IIRRM Public Comment Resources

Proposed Federal Rule on Fertility Benefits

A proposed federal rule is open for public comment through Monday, July 13, 2026, that could have important implications for access to fertility care in the United States, including restorative reproductive medicine, fertility awareness-based methods, and treatment of the underlying causes of infertility.

This page provides resources to help you understand the proposed rule and prepare comments in your own words, using evidence relevant to your experience and perspective.

Informational Sessions Prepare a Comment Themes & Evidence Submit Comment

Comment deadline: Monday, July 13, 2026

What is the proposed rule?

The proposed rule — published May 13, 2026 by the Departments of Treasury, Labor, and HHS — would create a new category of “Excepted Fertility Benefits” allowing employers to offer fertility coverage separately from major medical insurance.

While much of the public discussion around fertility benefits has focused on IVF, the proposed rule also includes language relevant to diagnosis, mitigation, and treatment of infertility and infertility-related reproductive health conditions.

Key provisions include:

  • Explicit inclusion of root-cause and restorative treatments, fertility awareness-based methods, pre-conception care, and lifestyle-based interventions
  • Coverage for male factor infertility evaluation and treatment
  • Comprehensive diagnostic testing including hormone panels, imaging, and surgical evaluation
  • A $120,000 lifetime benefit per participant, indexed to medical inflation

Potentially covered diagnosis

  • Hormone panels
  • Imaging
  • LH testing
  • Semen analysis
  • Laparoscopy, hysteroscopy, and genetic evaluation

Potentially covered treatment

  • Ovulation induction and surgical treatment
  • Male factor infertility evaluation and treatment
  • Fertility awareness-based methods
  • IUI, IVF, and other ART

Mitigation of infertility

  • Fertility awareness-based methods
  • Pre-conception care and lifestyle evaluation
  • Elimination or reduction of environmental endocrine disruptors

View the full proposed rule: https://www.federalregister.gov/d/2026-09479

Free Informational Zoom Sessions

IIRRM is hosting free informational Zoom meetings to review the proposed rule and help people understand the public comment process. If you are unable to attend live, you can view the recording below. We will add frequently asked questions from the informational sessions and email inquiries to this page as they arise.

Wednesday, July 1

8:00 – 9:00 AM Eastern Time

Wednesday, July 1

9:30 – 10:30 PM Eastern Time

Zoom registration/link:
https://us06web.zoom.us/meeting/register/BseNRT0NTlKwqYBCiamMxw

Meeting ID: 822 6386 3597
Passcode: 185659

Download materials

Slides

Session Slides

Download the slide deck used from the webinar above.

Download slides

Evidence

RRM References

Download references with short summaries, organized by theme, to support evidence-based public comments.

Coming Soon!

Patient outreach

Patient Invitation Template

Download a modifiable letter you can share with patients about the public comment opportunity.

Download template letter

How to prepare your comment

Step 1

Tell your story

Explain who you are and why the proposed rule matters to you. Patients, clinicians, employers, organizations, family members, and advocates may each have a relevant perspective.

Step 2

Pick your theme

Choose one or two main themes so your comment is focused and easy to follow.

Step 3

Add evidence

Use experience, clinical examples, data, or research that supports the points most relevant to your comment.

Step 4

Submit

Submit your comment through the Federal Register before the July 13, 2026 deadline.

Important: Use your own words. The examples and evidence below are provided to help you organize your thoughts, not as a required script. Public comments are generally posted online, so do not include private medical information you do not want made public.

Step 1: Tell your story

Patients and families

Describe your experience seeking answers, diagnosis, treatment, or culturally appropriate fertility care. You do not need to share private details.

Clinicians and fertility educators

Describe the patients you serve, the diagnoses you commonly see, and why comprehensive evaluation and restorative treatment matter.

Employers and HR professionals

Describe why fertility benefits matter to employees and why benefit designs should allow diagnosis, treatment of underlying causes, and patient choice.

Organizations and advocates

Describe the needs of the community you represent and how the proposed fertility policy may affect access, needs and care.

Need help getting started? View example opening approaches

These examples are meant as starting points. Please adapt them to reflect your own experience, perspective, and words.

Patient: “I am a patient who experienced infertility and needed more than a referral to assisted reproduction. I needed a clinician to investigate the underlying causes of my reproductive health concerns.”

Patient: “After years of infertility treatment, I finally received a more complete evaluation and was diagnosed with conditions that had not previously been addressed. Patients deserve access to care that looks for underlying causes, not only treatment pathways that bypass them.”

Family member: “I watched someone I love experience recurrent miscarriage and struggle to find answers. Access to restorative reproductive medicine gave her a path to evaluation, treatment, and hope. I want other families to have access to this kind of care.”

Patient: “I am an indigenous woman of faith who believes that RRM offers a more natural approach that respects my beliefs and poses no ethical issues for me.”

Clinician: “I am a clinician who cares for patients with infertility and recurrent pregnancy loss. I have seen how important it is for patients to have access to diagnostic evaluation and treatment of underlying reproductive health conditions.”

Clinician: “I became interested in restorative reproductive medicine because many patients were asking, ‘What is wrong, and how can we treat it?’ RRM helps clinicians investigate underlying pathology while empowering patients with knowledge about their reproductive health.”

Employer or HR professional: “I am an employer interested in fertility benefits that support family formation while also encouraging good medicine, appropriate diagnosis, and cost-conscious care.”

Employer or HR professional: “I own a business and want to help my employees with infertility in an affordable way that addresses their concerns. Restorative reproductive medicine does that in a way that ART cannot.”

Fertility awareness educator: “I am a fertility awareness educator and have seen how cycle charting and fertility education can help patients and clinicians identify patterns that warrant medical evaluation.”

 

Step 2: Pick your theme and add evidence

Each theme below includes a short summary and evidence points you may draw from. Choose one or two main themes so your comment is focused and easy to follow. Citation numbers correspond to the reference list at the bottom of this page.

Public health

RRM is a longitudinal model, chronic-disease based approach that prioritizes healthy singleton pregnancy, full-term birth, and optimized maternal and neonatal outcomes, while also addressing underlying health conditions that may contribute to infertility. Long term this reduces the public health burden 1, 7, 14, 92, 93

  • Published RRM outcome studies — now numbering more than a dozen peer-reviewed cohorts across eight countries – report crude live birth rates of 26–41% and adjusted cumulative live birth rates of 52–73% over 12–24 months, depending on the population and analysis method.9, 14, 96, 97, 98
  • RRM birth outcomes are characterized by lower rates of multiple gestation, preterm delivery, and low birth weight compared with IVF datasets.14, 102, 103
  • Wheras, IVF-conceived pregnancies are associated in the cited literature with elevated risks of preterm birth, low birth weight, multiple gestation, and certain longer-term offspring concerns that are relevant to informed consent and patient counseling.95, 103, 104, 105
  • In the United States, TFR has generally been below replacement since 1971 and as of 2024 sits at about 1.6 creating multiple challenges in public health.  Prolonged decline risks an inverted dependency ratio, threatening the long-term stability of workforce productivity, public pensions, and healthcare systems. In an optimistic scenario a modelling study suggested RRM could increase the TFR increased to 2.02, a 14.5% relative increase, approaching replacement-level fertility.140, 141
  • RRM may be well suited to community-based and telehealth-supported models of care, allowing services to be expanded through distributed clinical networks and existing healthcare infrastructure, including in rural, remote, and underserved communities.120, 121, 122, 123, 124, 125
  • Geographic access to IVF and ART services remains limited in many regions because services are concentrated in specialized fertility centers, often in metropolitan areas.120, 123, 124
  • Male infertility is a public health issue, not only a reproductive issue. Poor semen quality has been linked to earlier morbidity, cardiometabolic comorbidities, and shorter lifespan. RRM evaluates infertility as a couple-based and whole-health concern, including appropriate male factor evaluation, diagnosis, and treatment.85, 86, 87
  • Environmental impact of RRM is minimal; Fertility clinics and In Vitro Fertilization (IVF) labs generate a significant carbon footprint and high volumes of waste, largely due to extreme energy demands, specialty gases, and sterile single-use plastics.50
Clinical and diagnostic approach

RRM Diagnoses and treats underlying pathology and root causes in a patient-centered holistic approach rather than procedural. 1, 7, 8, 13

  • RRM baseline evaluation is comprehensive from the first encounter, with both male and female partners evaluated across anatomic, hormonal, metabolic, immunologic, ovulatory, inflammatory, infectious, environmental, and lifestyle factors.7, 13, 14
  • Cycle charting is a highly accessible assessment tool in RRM, using woman-observed biomarkers such as cervical fluid, basal body temperature, and urinary hormone metabolite monitoring to guide evaluation and treatment timing. 3, 20, 21, 22, 25, 33
  • Cycle-timed hormonal evaluation is used to assess ovulatory quality, luteal phase adequacy, progesterone sufficiency, and dynamic hormonal patterns across the cycle rather than relying only on early follicular testing. This provides a more accurate and comprehensive picture of reproductive health than single-point testing3, 13, 20, 33
  • RRM emphasizes treatment of specific diagnoses such as PMOS/PCOS, endometriosis, anatomic factors, metabolic dysfunction, inflammatory and immune contributors, infectious factors, and male factor infertility. 36, 40, 45, 46, 48, 52, 55, 56, 57, 62, 64, 67, 70, 72, 81
Patient experience

RRM patients are active participants in their care. Patient-generated cycle observations help guide diagnosis, timing of investigations, monitoring of treatment response, and assessment of restored reproductive function.1, 3, 16, 20, 21, 22

  • RRM relies on natural intercourse timed to the fertile window, with the clinical team advising couples on timing and evaluating the reproductive health of both partners.7, 20, 22
  • The patient experience theme can address the need for answers, shared decision-making, and fertility care that treats patients as partners rather than only as gamete providers.
  • Informed consent is also relevant when patients compare RRM, ART, risks, costs, ethical concerns, and available alternatives.112
Cost and complications

RRM treatment costs vary by clinical complexity but typically range from $7,500–$15,000 USD for the evaluation and longitudinal treatment program, exclusive of medications. Approximately 30% of patients require surgical intervention — including laparoscopy for endometriosis excision or other corrective procedures — which may add $7,500–$25,000 depending on surgical complexity. IVF per-cycle costs frequently exceed $15,000–$20,000 before medications and add-ons. Many women requrie multiple cycles.102, 117, 118, 119

  • RRM cost drivers are described as largely team-based and longitudinal, while ART/IVF cost drivers include laboratory infrastructure, medications, procedures, and embryology laboratory services.117, 118, 119, 131
  • Downstream costs associated with preterm birth, multiple gestation, and neonatal complications are relevant when comparing benefit design options.95, 102, 103
  • Employers may wish to consider fertility benefits that support diagnosis, treatment of reversible causes, patient choice, and potentially lower-cost care pathways where clinically appropriate.116, 121, 122
Cultural appropriateness & ethical concerns

For some patients, RRM may offer a fertility care pathway that is more compatible with their cultural, religious, or ethical commitments, because conception occurs through natural intercourse and does not require laboratory fertilization, embryo creation outside the body, embryo cryopreservation or disposal, or third-party gametes.1, 111

  • This theme may be relevant for individuals and organizations concerned that standard ART practices may raise unresolved cultural, moral, religious, or ethical concerns for some patients.
  • For some patients, ART may involve ethical considerations related to informed consent, embryo donation, gametes and embryos, and access disparities. These issues may be important in patient counseling, shared decision-making, and benefit design.112, 113, 114, 115
  • A benefit structure that recognizes RRM may improve access for patients whose values make ART inaccessible or unacceptable, while still supporting medical treatment of infertility.
  • Objections to being involved in anyway with people who use an approach that creates and destroys or stores embryos severely limits access to infertility treatment for many patients. This barrier does not exist in RRM, and most cultures and faiths support treating infertility and restoring health.
Professional training and expertise

RRM training may be undertaken by physicians and advanced practice providers from multiple specialties, allowing broader workforce participation while maintaining specialty-specific clinical expertise. 132

  • Clinicians entering RRM training are already highly trained healthcare professionals. Physicians have completed a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree, followed by residency in specialties such as obstetrics and gynecology, family medicine, internal medicine, endocrinology, urology, reproductive endocrinology, or other related disciplines (17,000 -18,000 annually).
  • This contrasts this with the REI/IVF workforce pathway, which is based on OB/GYN residency, REI fellowship, and board certification. There are no other pathways for REI’s, limiting recruitment to this pool of doctors (1500 -1600 annually).133, 134, 135
  • This represents over a ten-fold increase in possible trainees for RRM vs REI, not including the use of APPs.
  • To provide patients with optimal care, it is necessary for them to be able to easily ascertain if someone has expertise and experience in the field. IIRRM maintains a professional credentialing record for RRM clinicians from all approaches.
Data collection and informed consent

STORRM, the Surveillance of Treatment Outcomes in Restorative Reproductive Medicine registry, is an international registry designed to collect standardized clinical and outcomes data for subfertility and recurrent pregnancy loss, with healthy live birth as the primary outcome.138

  • The STORRM registry supports clinical research, quality improvement, evidence generation, and benchmarking across RRM practices.138
  • ART outcomes in the United States are reported through national data systems such as CDC ART surveillance and SART reporting systems, but there are limitations in what those systems capture.99, 110, 139
  • Informed consent is an important theme where patients need understandable information about success rates, risks, alternatives, costs, cultural/ethical issues, and the difference between treating underlying pathology and bypassing it.112

For organizations preparing comments

Organizations preparing comments are encouraged to use evidence relevant to their mission, patient population, or professional perspective. IIRRM may be able to provide medical or evidence-based support for organizational comments.

For support, contact: [email protected] or [email protected]

Submit your public comment

Comments are due Monday, July 13, 2026.

Open Comment Portal

File code: 1210-AC40

References

1. Boyle P. Understanding Restorative Reproductive Medicine. J Restorative Reprod Med. 2025;1:1-2. doi:10.63264/f0b0xh81

2. Arraztoa JA. Commentary On Infertility and Restorative Reproductive Medicine. J Restorative Reprod Med. 2025;1:1-5. doi:10.63264/7eg52623

3. Vigil P, Lyon C, Flores B, Rioseco H, Serrano F. Ovulation, a sign of health. Linacre Q. 2017;84(4):343-355. doi:10.1080/00243639.2017.1394053

4. Fertility Clinic Success Rate and Certification Act of 1992. Public Law 102–493. 42 U.S.C. § 263a-1 et seq. U.S. Congress. 1992.

5. Centers for Disease Control and Prevention. National ART Surveillance System (NASS) [Internet]. cdc.gov. [cited 2026 May]. Available from: https://www.cdc.gov/art/nass/

6. Sunderam S, Kissin DM, Zhang Y, et al. Assisted Reproductive Technology Surveillance – United States, 2018. MMWR Surveill Summ. 2022;71(4):1-19. Published 2022 Feb 18. doi:10.15585/mmwr.ss7104a1

7. Duane M, Stanford JB, Porucznik CA, Vigil P. Fertility Awareness-Based Methods for Women’s Health and Family Planning. Front Med (Lausanne). 2022;9:858977. Published 2022 May 24. doi:10.3389/fmed.2022.858977

8. 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;21(5):375-384. doi:10.3122/jabfm.2008.05.070239

9. Sánchez-Méndez JI, Lombarte M, Abengózar-Muela R, et al. Natural procreative technology (NaProTechnology) for infertility: take-home baby rate and clinical outcomes in a 5-year single-center cohort of 1,310 couples. Front Reprod Health. 2025;7:1696679. Published 2025 Nov 14. doi:10.3389/frph.2025.1696679

10. Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021;116(5):1255–1265. https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-evaluation-of-infertile-women-a-committee-opinion-2021/

11. Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. J Urol. 2021;205(1):36–43. / Part II: J Urol. 2021;205(1):44–51.

12. WHO. Guideline for the prevention, diagnosis and treatment of infertility. Geneva: World Health Organization; 2025. https://www.who.int/publications/i/item/9789240115774

13. Stanford JB, Parnell T, Kantor K, et al. International Natural Procreative Technology Evaluation and Surveillance of Treatment for Subfertility (iNEST): enrollment and methods. Hum Reprod Open. 2022;2022(3):hoac033. Published 2022 Aug 9. doi:10.1093/hropen/hoac033

14. Boyle P, Toth A, Minjeur M, Turczynski C. Restorative reproductive medicine (RRM) outcomes compared to in-vitro fertilization (IVF) for the treatment of infertility:  a retrospective evaluation of a 2019 clinic cohort compared to one cycle of IVF. J Restorative Reprod Med. 2025;1:1-15. doi:10.63264/gejytw70

15. Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril. 2020;114(6):1151-1157. doi:10.1016/j.fertnstert.2020.09.134

16. Stanford JB, Carpentier PA, Meier BL, Rollo M, Tingey B. Restorative reproductive medicine for infertility in two family medicine clinics in New England, an observational study. BMC Pregnancy Childbirth. 2021;21(1):495. Published 2021 Jul 7. doi:10.1186/s12884-021-03946-8

17. Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020;113(2):305–322. doi:10.1016/j.fertnstert.2019.10.014.

18. Mackens S, Santos-Ribeiro S, van de Vijver A, et al. Frozen embryo transfer: a review on the optimal endometrial preparation and timing. Hum Reprod. 2017;32(11):2234-2242. doi:10.1093/humrep/dex285

19. Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2021;116(3):651-654. doi:10.1016/j.fertnstert.2021.06.050

20. Hilgers TW. The Medical and Surgical Practice of NaProTechnology. Pope Paul VI Institute Press; 2004.

21. Bouchard TP, Fehring RJ, Schneider MM. Achieving pregnancy using primary care interventions to identify the fertile window. Front Med (Lausanne). 2018;4:250. doi:10.3389/fmed.2017.00250.

22. Mu Q, Fehring RJ. Efficacy of achieving pregnancy with fertility-focused intercourse. MCN Am J Matern Child Nurs. 2014;39(1):35-40. doi:10.1097/NMC.0b013e3182a76b88

23. Ceric F, Silva D, Vigil P. Ultrastructure of the human periovulatory cervical mucus. J Electron Microsc (Tokyo). 2005;54(5):479-484. doi:10.1093/jmicro/dfh106

24. Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Reproductive Endocrinology and Infertility, Penzias A, Azziz R, et al. Optimizing natural fertility: a committee opinion. Fertil Steril. 2022;117(1):53-63. doi:10.1016/j.fertnstert.2021.10.007

25. Hilgers TW, Prebil AM. The ovulation method — vulvar observations as an index of fertility/infertility. Obstet Gynecol. 1979;53(1):12–22.

26. Practice Committee of the American Society for Reproductive Medicine. Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline. Fertil Steril. 2021;116(1):36-47. doi:10.1016/j.fertnstert.2021.02.024

27. Ethics Committee of the American Society for Reproductive Medicine. Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion. Fertil Steril. 2024;121(4):604-612. doi:10.1016/j.fertnstert.2023.12.030

28. Practice Committee of the American Society for Reproductive Medicine. Fertility preservation in patients with medical indications: a committee opinion. Fertil Steril. 2026;125(2):247-259. doi:10.1016/j.fertnstert.2025.12.001

29. Practice Committee of the American Society for Reproductive Medicine, Practice Committee of the Society for Assisted Reproductive Technology, and Practice Committee of the Society of Reproductive Biologists and Technologists. Minimum standards for practices offering assisted reproductive technologies: a committee opinion. Fertil Steril. 2021;115(3):578-582. doi:10.1016/j.fertnstert.2020.12.036

30. Practice Committees of the American Society for Reproductive Medicine (ASRM) and the Society for Reproductive Biologists and Technologists (SRBT). Comprehensive guidance for human embryology, andrology, and endocrinology laboratories: management and operations: a committee opinion. Fertil Steril. 2022;117(6):1183-1202. doi:10.1016/j.fertnstert.2022.02.016

31. Practice Committee of the American Society for Reproductive Medicine. Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril. 2021;115(5):1143-1150. doi:10.1016/j.fertnstert.2021.01.051

32. ESHRE Working Group on Recurrent Implantation Failure, Cimadomo D, de Los Santos MJ, et al. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open. 2023;2023(3):hoad023. Published 2023 Jun 15. doi:10.1093/hropen/hoad023

33. Vigil P, Blackwell LF, Cortés ME. The Importance of Fertility Awareness in the Assessment of a Woman’s Health a Review. Linacre Q. 2012;79(4):426-450. doi:10.1179/002436312804827109

34. Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem. 2018;62:2-10. doi:10.1016/j.clinbiochem.2018.03.012

35. Babayev E, Seli E. Oocyte mitochondrial function and reproduction. Curr Opin Obstet Gynecol. 2015;27(3):175-181. doi:10.1097/GCO.0000000000000164

36. Vigil P, Contreras P, Alvarado JL, Godoy A, Salgado AM, Cortés ME. Evidence of subpopulations with different levels of insulin resistance in women with polycystic ovary syndrome. Hum Reprod. 2007;22(11):2974-2980. doi:10.1093/humrep/dem302

37. Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertil Steril. 2021;116(5):1266-1285. doi:10.1016/j.fertnstert.2021.08.018

38. Sermondade N, Huberlant S, Bourhis-Lefebvre V, et al. Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis. Hum Reprod Update. 2019;25(4):439-451. doi:10.1093/humupd/dmz011

39. Teede HJ, Khomami MB, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026;407(10545):2329-2339. doi:10.1016/S0140-6736(26)00717-8

40. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of PCOS. J Clin Endocrinol Metab. 2023;108(10):2447–2469. doi:10.1210/clinem/dgad463

41. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008;23(3):462-477. doi:10.1093/humrep/dem426

42. Practice Committee of the American Society for Reproductive Medicine. Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril. 2024;121(2):230-245. doi:10.1016/j.fertnstert.2023.11.013

43. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of PCOS. J Clin Endocrinol Metab. 2023;108(10):2447–2469. doi:10.1210/clinem/dgad463

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45. Macer ML, Taylor HS. Endometriosis and Infertility: A Review of the Pathogenesis and Treatment of Endometriosis-Associated Infertility. Obstet Gynecol Clin North Am. 2012;39(4):535-549. doi:10.1016/j.ogc.2012.10.002

46. Van Gestel H, Bafort C, Meuleman C, Tomassetti C, Vanhie A. The prevalence of endometriosis in unexplained infertility: a systematic review. Reprod Biomed Online. 2024;49(3):103848. doi:10.1016/j.rbmo.2024.103848

47. Yeung P, Mohan A, Gavard JA. The long-term rate of repeat surgery after optimal excision surgery of endometriosis at a single tertiary referral center. Acta Scientific Women’s Health. 2025;7(1):3–12. Available from: https://actascientific.com/ASWH/pdf/ASWH-06-0643.pdf

48. Yeung P Jr. The laparoscopic management of endometriosis in patients with pelvic pain. Obstet Gynecol Clin North Am. 2014;41(3):371-383. doi:10.1016/j.ogc.2014.05.002

49. Yeung P Jr, Sinervo K, Winer W, Albee RB Jr. Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary?. Fertil Steril. 2011;95(6):1909-1912.e1. doi:10.1016/j.fertnstert.2011.02.037

50. Farlie F, Palmer GA, Cohen J, et al. Sustainability in the IVF laboratory: recommendations of an expert panel. Reprod Biomed Online. 2024;48(1):103600. doi:10.1016/j.rbmo.2023.103600

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52. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. Published 2022 Feb 26. doi:10.1093/hropen/hoac009

53. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):591-598. doi:10.1016/j.fertnstert.2012.05.031

54. Vercellini P, Buggio L, Berlanda N, Barbara G, Somigliana E, Bosari S. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril. 2016;106(7):1552-1571.e2. doi:10.1016/j.fertnstert.2016.10.022

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56. Tańska K, Gietka-Czernel M, Glinicki P, Kozakowski J. Thyroid autoimmunity and its negative impact on female fertility and maternal pregnancy outcomes. Front Endocrinol (Lausanne). 2023;13:1049665. Published 2023 Jan 11. doi:10.3389/fendo.2022.1049665

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58. Empson M, Lassere M, Craig J, Scott J. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev. 2005;2005(2):CD002859. Published 2005 Apr 18. doi:10.1002/14651858.CD002859.pub2

59. Garmendia JV, De Sanctis CV, Hajdúch M, De Sanctis JB. Exploring the Immunological Aspects and Treatments of Recurrent Pregnancy Loss and Recurrent Implantation Failure. Int J Mol Sci. 2025;26(3):1295. Published 2025 Feb 3. doi:10.3390/ijms26031295

60. Practice Committee of the American Society for Reproductive Medicine. Recurrent pregnancy loss: a committee opinion. Fertil Steril. 2026 Jun;125(6):1023-1041. doi: 10.1016/j.fertnstert.2026.03.001. 

61. Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012;98(5):1103-1111. doi:10.1016/j.fertnstert.2012.06.048

62. Aitken RJ, Smith TB, Jobling MS, Baker MA, De Iuliis GN. Oxidative stress and male reproductive health. Asian J Androl. 2014;16(1):31-38. doi:10.4103/1008-682X.122203

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