Artificial insemination does not come cheap, and depending on your health insurance provider, you may be offered some help if it proves to be your only option for starting a family. More specifically, If your doctor has diagnosed you as infertile, some plans might actually help cover part of your fertility treatment.
However, it has recently come to the public’s attention that these options aren’t necessarily offered to all couples. Sarah and Jill Soller-Mihlek were recently featured in the New York Times for being a same-sex couple denied the same rights that their insurance company offers to heterosexual couples struggling with infertility.
The article focuses on lesbian women having to use donated sperm and undergo intrauterine insemination in order to get pregnant, and whether this deems them deserving enough to qualify for the same coverage as women unable to get pregnant by means of heterosexual intercourse.
The real underlying question that everyone is asking now, is what is the fair definition of infertility, and are we now dealing with discrimination or ignorance?
Infertility and Health Coverage
The policy that the Soller-Mihlek came up against stated that an acceptable case of infertility is the “inability to achieve pregnancy after 12 months of unprotected heterosexual intercourse.” Because of the wording, this rule actually requires a woman to engage in intercourse with a man in order to eventually come to the conclusion that she is indeed “infertile”.
The actual definition and possible causes for a woman’s infertility is a lot more complex than that, and there are other options available that can more definitively diagnose this condition. For example: a woman may be suffering from an ovulation disorder such as one of the following:
- Polycystic ovary syndrome: Results in a hormone imbalance which affects ovulation.
- Hypothalamic dysfunction: Abnormal stress or body weight resulting in hormonal dysfunction, disrupting ovulation.
- Premature ovarian failure: When the ovary no longer produces eggs.
- Too much prolactin: Usually the result of a pituitary gland issue causing a lack of estrogen production.
Infertility can also be caused by damage to the fallopian tubes or a condition called endometriosis. “Endometriosis occurs when the tissue that normally grows in the uterus implants and grows in other locations.” Doctors can diagnose such conditions by doing different variations of fertility testing including:
- Ovulation testing: “An at-home, over-the-counter ovulation prediction kit detects the surge in luteinizing hormone (LH) that occurs before ovulation. A blood test for progesterone -- a hormone produced after ovulation -- can also document that you're ovulating. Other hormone levels, such as prolactin, also may be checked.”
- Hysterosalpingography: An “x-ray contrast is injected into your uterus and an X-ray is taken to detect abnormalities in the uterine cavity. The test also determines whether the fluid passes out of the uterus and spills out of your fallopian tubes.”
- Ovarian reserve testing: Determines the number of eggs available for ovulation
- Other hormone testing: Which “check levels of ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes.”
- Image testing: Such as an ultrasound or hysterosonography.
After 12 months of unsuccessful treatments of intrauterine insemination, Jill Soller-Mihlek went to her insurance company for assistance with the costs to do further treatment. However, she did not get approved for the help based on the terminology of the policy.
Because of this, she decided to undergo fertility tests which revealed that Jill had endometriosis. With this diagnosis, she was then able to get the financial help that was required for another intrauterine insemination, but the way that she and her partner were mistreated continues to stand for questioning.
Same Sex Couples & Redefining Policies
The fact that this policy specifically requires “heterosexual intercourse” doesn’t leave any options available for those involved in any other type of relationship. The Soller-Mihleks had to spend $22,000 on treatments before they came to the conclusion that something wasn’t right, but this was not enough proof for their healthcare provider.
Yet, technically they were in the exact same boat that a heterosexual couple attempting to conceive through intercourse would be. The difference between the two is simply in the wording. In a fair world, no matter who you are, you should have the same options for the medical support to become a parent as the next person.
In order for this to happen, what constitutes “infertility” may have to be redefined. If anything, the companies providing coverage for couples and their infertility may have to reconsider all of the possibilities and the broader spectrum of people that are affected.