For years, the fertility industry has attacked restorative reproductive medicine with two contradictory arguments.  The first is that RRM is not real medicine. The American Society for Reproductive Medicine (ASRM) dismisses it as an unrecognized subspecialty, and editorials in the industry’s own journals characterize it as unscientific and ideologically driven.  The second is that the infertility treatment is unnecessary because fertility clinics already provide the thorough diagnostic workups and root-cause treatment that RRM promises. When the federal government proposed an “excepted fertility benefit” earlier this year to address the “diagnosis, mitigation, or treatment of infertility or infertility-related reproductive health conditions,” ASRM objected that the rule’s emphasis on treating underlying conditions covers “a gap that does not exist” because standard care already includes thorough workups and root-cause treatment. Notice that these claims cannot both be true. If the fertility industry is to be believed, RRM is either quackery or exactly the care the industry already delivers. Yet a study released in July suggests the truth is neither. The care that supposedly makes RRM redundant is, for many patients, not happening at all. The study, conducted by researchers at the International Institute for Restorative Reproductive Medicine and now under peer review, analyzed roughly five million insurance claims and identified commercially insured patients who were diagnosed with infertility and went on to receive IVF between 2021 and 2024. For each condition the study covered, the researchers asked a straightforward question: Before these patients began IVF, did they receive the evaluations and first-line treatments that ASRM’s own published guidelines recommend?  The study did not measure clinics against RRM’s more extensive protocols. It measured them against the fertility industry’s own standards, written by the professional societies to which these physicians belong. The result? The industry failed its own test.  Across nearly every condition studied, care gaps ranged from roughly 13 to 78 percentage points, depending on the workup. Within one month of an infertility diagnosis, up to 12% of patients had already started IVF before the basic diagnostic picture was complete. Only 1% of men had completed the two semen analyses that guidelines recommend as the starting point of any male evaluation. By nine months, 70% to 85% of patients had begun IVF, while many of the evaluations and treatments the industry itself recommends sat below 40% completion, and several remained in the single digits. The condition-by-condition numbers are worse. Take endometriosis, a chronic disease affecting more than 11% of American women between 15 and 44 and making up 30% to 50% of infertility diagnoses. Among younger women with the condition, only 9.3% received the recommended first-line intervention by nine months, while more than 80% had already started IVF.  Hyperprolactinemia, a hormonal disorder usually correctable with an inexpensive daily pill, showed a gap of nearly 60 percentage points: 25.7% of women received the recommended dopamine agonist, while 85.5% had begun IVF. Likewise, care for PMOS, the most common cause of ovulatory infertility, ran the same way: Guidelines say letrozole should be the first-line drug for inducing ovulation, and it costs a few dollars a cycle, but only 34.1% of these women had been prescribed it by nine months, while 78.4% had begun IVF. Men fared no better. Male-factor problems contribute to roughly half of infertility cases, yet the male half of the workup was the more neglected one. Among men diagnosed after recurrent pregnancy loss, just 3.2% received the recommended sperm DNA testing and 24.5% a karyotype, while 81% had already begun IVF. Notably, a semen analysis is not only a fertility test: male infertility signals undiagnosed conditions that carry consequences long after the question of conception is settled, which means a skipped workup leaves a question about a man’s health not just unanswered but unasked. Why does this matter? Because infertility is not a standalone disease. It is a symptom of underlying conditions, such as endometriosis, PMOS, and thyroid disorders in women and low sperm count, low motility, abnormal sperm, and varicoceles in men, with diagnoses split roughly evenly between the sexes. RRM diagnoses and treats those conditions in the hope that couples restore their health and go on to conceive naturally.  When a clinic moves a couple into IVF without completing the recommended evaluation, it is not simply choosing one fertility treatment over another. It is bypassing the diagnosis of a disease that will continue to affect that patient’s health, whether or not the IVF cycle produces a child. This is precisely the distinction restorative reproductive medicine exists to address: RRM identifies and treats the underlying condition so that couples can conceive naturally, while IVF bypasses the body to create human embryos in a laboratory setting. IVF may result in the live birth of a child, but it cannot heal anyone, and, in fact, results in much higher rates of adverse outcomes for the mother and baby.  While I don’t think that individual doctors, who are themselves captive to the health insurance model, are motivated by financial gain, it is hard to ignore the economics of fertility clinics. Over a third of U.S. fertility clinics are now owned by or affiliated with private equity firms, up from just 4% in 2013, and these clinics perform more than half of all IVF cycles in the country. Private equity does not invest in slow medicine. These firms buy businesses with high patient turnaround and recurring revenue, and they impose a standardized operating model designed to maximize both. The economics of fertility care help explain how this pattern became standard practice. Diagnosing and treating the underlying causes of infertility in both patients takes time, and a full restorative evaluation and course of treatment typically runs $7,500 to $15,000. A single IVF cycle costs $15,000 to $30,000, succeeds 25% to 35% of the time, and generates additional cycles when it fails or when a couple returns hoping for another child. A treatment model that resolves a patient’s condition does not produce that kind of recurring revenue. The public seems to have noticed as well. Earlier this year, when the Health and Human Services, Labor, and Treasury departments proposed the excepted fertility benefit, a new insurance option designed to cover the diagnosis and treatment of infertility-related conditions, the agencies invited the public to weigh in. The response was extraordinary by the standards of federal rulemaking. Most proposed rules pass through their comment periods in near silence; about 80% draw 10 or fewer comments.  By the time this one closed on July 13, the docket held 4,652 comments. And the message was consistent. By two preliminary counts, at least 62% of commenters called for greater access to root-cause care, from fertility awareness-based methods to treatment of underlying reproductive health conditions, and many asked that restorative reproductive medicine be named and promoted in the final rule. ASRM, faced with thousands of Americans asking for exactly the care it insists patients already receive, responded by asking the government to withdraw the rule entirely. The comment docket is no outlier. A March survey by Carrot, a fertility benefits company, found that 89% of women would prefer to try a less invasive option before IVF if it came with clinical guidance, and 78% said better information alone would make them more likely to pursue non-IVF options. Interest in metabolic health support topped every option surveyed, yet fewer than half of the women had ever had a single clinical conversation about metabolic health in their entire fertility journey. The demand for this medicine is real, and it is growing along with the problem it addresses: More than 16% of married women now experience infertility, and most intend to have another child. RRM’s record with these patients deserves attention, too. Women with one to nine failed IVF cycles still have nearly a one in three chance of conceiving through restorative care. The fertility industry can keep calling RRM fake medicine, or it can keep insisting it already provides the same care. It cannot do both — and after the review of five million insurance claims, it cannot credibly do either. The billing records show an IVF-first approach that routinely bypasses the industry’s own guidelines. American families have said clearly that they want something better, and federal policy and public awareness campaigns should ensure they can find it. *** Emma Waters is a policy analyst at the Heritage Foundation and the author of the book “Lead Like Jael: Seven Timeless Principles for Today’s Women of Faith” and host of the new podcast “Rethinking Fertility.”  This article is part of Upstream, The Daily Wire’s new home for culture and lifestyle. Real human insight and human stories — from our featured writers to you.