Definition of infertility: a committee opinion
Download a PDF of this document
Infertility is defined. This document replaces the document titled ‘‘Definitions of infertility and recurrent pregnancy loss: a committee opinion,’’ last published in 2020 (Fertil Steril®. 2020;113:533-535. PMID: 32115183). (©2023 by American Society for Reproductive Medicine.)
‘‘Infertility’’ is a disease, condition, or status characterized by any of the following:
Nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation.
Acknowledgments: This report was developed under the direction of the Practice Committee of the American Society for Reproductive Medicine as a service to its members and other practicing clinicians. Although this document reflects appropriate management of a problem encountered in the practice of
reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations.
The Practice Committee and the Board of Directors of the American Society for Reproductive Medicine have approved this report.
The following members of the ASRM Practice Committee participated in the development of this document: Clarisa Gracia, M.D., M.S.C.E.; Jacob Anderson; Paula Amato, M.D.; Rebecca Flyckt, M.D.; Karl Hansen, M.D., Ph.D.; Micah Hill, D.O.; Sangita Jindal, Ph.D.; Suleena Kalra, M.D., MSCE; Tarun Jain, M.D.; Bruce Pier, M.D.; Michael Thomas, M.D.; Jared Robins, M.D.; Chevis N Shannon, Dr.Ph., M.B.A., M.P.H.; Anne Steiner, M.D., M.P.H.; Cigdem Tanrikut, M.D.; and Belinda Yauger, M.D. All Committee members disclosed commercial and financial relationships with manufacturers or distributors of goods or services used to treat patients. Members of the committee who were found to have conflicts of interest based on the relationships disclosed did not participate in the discussion or development of this document.
- The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
- The need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner.
- In patients having regular, unprotected intercourse and without any known etiology for either partner suggestive of impaired reproductive ability, evaluation should be initiated at 12 months when the female partner is under 35 years of age and at 6 months when the female partner is 35 years of age or older.
Nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation.
Acknowledgments: This report was developed under the direction of the Practice Committee of the American Society for Reproductive Medicine as a service to its members and other practicing clinicians. Although this document reflects appropriate management of a problem encountered in the practice of
reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations.
The Practice Committee and the Board of Directors of the American Society for Reproductive Medicine have approved this report.
The following members of the ASRM Practice Committee participated in the development of this document: Clarisa Gracia, M.D., M.S.C.E.; Jacob Anderson; Paula Amato, M.D.; Rebecca Flyckt, M.D.; Karl Hansen, M.D., Ph.D.; Micah Hill, D.O.; Sangita Jindal, Ph.D.; Suleena Kalra, M.D., MSCE; Tarun Jain, M.D.; Bruce Pier, M.D.; Michael Thomas, M.D.; Jared Robins, M.D.; Chevis N Shannon, Dr.Ph., M.B.A., M.P.H.; Anne Steiner, M.D., M.P.H.; Cigdem Tanrikut, M.D.; and Belinda Yauger, M.D. All Committee members disclosed commercial and financial relationships with manufacturers or distributors of goods or services used to treat patients. Members of the committee who were found to have conflicts of interest based on the relationships disclosed did not participate in the discussion or development of this document.
Practice Documents
ASRM Practice Documents have been developed to assist physicians with clinical decisions regarding the care of their patients.
The International Glossary on Infertility and Fertility Care, 2025
Previous editions of the International Glossary on Infertility and Fertility Care (2006, 2009, 2017) established internationally recognized definitions related to clinical practice, research, and policy.
Witnessing and protocol deviations in the in vitro fertilization and andrology laboratory: a committee opinion
A number of key misidentification risk points occur during an in vitro fertilization cycle in the laboratory that require robust witnessing.
Intracytoplasmic sperm injection for nonmale factor indications: a Committee opinion (2026)
ICSI use extends beyond male infertility, raising questions about benefits when semen parameters meet WHO reference values.
Recurrent pregnancy loss: a committee opinion (2026)
The majority of miscarriages are sporadic and most result from genetic causes that are greatly influenced by maternal age.More Resources
ASRM Practice Documents
These guidelines have been developed by the ASRM Practice Committee to assist physicians with clinical decisions regarding the care of their patients.
ASRM Academy on the Go
ASRM MAC Tool 2021
The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.
Practice Guidance
Coding Corner Q & A
The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.
Practice Guidance
EMR Shared Phrases/Template Library
This resource includes phrases shared by ASRM physician members to provide a template for individuals to create their own EMR phrases.
ASRM Ethics Opinions
Ethics Committee Reports are drafted by the members of the ASRM Ethics Committee on the tough ethical dilemmas of reproductive medicine.
Practice Guidance
COVID-19 Resources
A compendium of ASRM resources concerning the Novel Corona virus (SARS-COV-2) and COVID-19.
Patient Resources
ReproductiveFacts.org provides a wide range of information related to reproductive health and infertility through patient education fact sheets, infographics, videos, and other resources.
Topic Resources
View more on the topic of infertility
The International Glossary on Infertility and Fertility Care, 2025
Previous editions of the International Glossary on Infertility and Fertility Care (2006, 2009, 2017) established internationally recognized definitions related to clinical practice, research, and policy. View the Committee Opinion
Fertility and Sterility On Air - Unplugged: April 2026
Explore the latest fertility research on IVF, mental health, embryo transfer, PFAS exposure, and reproductive medicine in Fertility & Sterility Unplugged. Listen to the Episode
Half of Infertility Cases Involve Men. Why Does Care Still Treat It as a Women’s Issue?
Since 1989, National Infertility Awareness Week (NIAW) has marked a critical moment each April to elevate public understanding of infertility and push for better care. View the Press Release
National Infertility Awareness Week Highlights Record IVF Births, Growing Demand for Fertility Care
IVF births surpass 100,000 in one year, highlighting demand for fertility care as ASRM urges awareness, reduced stigma, and expanded access nationwide. View the Press Release
Fertility and Sterility On Air - Unplugged: March 2026
Fertility podcast explores IVF research, PRP risks, and recurrent pregnancy loss, highlighting evidence gaps, patient safety, and emerging reproductive medicine trends. Listen to the Episode
National Infertility Awareness Week
April 18-24, 2027, is National Infertility Awareness Week (NIAW)!
View the NIAW Toolkit
Mar 2026: Is Infertility a Chronic Disease? Why This May Matter for Billing and Coding
This document reviews a recent question regarding whether infertility is considered a chronic disease. View the blog post
Fertility and Sterility On Air - Roundtable: Should you do ultrasound monitoring for IUI cycles?
This episode of Fertility and Sterility is a roundtable, hosted by Dr. Emily Barnard and Dr. Ben Peipert with a discussion with the authors of "Views and Reviews" and "Fertile Battle" articles published in a recent issue of Fertility and Sterility. Listen to the Episode
From Guidance to Global Impact: How ASRM’s Updated Definition of Infertility Helped Shape Policy in Australia
SRM's updated infertility definition became a catalyst for regulatory action internationally and yielded new hope for growing families on the other side of the world. Read about the impact
Journal Club Global: Emulated Trials - A New Research Method With Insights Into Fertility Vitamin Supplements
Explore how emulated trials reveal the impact of vitamin D on fertility, featuring ASRM experts and real-world research insights from the FAST trial. View the Video
The reproductive endocrinology and infertility subspecialist: definition, training, and scope of practice in the United States (2025)
Learn the 2025 ASRM definition, training, and scope of practice for reproductive endocrinology and infertility subspecialists in the U.S. View the Committee Opinion
Improving access to care and delivery to marginalized and vulnerable populations: a committee opinion (2025)
ASRM committee opinion on reducing infertility care disparities, outlining barriers and actionable strategies to improve equitable access. View the opinion
Key Abstracts Presented at the ASRM 2025 Scientific Congress & Expo
ASRM 2025 reveals support for IVF access, wildfire smoke's fertility risks, and how insurance mandates improve outcomes in reproductive health care. View the Press Release
Fertility and Sterility Publishes Editorial Exploring the Origins of “Restorative Reproductive Medicine” and Why Modern Fertility Care Must Remain Comprehensive
Restorative reproductive medicine overlooks IVF, male-factor care, and the need for full-spectrum fertility treatment using modern technologies. View the Press Release
ASRM PRIMED Cohort Members—Including Physicians, Providers, and Experts—Meet with Congressional Offices to Advocate for IVF Access & Educate About Realities of Restorative Reproductive Medicine
ASRM PRIMED cohort meets Congress to push for IVF access, clarify risks of restorative reproductive medicine, and defend science‑based fertility care. View the Press Release
ASRM Hosts Capitol Hill Briefing for Policymakers & Congressional Staff to Hear From Providers & Patients About Importance of IVF Access, Realities and Limitations of Restorative Reproductive Medicine
ASRM briefing united lawmakers, physicians & patients on IVF access, exposing RRM limits and urging policies to expand fertility care options. View the Press Release
SRS Warns Against Limiting Access to IVF Under the Guise of “Restorative” Care
SRS, an ASRM affiliate, advocates evidence-based reproductive surgery and full-spectrum fertility care for conditions like endometriosis, fibroids, and PCOS. View the Press Release
Fertility and Sterility Publishes Editorial Piece on How Restorative Reproductive Medicine Violates Reproductive Autonomy and Informed Consent
Editorial in Fertility and Sterility warns that Restorative Reproductive Medicine spreads stigma, delays care, and undermines IVF and patient autonomy. View the Press Release
F&S Reports Publishes Editorial Piece on the Unscientific Nature of the Arguments for “Restorative Reproductive Medicine” and Why We Need to Understand Them
F&S Reports editorial critiques “Restorative Reproductive Medicine” as unscientific, faith-driven, and a threat to evidence-based IVF care and reproductive rights. View the Press Release
ASRM, Leading Medical Organizations Urge National Governors Association to Reject ‘Restorative Reproductive Medicine’ in Open Letter
Medical groups urge governors to reject Restorative Reproductive Medicine laws, defending evidence-based infertility care and IVF access. View the Press Release
Reproductive Medicine in the Era of Social Media: Pearls and Pitfalls
For couples struggling to conceive, social media has become a lifeline, a source of information, inspiration, and community. View the Latest Tech Talk post
ASRM Center for Policy and Leadership Releases Fact Sheet on Following the Science & An Evidence-Based, Science-Driven Response to Infertility
ASRM’s fact sheet outlines an evidence-based infertility care pathway, countering misleading RRM claims with science-backed medical best practices. View the Press Release
Follow the Science: An Evidence-Based, Science-Driven Response to Infertility
A science-based infertility evaluation and treatment guide, grounded in clinical best practices, counters ideologically driven alternatives like RRM. View the advocacy resource
ASRM Ethics Committee Delivers New Opinion on Assisted Reproduction with Advancing Parental Age
ASRM Ethics Committee issues guidance on assisted reproduction and advanced parental age, addressing medical, ethical, and psychological considerations. View the Press Release
Empathy in Action: Strengthening the Patient-Provider Connection
Dr. Tara Harding discusses how healthcare providers can foster empathy, trust, and patient-centered care to improve women's health outcomes. View the ASRMed Talk Video
Use of preimplantation genetic testing for monogenic adult-onset conditions: an Ethics Committee opinion (2024)
Preimplantation genetic testing for adult-onset monogenic diseases is ethically allowed when fully penetrant or conferring disease predisposition. View the Committee Opinion
Appropriate Use of Modifier -25
Is Modifier -25 appropriate in the monitoring cycle when an ultrasound View the Answer
Billing for E/M Visits
When billing Evaluation & Management (E/M) visits based on medical decision-making, would we View the Answer
When to use code Z31.83
When a patient is completing an approved fertility cycle, is it necessary View the Answer
Timed Intercourse Cycle Codes
Is it appropriate to utilize codes N97.8 or View the Answer
The use of preimplantation genetic testing for aneuploidy: a committee opinion (2024)
PGT-A use in the U.S. is rising, but its value as a routine IVF screening test is unclear, with mixed results from various studies. View the Committee Opinion
Fertility Support and AI: Help or Hinderance
Discover how fertility apps impact patient care and nursing staff. Explore the balance between tech and human touch in complex fertility treatments View the ASRMed Talk Video
HyCoSy and CPT 74740
When Office HSG/HyCoSy is performed but no x-ray/fluoroscopic imaging is performed, only ultrasound is done, is it appropriate to bill CPT code 74740? View the Answer
Subclinical hypothyroidism in the infertile female population: a guideline (2024)
This guideline reviews the risks and benefits of treating subclinical hypothyroidism in female patients with a history of infertility and miscarriage. View the Committee Guideline
Tobacco or marijuana use and infertility: a committee opinion (2024)
In the United States, approximately 21% of adults report some form of tobacco use, although 18% report marijuana use. View Committee Opinion
Journal Club Global: The future of REI Fellowship training: debating opportunities and threats
This exciting collaboration discusses the controversy and future directions for the field of Reproductive Endocrinology and Infertility medicine. View the Video
Journal Club Global: Infertility and Subclinical Hypothyroidism
The impact of treating SCH on fertility, obstetric outcomes, and offspring neurocognitive development is debated in the literature. View the Video
Ethical considerations for telemedical delivery of fertility care: an Ethics Committee opinion (2024)
Telemedicine has the potential to increase access to and decrease the cost of care. View the Committee Opinion
Ethical obligations in fertility treatment when intimate partners withhold information from each other: an Ethics Committee opinion (2024)
Clinicians should encourage disclosure between intimate partners but should maintain confidentiality where there is no harm to the partner and/or offspring. View the Committee Opinion
Definition of infertility: a committee opinion (2023)
Defines infertility as a disease impacting reproductive function, guiding evaluation and inclusive treatment regardless of age, status, or orientation. View the Committee Opinion
Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion (2023)
It is the responsibility of the clinician to assess for erectile dysfunction, ejaculatory dysfunction, or diminished libido in men presenting for infertility. View the Committee Opinion
Journal Club Global - Actualización en la suplementación con progesterona en fase lútea para transferencias de embriones congelados
Efectividad del rescate de progesterona en mujeres que presentan niveles bajos de progesterona circulante alrededor del día de la transferencia de embriones View the Video
Post Vasectomy Infertility
If a husband has had a vasectomy, does the sterilization code apply to the wife's visits? View the Answer
Pregnancy Of Uncertain Viability Ultrasound
My staff is telling me that I am getting reimbursed for the first sonogram and OB visit (using ICD 10 code for pregnancy of uncertain viability – O36.80X0. View the Answer
Pregnancy Ultrasound
Our practice does routine ultrasounds (sac check- 76817) at the end of an IVF cycle and bill with a diagnosis code O09.081, pregnancy resulting from ART. View the Answer
Psychological Evaluation
Many REs require patients (and their spouses/partners) who are considering using donor gametes to see an infertility counselor first. View the Answer
Self-referred New Patient
A patient self-refers to our physician for an initial new patient consultation instead of referred by another physician, how do we code for the consult? View the Answer
Surgery Coding
I took the ASRM coding course, and in that course, coding for bilateral neosalpingostomies was coded using only a dx of N70.11 (hydrosalpinx). View the Answer
Telephone Consult
Does a physician need to speak directly to a patient to code for a telephone consult (99371-99373) or can a staff member relay physician notes to patients? View the Answer
Testing With No History of Infertility
What diagnosis codes should providers submit to insurance carriers while trying to evaluate fertility issues? View the Answer
Infertility Consult
Does ASRM have any examples of evaluation and management documentation for patients being seen for an initial infertility evaluation? View the Answer
Infertility Consult by Nurse
What code is used for a nurse practitioner seeing a fertility patient for the first time? View the Answer
Initial Visit for Infertility With No Mandated Coverage
What code would be appropriate for an initial visit for infertility? View the Answer
IUI or IVF
Should other ovarian dysfunction (diagnosis code E28.8) or unspecified ovarian dysfunction (diagnosis code E28.9) can be used for an IUI or an IVF cycle View the Answer
Monitoring E&M
Our group would like to know if others are billing an evaluation and management code for ultrasound and blood draw visits? View the Answer
New vs Established Patient
How soon can you bill as a new infertility patient? View the Answer
General E&M Consult
Recently we have received a “re-code” on a new patient (we billed a 99203 and the insurance re-coded it to a 99213). View the Answer
Hysteroscopy Recurrent Implantation Failure
What is the appropriate ICD-10 code for recurrent implantation failure? View the Answer
D&C Under Ultrasound Guidance
What are the CPT codes and ICD-10 codes for coding a surgical case for a patient with history of Stage B adenocarcinoma of the cervix ... View the Answer
Diagnosis of Infertility for IVF Procedure
How important is it to have accurate documentation of the type of infertility diagnosis for IVF procedures? View the Answer
Diagnostic Testing of an Infertile Couple
The Z31.41 is or is not the correct code to use for diagnostic testing of an infertile couple? And If so can if be used as the primary and only code? View the Answer
Blood Draws
If a patient comes in only for a blood draw (venipuncture) and is seen only by the lab technician (not an MD, PA, or NP), may we bill for a (minimal) office visit? View the Answer
Blood Tests
Patients are requesting to have lab work drawn from the female patient moved to the males account due to the female fertility coverage being maxed out. View the Answer
Male Infertility
A summary of common codes for Male Infertility compiled by the ASRM Coding Committee. View the Coding Summary
Fertility evaluation of infertile women: a committee opinion (2021)
Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner. View the Committee Opinion
ASRM müllerian anomalies classification 2021
The Task Force set goals for a new classification and chose to base it on the iconic AFS classification from 1988 because of its simplicity and recognizability. View the Committee Opinion
Moving innovation to practice: an Ethics Committee opinion (2021)
The introduction of new strategies, tests, and procedures into clinical practice raises challenging ethical issues. View the Committee Opinion
Use of exogenous gonadotropins for ovulation induction in anovulatory women: a committee opinion (2020)
Pretreatment evaluation, indications, treatment regimens, and complications of gonadotropin treatment. View the Committee Opinion
Reproductive and hormonal considerations in women at increased risk for hereditary gynecologic cancers: Society of Gynecologic Oncology and American Society for Reproductive Medicine Evidence-Based Review (2019)
Providers who care for women at risk for hereditary gynecologic cancers must consider the impact of these conditions. View the Joint Statement
Guidance for Providers Caring for Women and Men Of Reproductive Age with Possible Zika Virus Exposure (Updated 2019)
This ASRM guidance specifically addresses Zika virus infection issues and concerns of individuals undergoing assisted reproductive technologies (ART). View the Guideline
Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion (2019)
The Ethics Committee recommends that in vitro fertilization (IVF) centers develop patient-centered policies regarding requests for futile treatment. View the Committee Opinion
American Society for Reproductive Medicine position statement on uterus transplantation: a committee opinion (2018)
Following the birth of the first child from a transplanted uterus in Gothenburg, Sweden, in 2014, other centers worldwide have produced scientific reports. View the Committee Opinion
Child-rearing ability and the provision of fertility services: an Ethics Committee opinion (2017)
Fertility programs may withhold services on the basis that patients will be unable to provide minimally adequate or safe care for offspring. View the Committee Opinion
The International Glossary on Infertility and Fertility Care, 2017†‡§ (2017)
A globally‑consensus glossary of 283 infertility and fertility‑care terms developed in 2017 to harmonize communication across clinicians, researchers & patients. View the Committee Joint Guideline
Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline (2017)
This review evaluates if uterine myomas impact likelihood of pregnancy and pregnancy loss, and if myomectomy influences pregnancy outcomes. View the Guideline
Improving the Reporting of Clinical Trials of Infertility Treatments (IMPRINT): modifying the CONSORT statement (2014)
Clinical trials testing infertility treatments often do not report on the major outcomes of interest to patients and clinicians and the public. View the Guideline
