WASHINGTON — With a plan for expanding access to in vitro fertilization (IVF) expected from the Trump White House any day, some analysts are hopeful that the initiative will give a boost to a growing field of medicine that seeks to address the root causes of infertility.

During the 2024 presidential campaign, then-candidate Donald Trump vowed to make IVF free to Americans amid backlash to an Alabama Supreme Court ruling that recognized the personhood of human embryos.

However, according to a report in The New York Times, Trump administration officials have not included the country’s largest IVF advocacy group in their consultations. This has led to speculation that the White House’s policy recommendations could advocate alternatives to IVF, namely “Restorative Reproductive Medicine” (RRM), a burgeoning field of medicine that promises an effective way help address infertility, a public-health issue that has become a national crisis. 

IVF is a form of assisted reproductive technology (ART) in which a woman’s egg and a man’s sperm are fused in a laboratory and then transferred to a woman’s uterus. The Catholic Church encourages couples seeking to have children to explore fertility methods to help them conceive and give birth, but Church teaching calls IVF “morally impermissible” because of the loss of human life involved — since millions of “surplus” human embryos are discarded annually due to the process — and because it resorts to an artificial means of having procreation, outside of the marital act. 

While RRM offers an ethical approach to infertility — one that Catholics can support — its advocates stress that it has also been proven to be more effective than IVF.

Natalie Dodson, policy analyst at the Ethics and Public Policy Center, and co-editor, along with the Heritage Foundation’s Emma Waters, of a recently published symposium, titled “Treating Infertility: The New Frontier of Reproductive Medicine,” emphasized to the Register that RRM is “scientific and evidence-based.”

“Restorative reproductive medicine is not simply practiced and used by religious individuals; rather, it is a medicine that’s desired across the board, beyond the political spectrum and religion,” Dodson said.

The methods used in RRM, she said, help couples understand how metabolic, nutritional, hormonal and endocrine systems work to “create bodies that are healthy and able to reproduce.”

“It’s fundamentally looking at the underlying causes of the infertility versus what in vitro fertilization or assisted reproductive technologies do, which is circumventing the infertility entirely,” she said.

The statistics are alarming: According to the Centers for Disease Control, infertility is on the rise among married women. From 2011 to 2015, 6.7% of married women of childbearing age reported experiencing infertility, while from 2015 to 2019 that number rose to 8.7%. 

There is also evidence that infertility among men is increasing. Men in Western countries account for 40% of all fertility issues, with one study showing that men seeking fertility treatment in Western countries showed a 42% decline in sperm count and quality from 2007 to 2017.

The infertility crisis has in turn meant big business for fertility clinics, which charge as much as $25,000 for one round of IVF treatment. For those who can afford it, it has become the go-to option for couples experiencing infertility, even though only 24% of every IVF attempt results in a live birth.

IVF’s ‘Band-Aid’ Approach

But a low success rate isn’t the only thing that is wrong with IVF, according to a symposium of articles published by the Ethics and Public Policy Center and the Heritage Foundation. 

Couples experiencing infertility would be better served by a holistic approach that uses RRM’s methods, the authors argue, as IVF fails to address the underlying health issues causing infertility. What’s more, it promises to resolve fertility issues, once and for all.

When patients are referred to IVF clinics, the authors write, the most common causes of infertility, including endometriosis, polycystic ovary syndrome (PCOS), uterine fibroids in women; and insulin resistance, high blood pressure, and poor sperm quality in men, often remain unaddressed.

“For many symptoms of reproductive health conditions or diseases, the medical professions’ instinctive response is pharmaceutical Band-Aids to mask and ignore the symptoms for as long as possible,” Dodson wrote in “Introduction to Restorative Reproductive Medicine.”

Even when IVF is successful and an embryo is produced outside of the uterus, there is no guarantee that it will be successfully implanted due to unaddressed medical issues, the report points out. And, what’s more, the couple will continue to experience infertility when they seek to have more children because the causes of reproductive dysfunction will not have been identified and treated.

RRM, on the other hand, offers the possibility of a “one-and-done” solution — a permanent fix to the most common causes of infertility — that has proven to be as successful as IVF in helping couples have children and is far more affordable. 

And the evidence shows that RRM works. 

A 2024 study based on data collected from an Irish fertility clinic showed evidence that their RRM-based approach is, in fact, more effective than IVF. According to the study, based on 2019 patient records, RRM resulted in a live birth rate of 40.4% for couples of all ages, compared to IVF’s live birth rate of 24% for women 42 and younger. 

A Canadian study backed up these results, showing that 66% of couples experiencing infertility who used natural procreative techniques (NPT, which are Church approved) for two years between 2000 and 2006 gave birth. Another 2017 study showed that previously infertile couples successfully became pregnant after using NPT. After eight months of training in the method, 38% became pregnant. Interestingly, among couples who had been trying to become pregnant for one to two years, the pregnancy rate went up to 56% after eight months of training. 

Why Is IVF the Default Option? 

So, why are doctors so quick to refer patients for IVF without addressing their health concerns? 

The answer has to do with money and the incentives created by high profitability of fertility clinics, a third of which are funded by private equity firms. According to an article in the medical journal The Lancet, the global fertility market was valued at $34.7 billion in 2023 and is expected to be worth $62.8 billion in the next decade. 

A look at one of the most common causes of infertility, endometriosis, a condition that affects 6 million women in the U.S., helps illustrate how patients are frequently referred to IVF at the expense of their health. 

Endometriosis occurs when tissue that normally lines the uterus is found elsewhere in the body, including on the ovaries and fallopian tubes, producing painful and irregular periods as well as infertility. The condition is notoriously difficult to diagnose.

According to the American Journal of Obstetrics and Gynecology, it takes between four and 11 years for a woman to be diagnosed with endometriosis, in part because medical professionals tend to prescribe oral contraceptives to treat the painful or irregular menstrual cycles associated with the endometriosis. While oral contraceptives can slow the growth of the lesions and allow a woman to proceed with IVF, they offer a temporary fix to the underlying cause of many women’s infertility. Tragically, even if a woman becomes pregnant through IVF, the unresolved condition often increases the risk of miscarriage. A 2015 study of 15,000 women in Scotland found that endometriosis increases the risk of miscarriage by 76%.

There aren’t any incentives within the U.S. health-care system to properly treat endometriosis, according to Dr. Patrick Yeung Jr., an OB-GYN specializing in laser surgery to treat endometriosis.. The only method that can effectively and permanently cure the disease, the complete surgical excision of endometriosis lesions, isn’t covered by insurance, Yeung explained in the Ethics and Public Policy Center-Heritage symposium. 

Yeung is the founder and owner of RESTORE Center for Endometriosis and is one of the few surgeons in the U.S. whose practice is dedicated to excising endometriosis.

“The usual treatments that are offered — pharmaceutical Band-Aids, bypass therapy for infertility, or repeated surgeries for the rest of one’s life — are not satisfactory,” Yeung wrote in “Restorative Reproductive Medicine: A Surgical Approach to Treating Endometriosis.”

Yeung has performed about 4,000 surgeries to completely remove the patient’s endometriosis. Calling it “one-and done” surgery, he contrasts it to the more commonly used ablation method, which merely burns of the lesions at the surface of the skin, and is at best a temporary fix.

This mainstream surgical method, according to Yeung, has a poor success rate: 40% to 60% of patients need to have additional surgery to remove endometriosis lesions within one to two years. While in 10 years of performing complete excision surgery, Yeung has only had 2.5% of patients require repeat surgery.

“One-and-done surgery is possible, and it should be the main option that medical professionals offer to patients,” Yeung wrote.

The problem, according to Yeung, is that the surgery takes hours, but insurance companies only have one billing code for in-network patients, meaning insurance doesn’t effectively cover it.

“No medical professional can survive in network by excising endometriosis. We, like all centers of endometriosis, provide these services out of network or on a cash pay basis in order to be able to do a good job,” wrote Yeung.

Consequently, there is a “bottleneck” in the system, with demand for the procedure overwhelming the number of doctors who are trained to perform it. For his part, Yeung plans to devote the latter part of his career to training medical professionals in the field.

RRM Provides Potential Cures 

Fortunately, today more couples experiencing fertility can find medical practitioners trained in RRM methods, using fertility-awareness-based methods (FABMs) to identify and treat the root causes of infertility. A woman will keep a daily diary of her menstrual cycle, and her doctor can use that information along with other biomarkers, such as cervical fluid secretions, the menstrual period, basal body temperature and urinary hormones, to identify the optimum time to conceive naturally and pinpoint conditions that may be contributing to her infertility.

According to Dr. Marguerite Duane, a board-certified family physician and co-founder and executive director of Fertility Appreciation Collaborative to Teach the Science (FACTS), identifying any abnormalities based on this data should be part of the normal medical response to infertility.

“Medical care is incomplete, and we do a disservice to our patients if we do not consider potential underlying causes of infertility and treat them in both the man and the woman,” Duane wrote in the EPPC-Heritage symposium.

She cited the case of a woman who had been diagnosed with infertility and PCOS who had suffered multiple miscarriages. Rather than take her physician’s advice to pursue IVF, she found Duane’s practice because “she questioned the advice, as her difficulty was not in getting pregnant but staying pregnant.”

Duane wrote that “almost immediately” the medical team identified several treatable factors contributing to her inability to have a child. She was treated for Hashimoto’s thyroiditis and several other hormonal conditions and diagnosed with endometriosis. She was then referred to a surgeon and treated with progesterone supplementation to prevent miscarriages. Two months later, she conceived and carried the child to term. 

Comprehensive medical protocols have been developed, such as Natural Procreative Technology (NaProTechnology) and NeoFertility, which can address hormonal imbalances, autoimmune diseases, as well as inflammatory conditions that may be causing infertility. 

Several medical institutions are offering residencies in the field, and some universities now offer training in fertility awareness. 

Duquesne University’s Center for Fertility Awareness Education and Research trains medical students and physicians in these methods, to promote fertility and overall health of the patient. Georgetown University School of Medicine offers an elective to educate medical students on the effectiveness of FABMs. In April, the University of Utah announced the establishment of the Joseph B. Stanford, M.D., and Kathleen B. Stanford Presidential Chair in Restorative Reproductive Medicine.

A movement to level the playing field for RRM is underway. In Arkansas, Gov. Sarah Huckabee Sanders recently signed the “Reproductive Empowerment and Support Through Optimal Restoration (RESTORE) Act,” based on model legislation from the Ethics and Public Policy Center and the Heritage Foundation. RRM advocates hope to see the passage of similar legislation in other states soon. 

Dietary Factors

RRM’s holistic approach involves taking a close look at the diet of a couple having difficulty conceiving and giving birth, as nutrition has also emerged as the possible source of fertility issues. 

PCOS, one of the leading causes of infertility, is a metabolic condition that affects 1 in 10 women, according to the Office on Women’s Health at the U.S. Department of Health and Human Services. The hormonal imbalance caused by PCOS interferes with ovulation. PCOS and metabolic dysfunction are linked to diet, according to Victoria Peck-Gray, a registered nurse, functional medicine dietician, and founder of Wonderfully Made Nutrition, writing in the Ethics and Public Policy Center-Heritage symposium..

Metabolic dysfunction impairs the body’s ability to convert food into energy, leading to insulin resistance and excess weight gain, two conditions known to contribute to infertility, according to Peck-Gray. The good news is treating these conditions is relatively simple with a focus on nutrition.

According to Peck-Gray, infertility can also be the result of vitamin deficiencies. She points out many Americans are not getting the recommended daily amounts of magnesium (effects energy production within eggs and sperm); zinc (supports the maturation of eggs, assists in hormone production, and enhances sperm quality); and Omega-3 fats (reduce inflammation and improve blood flow to reproductive organs). 

Government Support

In Arkansas, where the RESTORE Act was just made law, fertility-awareness methods are now offered as part of the state’s public health services. Health-insurance policies are required to cover restorative reproductive medicine, and medical practitioners are permitted to opt out of participating in assisted reproductive technologies if they conflict with their religious or moral beliefs. 

Advocates for RRM say the federal government could support their efforts further by funding grants for medical research into the root causes of infertility.

In addition, the Trump administration could change the federal rules to update health insurance coding, billing and coverage to cover procedures performed by RRM providers. 

Resources for Couples

To learn more about the medical field of RRM visit the website for the International  Institute for Reproductive Medicine, which provides updated research by peer-reviewed studies on infertility and holistic methods of treating it. 

IIRRM is in the process of setting up searchable database of recommended clinicians who are trained in are practicing RRM care. Until it is completed, they are asking those interested in finding a provider email them at [email protected].