Restorative Reproductive Medicine (RRM), a decades-old subspeciality of medicine that seeks to treat underlying reproductive conditions that affect fertility, has a growing base of both practitioners and patients. However, for a variety of reasons, RRM has been dismissed by the mainstream press and maligned by several of the leading medical societies in the United States. A leading critique is the belief that RRM is merely a “repackaging of what infertility clinics already do” prior to offering in vitro fertilization (IVF)—but a brand-new, five-million-member insurance claims analysis reveals a very different story about the care patients actually receive before being offered IVF.
In the news: RRM vs IVF
In September 2025, the American Society of Reproductive Medicine (ASRM) hosted a congressional briefing that “painted restorative reproductive medicine as a branding exercise that repackages many of the methods already used in fertility clinics nationwide.” The organization also released an resumen temático y un editorial on RRM arguing that its emphasis on lifestyle modification, cycle tracking, and surgery is “already well within the domain of what reproductive endocrinology and infertility specialists and reproductive urologists do every day.”
Furthermore, ASRM’s president has taken to the pages of prominent news outlets to paint RRM as “dangerous and misleading,” and to assure the public that in following the medical standard, ASRM-affiliated medical practitioners would sólo propose IVF after uncovering the root cause of infertility and determining that other treatments would not work.
To whit, ASRM’s latest letter to the International Institute for Restorative Reproductive Medicine of America (IIRRM) and its board of doctors concluded with their stance on the matter: “We agree that infertility often reflects broader health issues, and we support comprehensive evaluation and treatment of underlying conditions as standard evaluation and initial practice. However, we will continue to oppose any policy that limits IVF access or prioritizes one philosophy of care at the expense of patient autonomy.”
The infertility workup patients are supposed to get
At first glance, the statement that the principles underlying RRM—that is, identifying and treating root causes of infertility—have long been part of standard fertility care seems credible enough. After all, why wouldn’t the leading medical society for Americans’ reproductive health include diagnostics and treatments of underlying conditions as part of a standard infertility workup?
To their credit, it’s certainly true that ASRM has several practice guidelines that cover a range of conditions that affect fertility—PMOS/PCOS, hiperprolactinemia, endometriosis, hipotiroidismo, and even male factors such as salud del esperma and virility. These conditions are often linked to infertility, many because they affect healthy ovulation or sperm development.
For PMOS/PCOS, the ASRM protocol sets out Letrozole as the first-line treatment, a drug that helps to induce ovulation. For hyperprolactinemia, absent another organic condition, dopamine agonists like cabergolina or bromocriptine are the preferred treatment, because they help to lower prolactin levels (elevated prolactin can suppress ovulation).
For hypothyroidism, ASRM states that abnormal TSH should be followed up and treated with levothyroxine. For suspected endometriosis, laparoscopy is named as the only way to definitively diagnose. Finally, for men, ASRM protocols recommend at least two semen analyses to begin an evaluation.
Every one of these important steps finds something that might be fixable about a couple’s underlying health, something that may be affecting their fertility alongside their overall health and wellbeing. These conditions then have a suggested treatment method, many of which have very high success rates when completed.
Every one of these important steps finds something that might be fixable about a couple’s underlying health, something that may be affecting their fertility alongside their overall health and wellbeing. These conditions then have a suggested treatment method, many of which have very high success rates when completed.
But herein lies the crux of the matter: are these diagnostic and treatment protocols actually being offered to the vast majority of American couples seeking infertility care?
Putting ASRM’s claims to the test
That’s the question the Institute of Restorative Reproductive Medicine (IIRRM) recently sought to answer. Rather than simply take ASRM’s claims at face value, a group of researchers at IIRRM performed a retrospective claims analysis which looked at five million commercially insured patient records, identified patients with infertility diagnoses who subsequently underwent IVF, then checked the claims record for evidence of the diagnostic testing and treatment recommended by ASRM and AUA/ASRM guidance antes de IVF began [1].
What the IIRRM researchers found wasn’t what ASRM has been touting. In fact, the claims analysis demonstrated that IVF initiation rose early, and consistently outpaced completion of nearly all guideline-recommended evaluations and treatments of the underlying causes of infertility.
IVF first, diagnosis later (if at all)
The claims analysis found that, for most conditions assessed, IVF was initiated well before doctors could measure any treatment effect aimed at restoring natural fertility. In other words, the study found a series of “absolute care gaps”—which they calculated by taking the share of patients who started IVF minus those who actually received the guideline-recommended next step. Below are some of the more striking examples of the care gaps currently being experienced by millions of American couples facing infertility.
The claims analysis found that, for most conditions assessed, IVF was initiated well before doctors could measure any treatment effect aimed at restoring natural fertility.
Care gaps for women facing infertility
SOP
- Laparoscopic ovarian surgery: a 76-point gap. 78.4% had begun IVF; 2.6% had the surgery.
- Letrozole, the guideline’s first-line treatment: a 44-point gap. 78.4% had begun IVF; 34.1% received it.
Hyperprolactinemia
- Bromocriptine: a 77-point gap. 85.5% had begun IVF; 8.2% received it.
- Cabergoline: a 60-point gap. 85.5% had begun IVF; 25.7% received it.
Suspected endometriosis
Diagnostic laparoscopy: a 67-point gap. 78.8% had begun IVF; 11.6% had the laparoscopy.
Amenorrea
AMH testing: a 52-point gap. 70.2% had begun IVF; 17.9% were tested.
Hipotiroidismo
Levothyroxine: a 13-point gap. 75.0% had begun IVF; 61.9% received it.
Care gaps for men facing infertility
Infertilidad masculina
Two or more semen analyses: a 71-point gap. 79.8% had begun IVF; 9.3% had completed the tests.
Recurrent pregnancy loss
- Sperm DNA-fragmentation testing: a 78-point gap. 81.2% had begun IVF; 3.2% were tested.
- Karyotype testing: a 57-point gap. 81.2% had begun IVF; 24.5% were tested.
Perhaps one of the most damning findings, however, was the claims analysis “one-month snapshot,” which found that within 30 days of an infertility diagnosis, between 4.7% and 12.3% of patients had already started IVF. Likewise, the claims analysis found that over 25% of couples who began treatment at a fertility clinic had begun IVF after just three months. After 9 months, up to 85% of couples were using IVF, while only 40% had started evaluation or treatment for an underlying condition.
The power of professional society guidelines
RRM physicians have long argued that mainstream infertility care pushes patients toward band-aid methods and incentivizes quick procedures that make doctors more money, rather than root cause treatments that actually address the cause(s) of infertility so couples can conceive without IVF—a position that appears to find confirmation in this claims analysis. All too often, it seems that even the bare minimum fertility evaluation is rarely completed.
Importantly, this pattern of care (or, rather, lack thereof) has ripple effects even beyond individual couples. Committee opinions and practice guidelines from specialty medical societies like ASRM aren’t just recommendations. Oftentimes, they are adopted into state standards of care, or even at individual hospitals and clinics as the proper diagnostic and treatment methods to use, which means that they can be used as standards in medical malpractice cases.
Importantly, this pattern of care (or, rather, lack thereof) has ripple effects even beyond individual couples.
Furthermore, specialty medical societies often have seats on the board that sets the insurance codes and reimbursement rates for the nation’s healthcare, meaning their stance on the legitimacy of certain procedures and treatments actually shapes what gets taught, covered, and paid for in medical schools, hospitals, and clinics across the country. This is why it matters greatly whether the guidelines are actually being followed.
RRM doesn’t just pay lip-service to finding out por qué couples are experiencing infertility—and doesn’t push everyone into a one-size-fits-all approach
The results of this claims analysis force us to face the question: If mainstream infertility care were conducting even the bare-minimum treatment protocols that ASRM recommends, who knows how many couples would have been saved from the physical, financial, and emotional toll of IVF? This isn’t even a question of whether RRM or IVF is more successful, it’s whether patients are receiving the evaluation and first-line treatment that their own physicians’ professional societies recommend, antes de their reproductive systems are bypassed via IVF and other forms of assisted reproductive technology (ART). Unfortunately, for the vast majority of American couples, the claims analysis demonstrates that the answer to that is simply, “no.”
Each of these missed steps represents a chance that a doctor had to find something treatable, but instead was left untreated as a couple pursued IVF with bodies whose reproductive systems weren’t functioning as they ought. This is not the preparation for parenthood that these parents deserve, or the healthy environments and parents that these future children need.
Each of these missed steps represents a chance that a doctor had to find something treatable, but instead was left untreated as a couple pursued IVF with bodies whose reproductive systems weren’t functioning as they ought. This is not the preparation for parenthood that these parents deserve, or the healthy environments and parents that these future children need.
When these underlying conditions go unevaluated and untreated for years on end, IVF becomes the go-to if a couple wants a child at all. It’s less of an integrated care pathway, and more a technological substitute for unresolved reproductive dysfunction.
Comprehensive evaluation of both partners—the kind offered by RRM—is an active search for underlying causes and treatment of what’s treatable, all antes de reproductive function is bypassed via IVF. And it’s what American families facing the heartbreak of infertility need and deserve.
Referencia:
[1] Parnell T, Minjeur M, Turczynski C, Pistilli T. Real World Fertility Evaluation & Care Prior to In Vitro Fertilization: Care Gaps That Could be Addressed by Restorative Reproductive Medicine: A Retrospective 5-Million Patient Claims Based Care-Gap Analysis. J Restorative Reprod Med. 2026;2:1-15. doi:10.63264/r27a3q62.
