Restorative Reproductive Medicine: An Ethical Approach to Fertility

By: Dr. Joseph Meaney, The Moral Mind, originally published May 13, 2025, The National Catholic Bioethics Center

Of very deep concern to my wife and I, along with the nearly one in seven couples who struggle with infertility, is the woeful lack of knowledge about restorative reproductive medicine (RRM) among medical professionals and others who almost always promote in vitro fertilization (IVF) instead. The good news is that something practical and positive is being done about it. This Spring, the state of Arkansas became the first to pass into law the “Reproductive Empowerment and Support Through Optimal Restoration RESTORE Act.” It orders insurance companies in the state to cover RRM procedures and defines this kind of care. “Restorative reproductive medicine means a scientific approach to reproductive medicine that seeks to cooperate with or restore the normal physiology and anatomy of the human reproductive system without the use of methods that are inherently suppressive, circumventive, or destructive to natural human functions.”

This legislative definition of restorative reproductive medicine shows exactly why it is an ethical way to care for fertility. It aims to treat the root causes of dysfunctions that make it difficult or impossible for couples to conceive and bring to birth children. Infamously, most artificial reproductive technology practitioners simply ignore the couple’s health problems and bypass conception via conjugal union to produce an embryo in a lab, sometimes using donor gametes. Whether IVF succeeds in bringing a baby in arms to the couple or not, the underlying health problems that led to infertility go completely unaddressed. In the case of IVF with gestational surrogacy, the woman no longer even bears the child who may or may not be genetically related to her. RRM, on the other hand, respects normal human reproductive physiology and seeks to achieve a natural pregnancy.

We have Natalie Dodson from the Ethics and Public Policy Center (EPPC) and Emma Waters from the Heritage Foundation to thank for the model bill language that became the first RESTORE Act passed in the US. A federal version of it has been introduced as a bill, and there is interest in several states to pass similar legislation. It is very much needed as insurance companies frequently do not cover or refuse to reimburse adequately the ethical procedures that married men and women need to improve their fertility. It is imperative that fertility awareness-based methods, infertility diagnostic procedures, and educational resources be made more widely known and accessible. All these ethically sound interventions are covered by the umbrella term of restorative reproductive medicine. Unethical practices like IVF and other forms of embryo manipulation, egg harvesting and cryopreservation, artificial insemination, etc., are excluded from the official definition of RRM.

My wife Marie and I wrote a short chapter about our experience and challenges in overcoming infertility for the EPPC and Heritage Foundation’s book, Treating Infertility: The New Frontier of Reproductive Medicine. Our focus was on the fact that we had to repeatedly go out of state for medical procedures and do our own research to find providers, as well as pay out of pocket for many expenses. Given the fact that the stress of infertility can sap the energy and hope of many, it is terrible to make people overcome so many obstacles in order to access the care they need and deserve. RRM practitioners are few and far between if you do not live in Nebraska or a few other blessed areas like Austin, which has the remarkable Vitae Clinic.

Ethically speaking, Catholic health care systems should be major players in restorative reproductive medicine, but they are not. After all, the Ethical and Religious Directives for Catholic Health Care Services (ERDs), in directives 38 and 39, encourages ethical medical care that assists the marital act to attain its procreative purpose. This approach respects the unitive and procreative meanings of sexual intercourse and does not artificially create or kill human embryos. Many RRM practitioners are Catholic, but ironically the lower cost of helping couples conceive naturally makes it less financially attractive than IVF. Also, RRM is more time intensive as the husband and wife need to be evaluated and their reproductive health dysfunctions treated as opposed to the IVF route which simply manipulates their bodies to obtain sperm and eggs, or failing that, goes outside the couple for gametes. The ERDs in directive 52 also encourages Catholic health institutions to provide instruction in fertility awareness based methods that are a key part of helping couples conceive. IVF is one more case of the culture of death, attracting investment and profits by offering a quick fix to infertility that kills or leaves in frozen storage up to 90% of the embryos conceived. Restorative reproductive medicine, on the other hand, is less profitable for practitioners and takes time and effort. It also, by the way, helps many women with painful symptoms of endometriosis or other reproductive conditions with treatments that give them relief and restore fertility. Promoting RRM should be a priority of the Church, pro-family legislators, and all those concerned about the ethical nightmare of IVF. Initiatives like the RESTORE Act are a great start and will offer the infertile seeking ethical treatments deeply needed support.

Joseph Meaney, PhD, KM, is the Past President and Senior Fellow of the National Catholic Bioethics Center.