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04/20/2015

How should we define infertility and who counts as infertile?

The concept of infertility seems relatively straightforward, yet there are many myths, confusions, and disagreements regarding who counts as being infertile. According to the World Health Organization (WHO), infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”Like many definitions of infertility, this one is based on a woman’s body since she is the one who experiences pregnancy. However, this definition may make it more difficult to understand and recognize male factor infertility. Indeed, defining infertility based solely on a woman’s ability to achieve pregnancy reinforces the myth that women are more likely to be infertile than men. In reality, women and men are equally likely to be infertile. The National Institutes of Health (NIH) definition of infertility is more inclusive: “the inability of a woman or man to conceive a child or the inability of a woman to carry a pregnancy to term.”
Another concerned with the WHO definition of infertility is that it is based on being in a heterosexual relationship. According to this definition and many others like it, people can only be considered infertile if they engage in “regular unprotected sexual intercourse.” This definition does not explicitly state that this it is referring to heterosexual intercourse, which is problematic. Given the narrow scope of this definition, how then should we diagnose infertility in lesbian and gay couples and heterosexual individuals who are singleand not engaging in regular unprotected sexual intercourse.
Some people find it useful to distinguish between physiological infertility (i.e. infertility due to a biological condition such as low sperm count or blocked tubes) and social infertility (i.e. situational infertility, such as whether one has a partner and if so, if that partner is fertile and together one and one’s partner have the “right” parts to reproduce biologically). Relying on this distinction, lesbian and gay couples and straight single individuals are always socially infertile, but may or may not be physiologically infertile. However, based on the WHO definition, we cannot determine if these individuals are physiologically infertile because they are not engaging in the sole criterion for this definition: “regular unprotected [hetero]sexual intercourse. ”There are medical tests that can be performed, such as checking hormone levels and sperm counts, in order to determine if an individual is physiologically infertile. These tests are standard procedure even for heterosexual couple with infertility because one individual in the couple may be physiologically infertile and the other may not be. The individual and the couple who is physiologically fertile is socially infertile because of her/his relationship with her partner.
The fact that the WHO and other definitions of infertility exclude people who we may want to classify as infertile (e.g. a single straight woman who is physiologically infertile) and include people who we may want to label fertile (e.g. a physiologically fertile woman married to a physiologically infertile man) is troubling. Furthermore, it highlights that many medical definitions of disease are not a priori and purely objective, but are socially situated and somewhat subjective since they are defined by people.
The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website. 

This entry was posted in Health Care, Reproductive Ethics and tagged , , . Posted by Hayley Dittus-Doria. Bookmark the permalink.

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