Sodomy is not infertility. But money and ideology encourage pretending otherwise.
For example, a recent piece in the New England Journal of Medicine complained that the World Health Organization’s guidelines on infertility aren’t inclusive enough because they “pertain only to heterosexual couples” rather than also encompassing “LGBTQ+ people, as well as single people.” The authors griped that the WHO’s “formal definition of infertility continues to exclude same-sex couples and to rely on intercourse-based framing.” Which is to say, infertility is defined as, well, infertility — when a man and a woman are failing to conceive via intercourse — without pretending that infertility includes the inability of same-sex couples to reproduce, an incapacity that is baked into the reproduction complementarity of the human species.
Same-sex marriage presumes that men and women are interchangeable, except as a matter of subjective sexual preference. This falsehood is refuted by the reality of reproduction, which is part of why article’s authors want to redefine infertility as the need for “donor gametes or embryos … for both single people and those with a partner.”
Of course, their definition of “donor” is as crooked as their definition of “infertility.” These “donors” are getting paid; none of this is free. Human eggs are especially costly to procure, particularly from the sort of accomplished, beautiful young women whose eggs are preferred. Likewise, hiring a woman to be a gestational surrogate (which is to say, leasing her womb) is expensive, even if the work is outsourced to the third world — Ghana is becoming popular, with a cost of about $50,000 per surrogacy and the women required to live in “dormitories” where they are monitored 24/7.
Motivated by Money
Money, as much as ideology, motivates the effort to redefine infertility. The authors of the NEJM piece complained that many insurance plans “define infertility as the inability to conceive after 6 to 12 months of unprotected heterosexual intercourse. Such policies effectively exclude many same-sex couples, single people, and some transgender people.” So yes, this is about money. Specifically, it is about forcing everyone else to pay so that men, whether in same-sex relationships or single, can buy babies for themselves.
Ownership of the American fertility industry is, as The New York Times and others have reported, dominated by private equity, and they want to maximize their return on investment by getting insurance, whether private or government-funded, to pay them. Of course, this means perverting the nature of both insurance and medicine.
Insurance is supposed to provide individuals protection against the vicissitudes of life by pooling risk, but two men being unable to have a baby together isn’t an unfortunate medical problem. Rather, it is the most obvious, predictable thing imaginable. Insuring against a dead cert isn’t insurance, it’s just a subsidy.
Medicine is supposed to heal. But, again, there is nothing to heal when sodomy, predictably, doesn’t result in progeny. And so the authors of the NEJM piece assert that “the modern understanding of the goal of fertility medicine is to enable family formation, not to narrowly cure a particular medical dysfunction.” Which is to say that it is not medicine, concerned with healing and health, but provision of a product, which is to say, a baby. This is not medicine but biological manufacturing: eggs and sperm are bought and sold and assembled in labs, with the resulting embryos gestated in rented wombs.
Then the babies are taken away and given to the buyer. These children are treated as commodities, made under contract as a sort of luxury good — complete with customization options ranging from sex selection to eye color to (so they claim) IQ. And now, in order to maximize this market, infertility is being redefined in defiance of biological reality. We are told that love makes a family, but what we see is cash and contract law making a family.
Children as Commodities
This evil hurts people. There are the children who are intentionally deprived of a mother or father, and those subjected to neglect and abuse because Big Fertility cares more about cashing checks than running background checks. There are the women exploited and injured by egg harvesting and surrogacy, or contractually commanded to go get abortions if the babies they are gestating don’t satisfy quality control.
Treating children as commodities produced to satisfy adult desires is wicked, a perversity made clear in the attempts to redefine reality. Against this evil we must proclaim and model the Christian truth that children are gifts from God, meant to be begotten in love through a marriage, which is a union that is one of the great goods of this life, and, as a symbol of our eschatological union with Christ, also points us toward greater in the world to come.
The richness of this vision also reveals why infertility, real infertility, hurts so much. Love longs to see itself multiplied, for union with the beloved to be fruitful. This is why the glory and responsibility of begetting new persons — immortals who can know and enjoy God forever — is rightly reserved for the marriage bed. It is sacrilege to turn the creation of new persons into a technical laboratory process for sale to anyone. And it is a sin against God and man to try to redefine reality so that insurance will pay for more baby-selling.
Nathanael Blake is a senior contributor to The Federalist and a fellow in the Life and Family Initiative at the Ethics and Public Policy Center. He is the author of "Victims of the Revolution: How Sexual Liberation Hurts Us All" (Ignatius, 2025).