Infertility is a disease, not a label for wanting a child

A broader definition can expand insurance eligibility¹ while leaving a woman seeking infertility care without coverage². Infertility should remain a medical diagnosis, and Katy Faust put the child’s stake plainly on October 18, 2026: “When you re-define infertility to be more "inclusive" of LGBT couples, you discriminate against children (who lose their mother or father) and against heterosexual couples.”³

Faust also shared Wesley J. Smith’s warning: “heterosexual couples will have to demonstrate [up to 12 months of] a factual inability to conceive before benefits would be payable. But gay people would be immediately eligible — even if biologically they are perfectly capable of reproducing”. Adults seeking reproductive assistance have interests, but so do the children those arrangements create. A definition should distinguish a medical impairment from the need for another person’s reproductive contribution. Otherwise, the word “infertility” settles an eligibility dispute before anyone has answered the question about mothers, fathers and children.

“When you re-define infertility to be more "inclusive" of LGBT couples, you discriminate against children (who lose their mother or father) and against heterosexual couples”

NEJM broadens infertility beyond disease

In their New England Journal of Medicine Perspective, Who Counts as Infertile? A Missed Opportunity for Inclusion, Paula Amato and I. Glenn Cohen object that the existing definition continues to exclude same-sex couples and to rely on intercourse-based framing, as quoted by Wesley J. Smith in National Review. ASRM’s broader definition includes people who need donor eggs or sperm to achieve pregnancy.

The World Health Organization states its guideline’s purpose differently: “to provide evidence-based recommendations to prevent, diagnose and treat infertility.”⁴ Prevent, diagnose, treat: those verbs give medicine a defined task. A need for assistance does not, by itself, identify an impairment in the person requesting it.

Wanting to become a parent cannot settle what a child is owed.

Insurers already use ASRM’s broader standard

Axios reported in October 2023 that the American Society for Reproductive Medicine had broadened its definition.

Infertility specialist Lucky Sekhon explained the practical leverage: “a number of insurance plans rely on the ASRM definition of what qualifies as a disease to determine coverage.”¹ That moves the dispute from a journal’s pages into benefit decisions. The definition helps determine which requests insurers recognize as treatment for a disease.

Lawmakers should challenge that transfer of authority. A professional organization can advise on treatment without being handed the final word on which family-building arrangements a medical benefit must support. Families deserve an explicit coverage decision, not a policy expansion carried inside a revised definition.

California’s mandate leaves Torres out

The Los Angeles Times reported that California became the 15th state to mandate IVF coverage in January 2026, with coverage for three egg retrievals and unlimited embryo transfers. But SB 729 excluded small-business employees and people with individual or marketplace plans².

Nicole Torres encountered that boundary after a nine-week ultrasound showed no heartbeat and her Cedars-Sinai OB-GYN referred her to an infertility specialist, the Times reported. Torres worked for a small brewery below the law’s coverage threshold; her patient portal delivered the answer: “The requested service is being denied because there is no covered benefit.”²

“We’re all struggling with the same infertility, the same heartache,” Torres said. After losing her job in April, she sought employers offering infertility coverage².

Her case exposes the limit of celebrating broader eligibility: a more expansive category still leaves patients facing closed doors. For Torres, access meant searching for a different employer while trying to build her family. “I’m 40. I don’t want to go six more months and ‘keep trying,’” she said².

Lawmakers should keep infertility medical

Torres deserves a policy debate focused on access to appropriate medical evaluation and treatment. Changing the meaning of infertility cannot substitute for confronting the coverage boundaries that blocked her referral. Nor should her experience become an argument for treating every need for reproductive assistance as an equivalent diagnosis.

Lawmakers should keep infertility medical and require insurers to explain which diagnostic criteria govern their benefits. They should distinguish treatment of an impairment from coverage for arrangements involving donated reproductive material or a gestational carrier. Those arrangements require their own scrutiny, including the child’s interest in knowing and being raised by a mother and father. Compassion for adults longing for children should sharpen that scrutiny, not end it.

Parents and patients can demand clear answers: Does this benefit treat diagnosed infertility? Who remains excluded, and why? What protection does the policy give the child’s interests? Keep the diagnosis medical, address the barriers patients actually face, and refuse to let adult eligibility erase the child.

Sources

1. Infertility has updated ASRM definition: "Game-changer" for hopeful LGBTQ+ parents
2. In California, IVF insurance haves and have-nots - Los Angeles Times
3. @Katy_Faust on X, 2026-10-18: When you re-define infertility to be more "inclusive" of LGBT couples, you discriminate against children (who lose their mother or father) and against heterosexual couples "There’s a disturbing irony here.... heterosexual couples will have to demonstrate up t, 2026-10-18
4. Guideline for the prevention, diagnosis and treatment of infertility