Defining Infertility

At times, there seems to be a temptation to put the world of infertility and the losses that often accompany it beyond the realm of language. Think of how often words and phrases like “unthinkable,” and “I can’t even imagine” get batted about when these stories are told. Even Hamilton, a play both written by and depicting a man blessed with a seemingly endless supply of linguistic prowess, describes the loss of a child as a “moment that the words don’t reach, …a suffering too terrible to name…unimaginable.”

 It’s true, of course, that sometimes words fail us in these moments, that there are very real limits to what aspects of an experience can be captured and represented to those who have not lived it themselves. At the same time, language is a powerful connective tool. Language is a huge part of what allows us to share experiences, to create moments of recognition and belonging and mutual obligation and care.

That’s why, as part of my Fertility Foundations series this month, I’m spending some of my time here and on social media defining some basic but specific terms. After all, if we don’t know what we mean when we use words like infertility, then those opportunities for meaningful connection are going to be significantly limited.

As those of you who follow me on social media might have seen, the most commonly used definition of infertility goes something like this: “Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse” (WHO, 2024).

This is a useful starting point. It captures some of the most important details (failure to achieve pregnancy), and it offers a timeline (twelve months). However, it also makes—and again, I mentioned this on social media—some key assumptions.

What is the person in question is not coupled?

What if they, and/or their partner, are not cis-gendered, or are members of the same sex?

Instances like this are sometimes referred to as social infertility, a term recognizing that some individuals may wish to have a child and be unable to do so due to their relational or social status. However, some organizations such as the American Society for Reproductive Medicine, have elected to revise their definitions of infertility to account for both physiological and social circumstances.

This is a positive and important step. I remember feeling genuinely emotional the first time I read the full version of their revised definition. However, the application of such revised definitions is another matter.

As some of you might know, I am currently in the process of obtaining a Masters of Arts in Counselling Psychology. One of the things I came across recently when composing a paper about the psychological impact of infertility is that every single article I read (and it was over 50, all published within the last seven years) used some version of the WHO’s definition.

Think about what this means, because it is not just an academic issue.

It means that an experience already made invisible and disenfranchised is doubly so for anyone whose journey does not align with the dominant narrative about what infertility is or looks like.

It means that we understand frighteningly little about the psychological impacts of infertility on 2SLGBTQIA+ people, on single people, and on anyone else who wants to have a child and cannot get there through the ‘usual’ methods. Given that many of the people who fall under such a banner are already prone to increased stress (a phenomenon called minority stress), this is incredibly important.

I’ll be writing to some of the psychology newsletters in Alberta to bring awareness to this issue within my own field. If you’re a mental health professional as well, I invite you to do the same!

But you don’t have to be directly employed in a related field to make a difference. A huge part of how these terms change is not only through large organizations making top-down statements, but through the community and how it makes use of its foundational concepts. I encourage you to be mindful of how you speak about infertility, recognizing that your experience may not encompass the full spectrum of challenges others face. By making space for diverse voices and perspectives through our definitions, we can create a more compassionate and comprehensive dialogue. Share your own story, listen to others, and advocate in your own way for a definition that truly reflects the wide array of experiences in our community. Together, let’s ensure that every individual’s journey is acknowledged and supported.