There is a prolific literature on medicalization. While that research highlights numerous effects of the process, it is just beginning to explore medicalization's complexity. In an effort to understand medicalization as a diverse, contextual process, I utilize the case of infertility in the U.S., a highly stratified, medicalized condition. I interviewed 95 individuals among those at the margins of mainstream understandings of reproduction-women of low socioeconomic status, men who were part of an infertile couple, and women in same-sex relationships who were accessing medical treatment to assist in conception-and compared their experiences to 17 straight women of high socioeconomic status who are at the center of reproductive care. Through such comparison, I examine the gender, class, and sexuality dimensions of inequality in medicalization. Ultimately, medicalization excludes, but it does so differentially and with different effects depending on an individual's social location. Such findings demonstrate that medicalization is not a fixed, universal process. It is fluid and relational and shifts depending on context. (C) 2016 Elsevier Ltd. All rights reserved.