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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<\/a>, 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 \u201crepackaging of what infertility clinics already do\u201d prior to offering in vitro fertilization (IVF)\u2014but a brand-new, five-million-member insurance claims analysis reveals a very different story about the care patients actually receive before being offered IVF.<\/p>\n\n\n\n In September 2025, the American Society of Reproductive Medicine (ASRM) hosted a congressional briefing<\/a> that \u201cpainted restorative reproductive medicine as a branding exercise that repackages many of the methods already used in fertility clinics nationwide.\u201d The organization also released an issue brief<\/a> and an editorial<\/a> on RRM arguing that its emphasis on lifestyle modification, cycle tracking, and surgery is \u201calready well within the domain of what reproductive endocrinology and infertility specialists and reproductive urologists do every day.\u201d <\/p>\n\n\n\n Furthermore, ASRM\u2019s president has taken to the pages<\/a> of prominent news outlets to paint RRM as \u201cdangerous and misleading,\u201d and to assure the public that in following the medical standard, ASRM-affiliated medical practitioners would only<\/em> propose IVF after uncovering the root cause of infertility and determining that other treatments would not work.<\/p>\n\n\n\n To whit, ASRM\u2019s 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: \u201cWe 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.\u201d<\/p>\n\n\n\n At first glance, the statement that the principles underlying RRM\u2014that is, identifying and treating root causes of infertility\u2014have long been part of standard fertility care seems credible enough. After all, why wouldn\u2019t<\/em> the leading medical society for Americans\u2019 reproductive health include diagnostics and treatments of underlying conditions as part of a standard infertility workup? <\/p>\n\n\n\n To their credit, it\u2019s certainly true that ASRM has several practice guidelines that cover a range of conditions that affect fertility\u2014PMOS\/PCOS<\/a>, hyperprolactinemia<\/a>, endometriosis<\/a>, hypothyroidism<\/a>, and even male factors such as sperm health<\/a> and virility. These conditions are often linked to infertility, many because they affect healthy ovulation or sperm development. <\/p>\n\n\n\n For PMOS\/PCOS, the ASRM protocol<\/a> sets out Letrozole<\/a> as the first-line treatment, a drug that helps to induce ovulation. For hyperprolactinemia, absent another organic condition, dopamine agonists like cabergoline<\/a> or bromocriptine are the preferred treatment<\/a>, because they help to lower prolactin levels (elevated prolactin can suppress ovulation).<\/p>\n\n\n\n For hypothyroidism, ASRM states that abnormal TSH should be<\/a> followed up and treated with levothyroxine<\/a>. For suspected endometriosis<\/a>, laparoscopy is named as the only way to definitively diagnose. Finally, for men, ASRM protocols<\/a> recommend at least two semen analyses to begin an evaluation. <\/p>\n\n\n\n Every one of these important steps finds something that might be fixable about a couple\u2019s 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. <\/p>\n\n\n\n Every one of these important steps finds something that might be fixable about a couple\u2019s 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. <\/p><\/blockquote><\/figure>\n\n\n\n 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?<\/p>\n\n\n\n That\u2019s the question the Institute of Restorative Reproductive Medicine (IIRRM) recently sought to answer. Rather than simply take ASRM\u2019s claims at face value, a group of researchers at IIRRM performed a retrospective claims analysis<\/a> 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 before<\/em> IVF began [1]. <\/p>\n\n\n\n What the IIRRM researchers found wasn\u2019t what ASRM has been touting. In fact, the claims analysis demonstrated that IVF initiation rose early, and consistently outpaced completion of nearly all<\/em> guideline-recommended evaluations and treatments of the underlying causes of infertility. <\/p>\n\n\n\n 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 \u201cabsolute care gaps\u201d\u2014which 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.<\/p>\n\n\n\n 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. <\/p><\/blockquote><\/figure>\n\n\n\n PCOS<\/strong> <\/p>\n\n\n\n Hyperprolactinemia<\/strong><\/p>\n\n\n\n Suspected endometriosis<\/strong> <\/p>\n\n\n\n Diagnostic laparoscopy: a 67-point gap. 78.8% had begun IVF; 11.6% had the laparoscopy.<\/p>\n\n\n\n Amenorrhea<\/strong> <\/p>\n\n\n\n AMH testing: a 52-point gap. 70.2% had begun IVF; 17.9% were tested.<\/p>\n\n\n\n Hypothyroidism<\/strong> <\/p>\n\n\n\n Levothyroxine: a 13-point gap. 75.0% had begun IVF; 61.9% received it.<\/p>\n\n\n\n Male infertility<\/strong> <\/p>\n\n\n\n Two or more semen analyses: a 71-point gap. 79.8% had begun IVF; 9.3% had completed the tests.<\/p>\n\n\n\n Recurrent pregnancy loss<\/strong> <\/p>\n\n\n\n Perhaps one of the most damning findings, however, was the claims analysis \u201cone-month snapshot,\u201d 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. <\/p>\n\n\n\n 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\u2014a 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. <\/p>\n\n\n\nIn the news: RRM vs IVF<\/span><\/h2>\n\n\n\n
The infertility workup patients are supposed to get<\/span><\/h2>\n\n\n\n
Putting ASRM\u2019s claims to the test<\/span><\/h2>\n\n\n\n
IVF first, diagnosis later (if at all)<\/span><\/h2>\n\n\n\n
Care gaps for women facing infertility<\/span><\/h3>\n\n\n\n
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Care gaps for men facing infertility<\/span><\/h3>\n\n\n\n
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The power of professional society guidelines<\/span><\/h2>\n\n\n\n