Infertility, Involuntary Childlessness, and Inclusion

Abstract: In this presentation I compare two approaches to inclusiveness around the problem of wishing to have children but being unable to do so in “the old-fashioned way”. “Inclusion” here refers to alternative family types beyond the heterosexual monogamous couple paradigm—especially same-sex couples, single individuals, and polyamorous families. One approach to inclusion—embodied in the ASRM‘s October 2023 revision of the definition of infertility—takes the approach of continuing to understand the problem as inherently medical/health-related in nature, but expanding the clinical definition of infertility. A contrasting approach been advocated by some in the philosophical bioethics literature; proponents of the social approach question whether the concept of “infertility”—with it inherent medical implications—is a helpful term. They advocate moving away from the medicalized framing and so suggest terms like “involuntary childlessness”—which capture a broader problem that is social in nature and which might or might not call out for medical/biotechnological solutions. I lay out the motivation for each of these approaches and evaluate the strengths and weaknesses of each. In my view, the involuntary childlessness approach has radical potential that those concerned with alternative family-making ought to embrace. Yet, I show that this approach also suffers from some of the same downsides as the medicalized approach. In particular, I suggest that what underlies the shared difficulties of both approaches is a failure to fully acknowledge the way in which both concepts embed and piggyback on assumptions about genetic parentage as what parenthood is ultimately about.