Fertility Rights and Responsibilities

Can a fertility program or clinic deny treatment to patient(s) if there is concern about the ability to care for the child(ren)?

Yes. Fertility programs can withhold services if there are signs that patients will not be able to care for their child (or children). Services should only be withheld with good reason, and it should happen only after a careful assessment has been made by the clinical team.

Can a fertility program deny services to people with disabilities?

Most people with disabilities are able and well-qualified to raise children. They should not be denied services only because of their disability. Disabled people are protected by the federal Americans with Disabilities Act.

Can a fertility program deny services to a patient who is single, gay, lesbian, or otherwise a member of the LGBTQ+ community?

No. ASRM states that patients should not be denied fertility services because of their marital status, sexual orientation, or gender identity.

Do all fertility programs offer services to HIVpositive patients?

More and more fertility clinics in the United States now offer services to couples where one partner has HIV, and the other partner does not. Recent information shows that HIVpositive patients can be treated similarly to people with other long-lasting viral infections. Working together with an infectious disease specialist to reduce the HIV viral load can make it easier for couples to get fertility counseling and explore different fertility treatment options, especially when the HIV viral load is undetectable.

Can a fertility program deny services to a woman after menopause?

In general, infertility is a natural part of aging and menopause. There are higher emotional and physical risks to pregnancy for a woman after the typical age of menopause. For these reasons, pregnancy after the typical age of menopause should be discouraged. However, some women go into menopause earlier than usual. Pregnancy after premature menopause, also known as primary ovarian insufficiency (POI), should not be discouraged unless there are other specific health concerns like Turner Syndrome that may increase the risk of significant health problems in pregnancy.

In most cases, women with POI will need donor eggs to get pregnant. Like every case where donor eggs are used, it is important to consider the woman’s health, medical, genetic, and psychosocial risks, and the plans for childrearing before deciding to go forward with egg donation.

Should patients with extremely low chances of success be allowed to continue treatment?

Clinicians need to discuss risks, benefits, and choices to patients when any type of treatment option is explored. When there is an extremely low chance of having a baby with treatment, it should be discouraged. Other options for family-building should be explored.

Are patients required to undergo parenting skills assessment?

No, patients are not required to undergo, and programs are not required to do, a parenting skills assessment. Sometimes problems are found during the course of treatment.

Are risk-sharing programs ethical?

Risk-sharing programs are an agreement between a clinic and a patient where a patient pays for several IVF cycles at the beginning. Most of the payment is refunded if a pregnancy or live birth does not happen by the time the series is finished.

ASRM states that these programs can be ethical if patients are protected by clearly spelling out beforehand:

• What is considered success
• What is the chance of success
• What are the pros and cons of the program
• That pregnancy and delivery are not guaranteed but a refund is guaranteed if not successful
• What type of refund is possible
• What is the cost 
• That patients will pay higher expenses with the program than if the sharing program is not chosen