Sarah’s story is similar to so many of our patients’: She had struggled with painful periods for years but was only offered birth control pills and increasing doses of pain meds — until she wanted to get pregnant. Then, she was given a couple of rounds of clomid to help her body ovulate, but her ob-gyn told her that in vitro fertilization (IVF) was likely her only option and referred her to a specialist who confirmed Sarah would never get pregnant naturally. She endured multiple rounds of failed embryo transfers. By age 40, feeling frustrated and hopeless, she went to a doctor trained in restorative reproductive medicine (RRM).
Recently, the American College of Obstetricians and Gynecologists (ACOG) characterized RRM as “nonmedical and non-patient-centered,” and the American Society for Reproductive Medicine (ASRM) called it “a rebranding of standard medical practice.” Both of these statements are inaccurate. As physician leaders who teach about RRM, incorporate this approach in clinical practice, and perform restorative surgeries, we firmly oppose this characterization.
RRM is the discipline that focuses on identifying and treating the root causes of reproductive dysfunction to restore the natural functions of the reproductive system and optimize the patients’ health. Although restorative reproductive care is both medical and patient-centered, it is not yet standard practice, particularly for the treatment of infertility.
In their recent statements, ACOG and ASRM appear to undermine this emerging field and discourage funding for education and research — just as everyday Americans and policymakers have recognized the acute need for better reproductive care. As it stands, about 9.7 million American couples are unable to have a child due to infertility or recurrent miscarriages.
The current standard practice of reproductive medicine does not provide enough answers or solutions. Although the recommended solution is primarily IVF, less than 100,000 babies are born via IVF each year, leaving 99 percent without a child or answers. Up to 48 percent of women undergoing IVF receive a diagnosis of “unexplained infertility.” While IVF can make it possible in some cases to bypass underlying conditions that cause infertility, RRM almost always identifies and treats the underlying cause(s).
Identifying Root Causes
Fortunately for Sarah, she was able to find an RRM-trained family physician, who first diagnosed her with insulin resistance and treated her with a combination of medications and dietary changes. She then referred Sarah to an RRM surgeon for definitive evaluation and treatment of her painful periods.
In a study of 1,072 couples visiting an RRM clinic for infertility, 58.8 percent had previously been diagnosed with “unexplained infertility” or “unexplained recurrent miscarriage.” After their RRM evaluation, over 99 percent had at least one diagnosis explaining their impaired fecundity or difficulty having a baby.
For example, endometriosis — a painful, often debilitating condition — is a leading cause of infertility that affects 3-6 million women in the United States. Yet, it takes 7-10 years on average for women to receive a diagnosis. Millions of women have polycystic ovary syndrome, amenorrhea, insulin resistance, and other causes and contributors to infertility without access to an accurate diagnosis or effective treatments. In addition to insulin resistance, Sarah is one of the millions of women who also suffers from endometriosis. Fortunately, her RRM surgeon completely excised all the lesions and Sarah conceived naturally within a couple of months.
Another woman who struggled with disabling pain from her menses, often missing school, work, or family functions, was also offered birth control pills and pain meds for more than a decade. When she finally found an RRM physician to address her underlying problems leading to her infertility, she had profound emotions following her surgery for endometriosis — joy at finally conceiving a few months after the surgery, but intense anger that her pain was literally gone and she had missed so much of life because of the band-aid approach she had received.
Observation Is Not Standard Practice
RRM-trained clinicians utilize real-time data from fertility awareness-based method charts, in which women record their daily observations of physical signs and/or biomarkers that reflect day-to-day internal changes in their hormone levels. RRM physicians may notice clues in the cycle chart that signal potential underlying disorders. Added to the patient’s history and examination, a patient’s chart guides the timing of laboratory and imaging studies to find answers and personalize treatment. The chart also guides the timing of interventions for hormone support, ovulation support or stimulation, and corrective surgery if needed. Furthermore, the chart of the female cycle is a valuable tool to monitor response to treatments; it also reflects the impact of lifestyle changes and, when needed, guides the couple on the optimal timing for fertility-focused intercourse.
RRM recognizes infertility is not a disease but a symptom of underlying disorders. When it comes to infertility, the RRM approach is not merely an alternative but has a different purpose and foundation from standard practice. The main goal of RRM is to identify and treat the root cause(s) of a patient’s symptoms to improve health and restore fertility by addressing the factors preventing pregnancy and live birth. Although the female cycle chart serves as a daily diary of a woman’s hormonal health, enables personalized care, and helps women understand their bodies, they are not used in standard medical practice, and this information is not routinely taught in medical schools.
When it comes to RRM’s approach to men’s reproductive health, including male factors of infertility, the principle is the same: diagnose and treat root causes. Depending on the needs of each patient, treatments may include medications, surgical procedures, and lifestyle modifications to optimize semen parameters and sexual function as well as metabolic, hormonal, and sleep health.
RRM Is Less Expensive than IVF
Regarding the cost of infertility treatment, a systematic review published in 2025 in Therapeutic Advances in Reproductive Health found that RRM is significantly less expensive than one IVF cycle, with the average cost for RRM being $2,000-$5,000 and the average cost of one IVF cycle reported at $10,000-$15,000. Moreover, RRM has higher live birth rates at 40-60 percent, compared to 30-40 percent per IVF cycle. Unlike IVF, RRM can be used to address reproductive health conditions long before a patient tries to conceive. Ideally, these conditions would be diagnosed early, not only to preserve or restore fertility, but also for the overall well-being of the individual.
Restoring Overall Health Too
Since restorative reproductive medicine is about restoring patients’ overall health, it also helps people who are not seeking pregnancy. Many young women who experience extreme period pain or irregular cycles seek answers and find support with RRM physicians. Hormonal health is related to reproductive health, which is related to overall health — an approach to treating patients that is unmistakably medical and patient-centered.
Ultimately, RRM educates both patients and clinicians to identify and treat underlying causes of reproductive and hormonal health issues by utilizing the chart of the female cycle as a fifth vital sign. The goal of RRM is not to limit patient choices but to expand them.
The need is great. The time to pursue this modern, evidence-based, patient-centered approach is now. Restorative reproductive medicine can help make America healthy, and fertile, again.
Marguerite Duane, MD, is the executive director of Facts about Fertility and associate professor of restorative reproductive medicine at Duquesne University College of Osteopathic Medicine. Lynn Keenan, MD, is president of the Institute of Restorative Reproductive Medicine of America. Naomi Whittaker, MD, is the founder of the Restorative Reproductive Medicine Academy. Patrick Yeung, MD, is founder of the Restore Center for Endometriosis. Gavin Puthoff, MD, is the founder and director of Veritas Fertility and Surgery.
