If Restorative Reproductive Medicine is so great, why have I never heard of it before?

A member of the Natural Womanhood team was recently asked the question: “If RRM is so great—if it’s this effective—then why on earth have I never heard about it before? Why aren’t the IVF clinics or our doctors encouraging us to try it first, before doing IVF?” The woman asking the question had been struggling with infertility for several years, had undergone multiple failed IVF cycles, and was nearing 40. She wanted to know if she should give one last IVF cycle a go, or if she should give this new approach she’d just heard about—Restorative Reproductive Medicine—a shot. She was skeptical, but willing to learn more.  

Her question is a good one–because for so many women, it rings true. Restorative Reproductive Medicine (RRM) hasn’t yet made it to the mainstream. While we know RRM treatments like laparoscopic excision surgery, bioidentical hormone therapies, and lifestyle interventions to reduce inflammation and correct hormonal dysfunction are more effective at actually restoring fertility in individuals and couples, as well as vastly cheaper than IVF, it’s hard to understand why fertility doctors wouldn’t embrace this framework for all women presenting with infertility.

The reality is, most women haven’t heard of RRM. And it isn’t their fault. IVF has become the default solution for couples struggling with infertility, and despite the studies that show RRM’s effectiveness, medical schools and fertility practices have not caught up. Furthermore, financial incentives, the standard of care promulgated by leading OB/GYN organizations, and the overall culture of women’s health have made it hard for RRM to become the first line of treatment. But, if we truly want women to have options when it comes to their healthcare, RRM must become mainstream. To start, we have to understand why it hasn’t been embraced in the first place.  

IVF has become the default solution for couples struggling with infertility, and despite the studies that show RRM’s effectiveness, medical schools and fertility practices have not caught up. Furthermore, financial incentives, the standard of care promulgated by leading OB/GYN organizations, and the overall culture of women’s health have made it hard for RRM to become the first line of treatment.

The problem with IVF as the default solution

In America today, over 13% of women ages 15-49 suffer from impaired fecundity, or difficulty conceiving and bearing a child. These rates have been climbing steadily since the 1990s, yet the “treatment” option has stayed readily singular: Artificial Reproductive Technologies (ART). 

Most people think of infertility as a challenge that must be bypassed with technology in order to be overcome. What they get wrong is that infertility is not a disease in itself, but rather a symptom displaying what could be a myriad of different underlying disorders. “Infertility” has been mistakenly accepted as a diagnosis, rather than a starting point to discover something deeper. 

“Infertility” has been mistakenly accepted as a diagnosis, rather than a starting point to discover something deeper.

With all ART comes some form of bypass—whether it be egg retrieval and fertilization, artificial insemination, donor sperm or eggs, or the use of a surrogate uterus—which overrides the broken reproductive system, attempting to force it to accept a baby that it wasn’t able to create or sustain naturally in the first place. 

Ovulation disorders, hormone deficiencies, endometriosis, Polyendocrine Metabolic Ovarian Syndrome (PMOS), hyper- or hypo-thyroidism, uterine abnormalities, and inflammatory diseases are just some of the underlying conditions that could be causing infertility in a woman—and there are a host of issues in the man that could be contributing, to the struggle to conceive, too. The problem is, IVF doesn’t actually treat any of these conditions. Rather than identifying why conception or healthy pregnancy isn’t happening, IVF creates an embryo outside of the womb and re-implants it in the hopes that it will take. This is precisely why the rates of success with IVF are so low: the embryo is being reimplanted into a system that was never healed. If IVF actually treated the underlying condition, success rates would arguably be much higher—especially in younger women without age-related factors to contend with.

This is why RRM is different. 

RRM operates from a completely different philosophy

RRM asks the question that matters: why can’t this couple conceive, and how can we treat and restore their health and fertility so they become capable of conceiving naturally? 

RRM asks the question that matters: why can’t this couple conceive, and how can we treat and restore their health and fertility so they become capable of conceiving naturally? 

Through the use of a Fertility Awareness Based-Method (FABM), an RRM physician will ask the female patient to chart her cycle-related biomarkers (like cervical mucus observations and basal body temperature) and other health symptoms in correlation with her cycle, as well as give instructions on intercourse timing to maximize the likelihood of conception. 

Through FABM charts and other diagnostic protocols like hormone panels or pelvic imaging, an RRM physician will target any specific issues that are discovered in an attempt to restore natural fertility. This may include recommending changes in diet and exercise, prescribing bioidentical hormones or various medications, and suggesting the reduction of inflammatory and endocrine-disrupting compounds in home and personal care products. In some cases, a doctor may conduct a diagnostic laparoscopy to definitively diagnose a disease like endometriosis. A patient may then be referred to a specialized surgeon for a laparoscopic excision of endometriosis adhesions and lesions, ovarian wedge resection for advanced PMOS, myomectomy for uterine fibroids, fallopian tube recanalization, or the repair of any other structural issues that may be contributing to infertility. 

So why isn’t RRM mainstream?

While this method of treatment would obviously be ideal for all patients struggling with infertility, unfortunately, it isn’t what most receive. This is because RRM still hasn’t been able to compete with the market of IVF when it comes to treatment of infertility. The following are just a few of the reasons why. 

Medical education and bias against FABMs

The vast majority of medical students are not taught even the basics of a woman’s menstrual cycle, much less what to do if a patient comes to them with abnormal cycles (beyond prescribing hormonal contraceptives, that is). This gap in training is compounded by the bias within medicine against “natural methods” of fertility tracking, in particular against FABMs, which are often written off as purely religious and unscientific (despite the fact that the use of certain FABMs alone has been shown to be effective at overcoming subfertility—even without medical intervention [1]). Unfortunately, because of the persistent bias against FABMs, very little research has been invested into proving the efficacy of restorative methods over technological intervention.  

Perverse financial incentives

The IVF market is gigantic—with costs sometimes reaching $30,000 for a single cycle—and as private equity firms acquire more IVF clinics across the globe, the market is growing, and growing fast [2]. IVF clinics are some of the most profitable medical clinics in the world, and because of the way our medical system in the United States is structured, the time an RRM doctor spends with a patient to restore natural fertility will never pay the same as an IVF referral. 

Further compounding the issue: insurance codes do not exist for a vast portion of RRM diagnostic and treatment protocols, meaning oftentimes RRM doctors have to move out of network in order to receive proper reimbursement for a patient’s care. Restorative care requires a more difficult level of problem-solving and individualized consultation than a referral to an IVF clinic—where the treatment protocol will remain more or less the same, regardless of why a couple is struggling to conceive. (This arguably makes it even more impressive when an RRM physician achieves success in patients with previously-failed IVF cycles) [3], [4]. 

Restorative care requires a more difficult level of problem-solving and individualized consultation than a referral to an IVF clinic—where the treatment protocol will remain more or less the same, regardless of why a couple is struggling to conceive. 

Poor standard of care

Physicians across the country practice medicine within established guidelines, most often those published by the medical society in their particular practice area. Treatments for infertility would fall under Obstetrics and Gynecology, and the American College of Obstetricians and Gynecologists (ACOG) publishes practice bulletins and committee opinions, which are formal clinical guidelines that define recommended methods of diagnosing and managing specific conditions. 

Currently, these guidelines differ substantially from an RRM workup, particularly in the diagnostics that would be considered before a referral to IVF. Under an RRM physician, a couple will not be named infertile without a corresponding diagnosis of the underlying condition that is causing the infertility, and this diagnosis will not be given until a full diagnostic and restorative protocol has been completed. 

Under the ACOG practice bulletin, however, only three diagnostic categories must be explored before a patient may receive a diagnosis of “unexplained infertility” and therefore merit a referral for IVF: ovarian reserve, ovulatory function, and structural abnormalities (tubal and uterine) [5]. The bulletin discourages diagnostic testing of laparoscopy, postcoital testing, immunologic testing, endometrial biopsy, and prolactin, all of which would be encompassed in an RRM infertility workup. Put simply: doctors who practice strictly within ACOG’s standard of care miss the opportunity to investigate and discover many treatable underlying conditions, and routinely refer patients for IVF without giving them the benefit of ever knowing what is actually causing their infertility. 

The broken culture of women’s healthcare

Finally, the culture of women’s healthcare is to blame. If you are a woman who has experienced doctors writing off your symptoms or offering you “solutions” that only suppress your symptoms rather than treat your condition—know that you aren’t alone. The experience is universal: women on both sides of the political aisle report feeling dismissed by doctors. 

Furthermore, the lack of body literacy education in our nation means we often can’t even tell when something is wrong with our cycles. Most girls aren’t taught the phases of their cycles, the signs of underlying dysfunction, or which medicine is healing, rather than just masking symptoms and kicking the can down the road until later in life (unless, of course, they learn these things through programs like Period Genius). 

In fact, 33% of teenage girls are on hormonal birth control for non-contraceptive reasons. The overuse of hormonal suppression rather than actual treatment is the reason we have so many women failing to discover that they have conditions affecting their fertility until they try unsuccessfully to have children years down the line. We have created a culture that teaches women to ignore and suppress their cycles—perhaps it’s no surprise that the medical system isn’t built to understand and treat them. 

The bottom line

Ultimately, the question is not whether RRM works. The growing body of evidence, along with experiences of thousands of women, increasingly shows that restorative approaches aimed at healing infertility are often successful on both fronts: achieving a healthy pregnancy and treating underlying conditions. And while RRM cannot solve every single infertility case, couples are often healthier for undergoing RRM care, even if they don’t ultimately conceive. Can IVF patients say the same?

The real question is why our medical system has been so slow to embrace RRM. And the answer lies in the money, bureaucracy, and broader cultural failures that teach women that suppression and technological bypass are better options than truly understanding our own bodies. 

Infertility is a deeply painful experience, and women desperate for a child while up against our broken medical system deserve our utmost compassion. But women also deserve honesty. They deserve to know that infertility is a symptom of underlying dysfunction, not simply a permanent condition to bypass—and that there is another way to approach infertility which understands this fundamental truth. 

Infertility is a deeply painful experience, and women desperate for a child while up against our broken medical system deserve our utmost compassion. But women also deserve honesty. They deserve to know that infertility is a symptom of underlying dysfunction, not simply a permanent condition to bypass—and that there is another way to approach infertility which understands this fundamental truth. 

Thousands of couples have experienced hope and healing through the work of RRM physicians, and the success stories are only growing. If we truly want women to have authentic reproductive healthcare, RRM cannot remain hidden at the margins. It must become mainstream in women’s healthcare, medical education, insurance coverage, and public conversation. Women shouldn’t have to stumble across RRM after years of pain, failed treatments, or repeated IVF cycles. They should be offered it from the beginning.

References

[1] Frank-Herrmann P, Jacobs C, Jenetzky E, Gnoth C, Pyper C, Baur S, Freundl G, Goeckenjan M, Strowitzki T. Natural conception rates in subfertile couples following fertility awareness training. Arch Gynecol Obstet. 2017 Apr;295(4):1015-1024. doi: 10.1007/s00404-017-4294-z. Epub 2017 Feb 9. PMID: 28185073.

[2] Katz P, Showstack J, Smith JF, Nachtigall RD, Millstein SG, Wing H, Eisenberg ML, Pasch LA, Croughan MS, Adler N. Costs of infertility treatment: results from an 18-month prospective cohort study. Fertil Steril. 2011 Mar 1;95(3):915-21. doi: 10.1016/j.fertnstert.2010.11.026. Epub 2010 Dec 4. PMID: 21130988; PMCID: PMC3043157.  

[3] Boyle PC, Stanford JB, Zecevic I. Successful pregnancy with restorative reproductive medicine after 16 years of infertility, three recurrent miscarriages, and eight unsuccessful embryo transfers with in vitro fertilization/intracytoplasmic sperm injection: a case report. J Med Case Rep. 2022 Jun 22;16(1):246. doi: 10.1186/s13256-022-03465-w. PMID: 35729591; PMCID: PMC9213097.

[4] Stanford JB, Parnell TA, Boyle PC. Outcomes from treatment of infertility with natural procreative technology in an Irish general practice. J Am Board Fam Med. 2008 Sep-Oct;21(5):375-84. doi: 10.3122/jabfm.2008.05.070239. Erratum in: J Am Board Fam Med. 2008 Nov-Dec;21(6):583. PMID: 18772291.

[5] Infertility Workup for the Women’s Health Specialist: ACOG Committee Opinion, Number 781. Obstet Gynecol. 2019 Jun;133(6):e377-e384. doi: 10.1097/AOG.0000000000003271. PMID: 31135764.