To become a mother is a dream not shared by all but desperately by some. The decision to live a childfree life differs profoundly from facing an involuntary childless life after having your dreams and anticipations of motherhood crushed.

For the infertile woman the infertility comes upon as an unwelcomed surprise after the decision to become a parent already is taken.

The transition to motherhood is surrounded by rituals provided by friends, family and society. However, the transition to none-motherhood follows no paved roads nor guidelines.

For the women affected by involuntary none-motherhood reproduction plays a major role throughout life. The sense of major loss triggered by infertility may cause a recurring identity crisis. The social isolation described by many caused by the childlessness may also worsen when entering the stage of grandchildlessness. The loss of the child that never came then turns into a loss of the grandchild that never came.

Health insurance plans will frequently pay for services related to testing for and diagnosing infertility. However, many plans say that once the cause of infertility has been recognized they will no longer pay for fertility related services i.e. the actual treatment. When applying the same rules to other diseases or conditions the thought becomes absurd. Never else where would we make the effort to understand the underlying cause and just to decide not to do anything about it. In striving to become a parent the knowledge of why you can’t is a poor consolation.

So what should be the role of health insurance? Should also the treatment of infertility, considered a medical disorder with a great impact on a woman’s life, be covered as an essential benefit? Or should we continue to look upon infertility treatment as a nice-to-have quality of life enhancing benefit that doesn’t necessarily needs to be covered? 

As a intersect between organ transplantation, fertility treatment, restorative/reconstructive medicine, uterus transplant has all qualities essential to raise as the Trojan horse that forces the insurance companies to regroup. Transplant medicine and restorative/reconstructive medicine are covered by health insurance. The majority of the infertile females that is eligible for a uterus transplant lacks the uterus due to either a congenital malformation or due to a cancer disease forcing a hysterectomy. Should the health insurance plans turn these young women with that are cancer survivors or have a birth defect down? Should they not cover restorative/reconstructive surgery as for other birth defects of cancer diseases?

A non-visible defect is still a defect and one might argue that it should be treated as such.