IIRRM Response to Statements by ACOG and ASRM

July 18, 2025 9:00 AM Eastern Daylight Time

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SAN FRANCISCO—July 18, 2025. The International Institute for Restorative Reproductive Medicine (IIRRM) is a global medical society representing clinicians and researchers from more than 50 countries who are committed to advancing restorative reproductive medicine (RRM). We promote evidence‑based practice in RRM, which seeks to diagnose and treat underlying health conditions contributing to reproductive dysfunction and suboptimal reproductive health, and to address critical factors to improve wellness and fertility.

The IIRRM appreciates increased attention to the problem of infertility in the United States. We are encouraged by the progress and promise of RRM and believe it can play an important role in addressing the growing problem of infertility. We are dedicated to helping patients suffering reproductive health challenges, and we welcome collaboration with medical professionals seeking to improve reproductive care.

Recent statements by two U.S. medical societies—the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM)—unfortunately have included erroneous claims about RRM. It is important to rectify the public record; to help do so, the IIRRM has prepared this statement including two attachments: “Misrepresentations from ACOG’s ‘Issue Brief’ and IIRRM Responses” and “Misrepresentations from ASRM’s ‘Fact Sheet on Misleading Terminology’ and ‘Just the Facts Advocacy Resource’ and IIRRM Responses,” with relevant citations. Both attachments can be downloaded here.

Since the founding of the IIRRM in 2000, restorative reproductive medicine has continued to grow as a distinct and pioneering field of research and practice, helping tens of thousands of patients to optimize their reproductive health.

“Studies from five different countries all show significant success rates using RRM to treat infertility, even in many patients who have tried other infertility treatments prior,” reports Dr. Tracey Parnell, IIRRM Global Director of Communications and Development. “On average 50% of couples who complete their RRM treatment will have a healthy live birth. Depending on important prognostic factors, the live birth rate may be even higher.”

RRM has a record of care that, compared to IVF, is less invasive, less expensive, and has improved maternal and neonatal health outcomes, including an average U.S. preterm birth rate of 8% compared to 14.1% for IVF. Restorative reproductive medicine research and training are supported at academic institutions throughout the world, including in the United States. Patients who receive RRM care routinely describe it as different, empowering, and life-changing:

“They have found things that the traditional fertility doctors overlooked…it’s so worth it to heal your bodies [female and male] and prepare for a healthy pregnancy.”

“They slowed down the process, digging deeper to find out what was really wrong, then they treated the issues–monitoring every step–to ensure our success. We are now blessed with our beautiful daughter and hopeful to continue adding to our family!”

“Working with a practitioner in restorative reproductive medicine was one of the single best things we’ve ever done for our health…changed my life forever.”

We are disappointed that the voices of many patients, and the work of dedicated medical professionals around the world to meet their needs, have been ignored in the ASRM and ACOG statements. We are hopeful for improved collegiality to better serve patients and would like to note precedents for fruitful collaboration:

  • The ASRM’s committee opinion on “Optimizing Natural Fertility” includes multiple citations of work by RRM researchers
  • A landmark systematic review of fertility awareness-based methods for pregnancy prevention, which was produced by a team comprised of RRM and non-RRM scientists, was published in Obstetrics & Gynecology and informed revision of the CDC’s public guidance on FABM effectiveness

“There is a fertility crisis in America, and it should be ‘all hands-on-deck,’” said Dr. Monica Minjeur, U.S. Director of Communications and Development for IIRRM. “We know infertility is not a diagnosis in and of itself but rather points to chronic underlying conditions, typically with multiple factors involved that can be female, male, or both. We urge reproductive health professionals to expand research and intensify efforts to improve outcomes and options for patients.”

About the IIRRM

The International Institute for Restorative Reproductive Medicine was founded in London, UK, in 2000. The mission of the IIRRM is to unite medical professionals and researchers to promote and improve clinical practice, research, and education in RRM. We have provided thousands of hours of educational Grand Rounds, case reviews, journal clubs, and other professional development activities as continuing medical education recognized by standard medical accrediting bodies. We maintain a clinician recognition program, an international clinical practice registry (Surveillance of Treatment and Outcomes in Restorative Reproductive Medicine), and a new academic journal (Journal of Restorative Reproductive Medicine). The IIRRM has held an annual international professional conference since 2004; the 21st International Clinical and Scientific Congress is scheduled for September 2025 in Zagreb, Croatia.

Contact:
Dr. Tracey A. Parnell
Global Director
Development & Communications
International Institute for Restorative Reproductive Medicine
[email protected]
T: +44 1293 378476 | T: +1 510-462-2770 (North America)

Media Contact:
Danielle West
Strategic Communication Director
Wixted & Company
515.297.6263
[email protected]

Misrepresentations from ACOG’s “Issue Brief” and IIRRM Responses

“Recently, a nonmedical approach called ‘restorative reproductive medicine’ (RRM) has entered the fertility discussions.”
“It is important to understand that RRM is not a medical term.”
“RRM is “an unproven concept.”

  • Medical terminology is continually changing as new treatment approaches are introduced and new specializations emerge. Restorative reproductive medicine (RRM) is a medical term that has been in use for 25 years to refer to a specific medical approach to reproductive health. RRM integrates long‑established medical knowledge with ongoing discovery to identify and treat underlying causes of reproductive dysfunction.
  • The conceptual framework of RRM is indisputably sound and has shown great promise for treating infertility in peer‑reviewed medical literature.1‑3 In studies to date, RRM cumulative rates of healthy live birth appear to be comparable to IVF.1‑6
  • RRM is practiced by licensed and certified medical professionals in more than 50 countries. The International Institute for Restorative Reproductive Medicine (IIRRM) is an established medical society that provides RRM professional development—including continuing medical education recognized by standard medical accrediting bodies—and maintains an international clinical practice registry and an academic journal.

“When provided as the primary or only option, RRM can expose patients to needless, painful surgical interventions; limit their access to the full range of evidence‑based fertility care interventions; and delay time to pregnancy, while potentially increasing overall costs.”
“Focusing on endometriosis excision as the chief barrier to pregnancy unnecessarily exposes some patients to the potential risk of complications associated with the procedure and may not be necessary to address in order to achieve a pregnancy.”

  • RRM does not focus on endometriosis as the chief barrier to pregnancy; it comprehensively evaluates and treats for underlying factors, recognizing that infertility typically is multi‑factor and can include female factors, male factors, or both. Of the many underlying factors routinely identified by RRM clinicians, endometriosis is a relatively commonly diagnosed factor; on average RRM clinicians diagnose about six factors per couple.2
  • RRM has both medical and surgical components, as well as a component of partnership with patients in understanding their fertility and impact of their lifestyle choices.7,8
  • It has been established that at least 10% of women in the U.S. suffer from endometriosis and the average time to diagnosis of endometriosis takes about 7 years; the entire medical community should be deeply concerned by these statistics.9,10
  • We have no reason to believe there are “needless” RRM surgical interventions, for endometriosis or anything else, and ACOG provides no basis for this claim. Removing disease to restore natural anatomy is hardly “needless” and improves the quality of life and fertility potential for patients with endometriosis.11 ACOG’s statement that endometriosis excision “may not be necessary to address in order to achieve a pregnancy” speaks to a fundamental difference between conventional and RRM care: the focus for conventional care often is limited to the immediate objective of “achieving a pregnancy,” while the focus for RRM is the broader objective of optimizing health for the well‑being of patients and their future offspring.
  • Many RRM surgeons record their surgeries and are prepared to offer their casework for independent review and would welcome comparative studies on this topic.
  • It is claimed that RRM patients may take longer to conceive than those undergoing IVF, but this raises two questions: (i) whether most IVF patients actually receive comprehensive evaluation and treatment prior to undergoing IVF, and (ii) whether this time interval is included in the IVF time‑to‑pregnancy calculation? We believe this would make for interesting comparative health services research: what are the timeframes, diagnoses, treatments, and outcomes for patients receiving RRM versus IVF, when all stages of care are included?
  • The cost of RRM total care is substantially less than IVF, and often only a fraction of the cost of IVF. We welcome and encourage further investigation into cost‑effectiveness of RRM versus IVF.
  • Available data indicate that RRM presents fewer risks to patient health than IVF, including a significantly lower preterm birth rate.3,12‑14 We welcome and encourage further investigation into the comparative maternal and neonatal health risks of RRM versus IVF.

“RRM is built on two major concepts: the incorrect suggestion that endometriosis is the dominant cause of infertility, and the idea that other causes of infertility can be addressed by fertility awareness and lifestyle changes.”
“Concentrating on fertility awareness and lifestyle changes can add unnecessarily to the timeline; be ineffective and redundant, as most patients have already tried these methods before seeking infertility treatment; and make patients less likely to have a baby by delaying the identification and treatment process until patients are much deeper into—or even past—their fertility window.”
“Although endometriosis excision, fertility awareness, and lifestyle changes may have value for some patients and should be a part of conversations people have with their doctors, they must not be the sole approaches available to people undergoing fertility treatment.”

  • Claims about endometriosis are addressed in point #2 above; the experience and data in the RRM field are that endometriosis is not “the dominant cause of infertility,” but rather is a common factor out of dozens of important diagnoses that patients are evaluated for.2
  • Likewise, poor body literacy and poor lifestyle factors are not the sole other possible causes of infertility but are additional factors among dozens that can cause or contribute to infertility. It is a gross distortion to claim that an RRM clinician would limit their assessment of a couple with infertility merely to consideration of endometriosis, cycle literacy, and lifestyle factors. However, to dismiss or gloss over the importance of either fertility awareness or lifestyle factors would constitute fundamentally inadequate care.
  • Specifically concerning fertility awareness cycle tracking: this is a significant differentiating aspect of RRM care that is largely overlooked by others.15 Cycle tracking is used as a tool to:
    • aid in evaluation as certain cycle patterns suggest conditions such as hormonal imbalances, PCOS, endometriosis, and luteal phase defects
    • time certain female factor blood work such as measurement of post‑peak progesterone to assess the quality of ovulation
    • time other evaluations such as ultrasound imaging for follicular studies to determine not simply whether a woman is ovulating, but the quality of her ovulation
    • time certain RRM treatments, such as luteal phase support or ovulation induction
    • empower couples trying to conceive with the knowledge to time intercourse during their fertile window16
    • assess progress during certain treatments for female factor conditions
  • We endorse fertility awareness cycle tracking as a valuable and fundamental reproductive health tool—hailed by many as a “fifth vital sign”—and we welcome and encourage further investigation on this critical factor.17
  • In our experience it often is the case that a couple facing infertility has limited understanding of the importance of lifestyle factors and the support to improve them. Lifestyle factors that can affect infertility include, but are not limited to, sleep, nutrition, exercise, stress management, environmental exposures, and cultivation of a sense of purpose separate from the call to parenthood.

“The RRM movement is, at its roots, tied to the so‑called personhood effort, which previously led to a temporary pause on IVF altogether in the state of Alabama.”
“The RRM movement has been used to discourage patients from accessing evidence‑based IVF in order to avoid the creation of fertilized eggs as part of the IVF process.”

  • The IIRRM is a medical society with zero political or legal activities or lobbying, including in support for, or against, the personhood movement.
  • The Alabama case, with which we had zero involvement, revolved around a lawsuit pursued by a couple who undertook IVF and lost their frozen embryos following an intrusion at the embryo storage facility. This had nothing to do with RRM.

“By focusing only on female patients, RRM approaches suggest that all infertility is caused by complications with the female reproductive system.”

  • It is categorically untrue that RRM focuses only on female patients. RRM at its core recognizes that natural conception results from intercourse, which requires healthy female and male reproductive function.
  • Restorative andrology is a core component of RRM; among many other professional development opportunities and trainings on male factor topics, the IIRRM is offering a two‑day pre‑conference, “Restorative Andrology,” as part of its September 2025 International and Scientific Congress.

“RRM narrowly defines family by excluding LGBTQ+ people; people who intend to solo‑parent; and people who may only be able to have a baby through fertility treatments, including IVF.”

  • RRM as a field is committed to helping any patient optimize their reproductive or post‑reproductive health, irrespective of their sex or sexual identity and irrespective of their family‑building aspirations.
  • RRM fertility educators and health coaches likewise work with any/all patients.
  • With regard to fertility, RRM is based on optimization of health for natural conception; therefore, it is not a method that can attain pregnancy for those seeking to become pregnant outside of heterosexual intercourse, or for women who have no uterus or fallopian tubes or have entered non‑reversible menopause, or for men with untreatable azoospermia, or for patients with non‑reversible sterilization. However, patients from these populations still may, and regularly do, benefit from RRM care for their overall reproductive health.

“Proponents of RRM advocate for policies that encourage a nonmedical and nonpatient‑centered approach, discourage medical interventions, and establish barriers to evidence‑based fertility care, thereby jeopardizing people’s ability to start and grow their families.”

  • We believe the contrary on all counts and are unaware of “proponents of RRM” who are advocating for any of these propositions.

Misrepresentations from ASRM’s “Fact Sheet on Misleading Terminology” and “Just the Facts Advocacy Resource” and IIRRM Responses

“It is crucial to be vigilant against misleading terminology, such as ‘Restorative Reproductive Medicine’ (RRM)…”
RRM is a “buzzword” and a “Rebranding of Standard Medical Practice”
“RRM is not a distinct specialty or a new concept. It repackages what fertility doctors already do for every patient.”
“Its proponents create a false narrative that standard fertility care skips proper diagnosis or healing, when in fact, it is based on precisely those principles.”
RRM “is simply fertility medicine minus key tools like IVF…”
RRM “may not address all fertility challenges, such as male factor infertility or blocked fallopian tubes.”

  • There is nothing “misleading” about the term “restorative reproductive medicine”; it describes precisely what RRM medical professionals transparently have provided for decades.18
  • We recognize RRM as a natural progression of the classic medical approach of evaluation, diagnosis, and treatment; unfortunately, this approach has become neglected with the advent of artificial/assisted medical practices such as IVF that bypass normal physiology. We submit that RRM, with its distinctive focus, comprehensive scope, and innovative customization, is a different and valuable option for patients. To dismiss RRM as a “buzzword” is simply wrong.
  • RRM seeks to address all underlying health conditions that cause or contribute to reproductive dysfunction and routinely includes assessments for male factor issues (see ACOG response point #5 above) and blocked fallopian tubes.
  • ASRM appears to contend the following:
    1. that their members who provide IVF first provide comprehensive non‑IVF fertility care (or determine prior care to have been comprehensive) for suitable patients as a prerequisite to IVF;
    2. that their members who provide IVF introduce IVF only when comprehensive non‑IVF care is ineffective;
    3. that RRM is redundant with, or possibly inferior to, the non‑IVF fertility care routinely provided by IVF doctors.
    We disagree with points a, b, and c, based on our clinical experience and what we hear from our patients. We recognize relevant health services research data are limited on this topic and support submitting these claims to robust empirical investigation.

“What distinguishes RRM is not medical practice but ideology.”

  • RRM amply is documented as “medical practice” in our cover statement, “The Progress and Promise of Restorative Reproductive Medicine,” and the attachments herein responding to ACOG and ASRM.
  • “Ideology” is a word with political connotations and therefore does not describe RRM. Whatever some politicians might decide to promote (or attack), RRM is not political and has no lobbyists; it is medical practice focused on cooperative and restorative care.

RRM “typically excludes IVF and related treatments on moral or religious grounds, not clinical evidence.”
“‘RRM’ is not an alternative to IVF.”

  • RRM prioritizes sound medical approaches to optimize patients’ natural bodily function and health; optimizing health and natural function in the least invasive manner possible is the clear preferred approach supported by clinical evidence.19‑21
  • Many medical professionals are drawn to RRM because of their personal ethical commitments. This does not make RRM a religious activity; it means it is a better professional fit for those individuals.
  • Patients seek RRM for many different motivations, including because they prefer to:
    • understand and address their underlying health
    • pursue natural reproductive function and intercourse as the means to family building, for any number of reasons including cultural appropriateness
    • avoid challenging ethical and legal questions associated with IVF
    RRM is an essential healthcare service that should be available to patients regardless of their underlying reasons for choosing it.
  • For some patients RRM is, in fact, an alternative—a welcome alternative—to IVF. For others, it is supplementary or complementary: some patients pursue RRM following failed IVF;3 others pursue IVF following RRM if they are unable to conceive naturally.

As ASRM notes, “Medical advancements often face initial skepticism and apprehension.” We suggest this currently is the case with RRM medical advancements and we support research directly comparing different approaches to fertility care in order that all interested parties gain better understanding of options for reproductive care.

References

  1. 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.
  2. 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.
  3. Boyle PC, de Groot T, Andralojc KM, Parnell TA. Healthy Singleton Pregnancies From Restorative Reproductive Medicine (RRM) After Failed IVF. Front Med (Lausanne) 2018;5:210.
  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;21(5):375‑84.
  5. Tham E, Schliep K, Stanford J. Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice. Can Fam Physician 2012;58(5):e267‑e274.
  6. McLernon DJ, Maheshwari A, Lee AJ, Bhattacharya S. Cumulative live birth rates after one or more complete cycles of IVF: a population‑based study of linked cycle data from 178 898 women. Hum Reprod 2016.
  7. Arraztoa JA. Commentary on infertility and restorative reproductive medicine. J Restorative Reprod Med 2025.
  8. Yeung Jr. P. Surgery in restorative reproductive medicine. J Restorative Reprod Med 2025.
  9. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020;382(13):1244‑1256.
  10. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011;96(2):366‑373.e8.
  11. Yeung P, Jr. The laparoscopic management of endometriosis in patients with pelvic pain. Obstet Gyecol Clin North Am 2014;41(3):371‑83.
  12. Berntsen S, Soderstrom‑Anttila V, Wennerholm UB, et al. The health of children conceived by ART: ‘the chicken or the egg?’. Hum Reprod Update 2019;25(2):137‑158.
  13. Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta‑analysis. Obstet Gyecol 2004;103(3):551‑63.
  14. Qin J, Liu X, Sheng X, Wang H, Gao S. Assisted reproductive technology and the risk of pregnancy‑related complications and adverse pregnancy outcomes in singleton pregnancies: a meta‑analysis of cohort studies. Fertil Steril 2016;105(1):73‑85 e1‑6.
  15. Duane M, Stanford JB, Porucznik CA, Vigil P. Fertility Awareness‑Based Methods for Women’s Health and Family Planning. Frontiers in Medicine 2022;9.
  16. Practice Committee of the American Society for Reproductive Medicine, Penzias A, Azziz R, et al. Optimizing natural fertility: a committee opinion. Fertil Steril 2022;117(1):53‑63.
  17. Vollmar AKR, Mahalingaiah S, Jukic AM. The Menstrual Cycle as a Vital Sign: a comprehensive review. F S Rev 2025;6(1).
  18. Bulletti FM, Giacomucci E, Guido M, Palagiano A, Coccia ME, Bulletti C. Revitalizing reproductive health: innovations and future frontiers in restorative medicine. Ther Adv Reprod Health 2025.
  19. Pinborg A, Wennerholm UB, Bergh C. Long‑term outcomes for children conceived by assisted reproductive technology. Fertil Steril 2023;120(3 Pt 1):449‑456.
  20. Zhang S, Luo Q, Meng R, Yan J, Wu Y, Huang H. Long‑term health risk of offspring born from assisted reproductive technologies. J Assist Reprod Genet 2024;41(3):527‑550.
  21. Sanders JN, Simonsen SE, Porucznik CA, Hammoud AO, Smith KR, Stanford JB. Fertility treatments and the risk of preterm birth among women with subfertility: a linked‑data retrospective cohort study. Reprod Health 2022;19(1):83.