospect of discrimination is a barrier” to care, Tang points out.
LGBTQ+ couples in which one or both partners are non-white deal with additional burdens. In the US, infertility is disproportionately common among people of color, Tang says. This is due to a variety of factors rooted in systemic racism. For example, people of color face increased exposure to air pollution and discrimination from healthcare providers, which can discourage people from seeking care for medical conditions linked to infertility.
Next, there are financial hurdles. Sixteen states require insurers to offer coverage for infertility treatments, but the specifics of the laws vary considerably. “Because most models rely on the biological definition of infertility, LGBTQ+ individuals often don’t get diagnosed. And if you don’t get diagnosed, depending on the state law, you don’t get insurance coverage,” Campo-Engelstein explains. Even then, few top insurance companies offer the same fertility treatment benefits to LGBTQ+ couples that they do to heterosexual couples, says Serena Johnson, chief program officer of Family Equality, a nonprofit organization advancing equality for LGBTQ+ families.
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Originally published September 10, 2020.