Today, Tuesday, September 16, two physician groups with contrasting philosophies are giving congressional briefings on medical treatment for infertility.
There is a debate in medical circles on the best type of infertility therapy. The birth rate in the U.S. is 1.62 per woman and declining. This is substantially below 2.1, which is needed for population replacement. In addition, almost 20% of couples have experienced problems conceiving.
President Trump on February 18, 2025 issued an executive order, “Expending Access to Vitro Fertilization (IVF),” calling for public policy recommendations to increase IVF to raise the birth rate. This was met by an outcry from certain physicians, who believed there are much better solutions for increasing fertility.
The first physician group to testify today will be by the American Society for Reproductive Medicine (ASRM), the very well funded professional organization of IVF physicians. This will be followed by a presentation from advocates of Restorative Reproductive Medicine (RRM), who hold to a newer and more holistic philosophy of women’s health care, with testimony from physicians and patients on infertility therapies.
The Restorative Reproductive Medicine philosophy is based on body literacy and a woman’s comfort and appreciation of her own cycles and fertility. Charting cycles with a variety of methods — including FertilityCare, FEMM, and Billings — not only enhance a woman’s understanding of her fertile times, but also helps diagnose problems with hormonal insufficiency or infection. “Ovulation, a Sign of Health,” a paper by Dr. Pilar Vigil, is an excellent expression of this philosophy. Naprotechnology — Natural Procreative Technology — is a successful program of evaluation and treatment of infertility developed over the past 40 years by Dr. Thomas Hilgers.
There are RRM education and advocacy groups — FACTS, FEMM, IIRRM, and IRRMA and clinics — such as Neofertility, REPLY, and the Gianna Center, that have excellent outcomes with infertility therapy. A complete restorative workup of both the woman and man — including sex hormones, thyroid, lifestyle, and nutrition, thorough testing of glucose and insulin, along with diagnosis of infections and immune status and possibly surgery — uncovers root causes of reproductive problems and is compatible with strategies promoting lifelong health. The goal is a healthy single pregnancy through normal sexual relations.
Many couples are told that IVF is the only solution to their infertility problems, especially “unexplained infertility.” This can be true for a limited number of conditions such as some cases of blocked fallopian tubes, or absent or very low sperm counts after proper testing. However, when a systematic and detailed evaluation is done, the category of “unexplained infertility” was shown in one study to be reduced from 23% to 2%. RRM evaluation usually finds multiple factors, such as low estrogen and progesterone, insulin resistance, thyroid, endometriosis, nutritional deficiencies, and infection, to be causes of infertility. Once identified, each and every problem can then be treated.
One woman will be sharing her experiences in today’s congressional hearing:
IVF physicians said I had unexplained infertility, possible polycystic ovarian syndrome, and that my fibroids might be a factor. After having surgery, they told me that if a couple cycles of ovulation induction medication did not work, then I would only be able to conceive via in vitro fertilization.
But after she was evaluated by RRM physicians,
one by one, we treated each of these issues, and for the first time in my life, I felt physically better. I did have a couple miscarriages in the earlier phases of my treatment but was able to conceive my son once all my issues had been addressed. I later had my daughter without any problems.
In the USA, in gynecology training programs, a woman’s understanding of her own cycles and normal ovulation are not prioritized, and training in cycle charting, endocrinology, and nutrition usually is poor or absent. The philosophy is that women need powerful synthetic hormones, intrauterine devices, or sterilization to suppress their fertility for almost all of their 30-year reproductive life span, from age 15 to 45. A short break is then perhaps taken from these measures to conceive one to two children. The goal of treatment for gynecologic problems is suppression of symptoms such as irregular or heavy periods with oral contraceptives or hormonal IUDs, with the additional purpose of pregnancy prevention and population control.
Usually, if miscarriages occur, the standard of care is “expectant management” to wait until three losses have occurred before seeking the underlying cause. If infertility or miscarriages later ensue, referral to a reproductive endocrinologist usually results in rapid resort to technology, rather than thoroughly evaluating and healing the couple. There can be an inherent conflict of interest: Accurate diagnosis for infertility can be complex, takes more time, and is often poorly compensated to the provider. But IVF is instead handsomely reimbursed — often by patients who mortgage their houses or go into debt, unless they are fortunate to have superior insurance coverage.
With the advent of in vitro fertilization in 1978, conventional infertility treatment took a detour away from thorough diagnosis and therapy of the couple. IVF was initially a therapy for animal husbandry before it was applied to humans. Initially, it treated married couples in which the woman had blocked fallopian tubes. It has now expanded into a method treating most male and female infertility (even past menopause) and facilitating pregnancy for single women and, via surrogacy and egg donation, for men and homosexual couples. Now, of the 3,600,000 babies born in 2023, 2% were conceived through IVF.
Frequently with IVF, rather than facilitating a normal single pregnancy, powerful medications are used for ovarian hyperstimulation to generate multiple follicles and eggs for harvesting and fertilization in a lab. Spare embryos that are not transferred back into the woman for a current pregnancy are then frozen for future use, discarded, or used for research. Problems arise when it is found later that excess embryos (now more mature fetuses) have survived in the woman’ s uterus. The couple is then presented with a recommendation to “reduce” the pregnancy to just one or two fetuses, aborting one or more of the “extras.” This is one of the several objections to the IVF process — the tremendous loss of early human life — through freezing, discarding, or “fetal reduction.”
Other objections to IVF include cost: approximate median cost per cycle from $19,234 to $24,373, and sometimes up to $61,000 for a successful birth. Costs can be much higher if donor eggs and gestational carriers (surrogates) are used — up to $200,000. Added to the costs of cycle treatment are the costs of multiple births and the associated prematurity. The average hospital and doctor expenditure for a single birth is approximately $21,458. For twins and triplets, the average costs rise, respectively, to $104, 831 and $407,199. The vast majority of higher-order births from triplets and beyond is almost exclusively due to IVF instead of natural conception.
Another concern is the commodification of human life — the sale of sperm, human eggs, and embryos — that some have called trafficking. This is inaccurately called sperm and egg “donation.” Add to that commercial surrogacy, amounting to womb-renting, which exploits young, fertile women and poses major health risks.
In other countries, IVF and associated practices are much more regulated. Transfer of the number of embryos is limited by some national health services, markedly reducing the incidence and costs of multiple births, which are borne by all of society. Commercial surrogacy is banned in most countries but allowed in many states in the USA. Sale of human eggs and sperm is prohibited in many countries, or their use restricted to married heterosexual couples with infertility. However, in the U.S., ASRM officially favors using all of these controversial and expensive technologies for any person who desires them and aggressively lobbies the government and insurance companies for compensation.
The ASRM group criticizes Restorative Reproductive Medicine on several points. It says IVF doctors do the RRM workup and treatment anyway, but this is not true and has not been the experience of most patients. They say that RRM is religiously based. It is true that many Catholics are pioneers in RRM — for faithful Catholics, conception should occur only through sexual relations of a married couple — but physicians of other faiths are prominent in research and treatment. Patients of many religions appreciate getting an accurate diagnosis of their infertility problem and avoiding the destruction of life that can be a feature of unregulated IVF. Additionally, ASRM complains that RRM does not include technology for homosexuals to be biological parents. It also objects when RRM evaluation and treatment can take longer than the typical IVF time frame.
The way forward in public policy would be to encourage, fund, and expand RRM research and training. Patient choice and the amount of public funding needed are key considerations in determining infertility therapies. There should be more debate about regulating commercial surrogacy, egg and sperm “donation,” and prevention of multiple births. Restorative Reproductive Medicine is the approach to infertility most compatible with MAHA and can be expected to yield greater improvements in general health.
Mary L. Davenport is a physician treating infertility.
Image: Nogwater via Flickr, CC BY-SA 2.0 (cropped).