In recent years, the American Society for Reproductive Medicine (ASRM) broadened its definition of ‘infertility’ to include ‘the need for medical intervention to achieve pregnancy...either as an individual or with a partner.’ Though some may view this change as purely semantic, broadening the definition cites a major shift in cultural expansions and acceptance of all those impacted by infertility.
Infertility does not discriminate.
Long gone are the days of associating fertility as only a white, wealthy, straight, heterosexual couple’s (or woman’s) issue. When systems of care exclude certain family-types, identities or geographies, the promise of fertility becomes uneven. Infertility affects people of diverse age, race, gender, geographic location, financial background, sexuality, relationship status, and much more.
Globally, it is well documented that marginalized patient communities face stark disadvantages; people of color and lower-income individuals may have up to 50% lower access to fertility treatment in some regions. Additionally, over 60 countries currently exclude LGBTQ+ or single- parent families from care entirely due to legal or policy bans.
Geography adds another layer to the access gap. Even in economically wealthy nations, rural and remote populations often travel hundreds of miles to access fertility services – creating time, cost and emotional burdens that fall disproportionately on underserved communities. For example in the U.S., people living in rural communities are 40% less likely to pursue treatment due to long travel distances, limited transportation, and higher associated costs. ASRM notes that roughly 75% of U.S. fertility clinics are concentrated in metropolitan areas, leaving many rural Americans without local access to specialists.
Research shows persistent inequities in who can access fertility care. Black women, despite having similar or even higher rates of infertility than white women, are 2-3 times less likely to receive treatment. The Center for Disease Control also reports that Asian women are significantly underrepresented in fertility care, in part due to cultural stigma and barriers that discourage help-seeking.
The future we envision is one where every person has recognition, access and dignity. And that future may be possible, thanks to the hard work of patients and providers alike advocating for more inclusive care.
WFA Argentina ambassador, and CEO of Grupo Procrearte, Santiago Rey Valzacchi shares, “Argentina has progressive legislation that guarantees access to fertility treatments, which is something to celebrate. However, as the CEO of one of the country’s leading reproductive health institutions, I see every day how access can still be uneven in practice. Implementation varies across provinces, and patients often face delays, lack of information, or administrative obstacles, especially outside of urban centers or among LGBTQ+ and single-parent families. While laws exist to support assisted reproduction, their implementation is uneven across regions and institutions. From my experience, many patients navigate a maze of bureaucracy, misinformation, and emotional burnout. Moreover, conversations about single parents by choice, LGBTQ+ family building, or egg/sperm donation are still limited. The need for cultural change is urgent.”
In the United Kingdom, WFA U.K. Ambassador and TV Star (Channel 4’s Hunted) Nichola Tidd reflects: “In the UK, infertility often comes with silence, stigma, systemic obstacles, and unequal access... When it failed, I felt like I had failed too, as a woman, as a partner, and as a future mother.”
Ariel Taylor, WFA Canada Ambassador, multiple time egg donor and gestational surrogate and patient advocate shares hope from her region of the world: “As a Canadian therapist and surrogacy educator, I feel a deep responsibility to ensure that fertility care remains not just accessible – but ethical, transparent, and empowering. Canada is one of the few countries where altruistic surrogacy is legal, well-regulated, and inclusive of LGBTQ+ families and single parents. That gives us a rare opportunity to lead by example.”
Closing these gaps requires meaningful policy reform, broader insurance coverage, and care that is inclusive, culturally responsive, and accessible to all.
Equity demands we question assumptions: Who is left out of care? Why? How can we support those living on the margins? It demands that access is not a privilege of geography, gender or income – but a right for all.
Because at pregnantish we’ve always believed that anyone who fights so hard to parent a child(ren), is exactly the kind of parent we want in the world.
