On February 18, 2025, President Donald Trump signed an executive order looking to expand access to in vitro fertilization (IVF). In the order, the president first acknowledges the infertility crisis faced by many couples in the United States and then offers the following statement as the guiding ethos behind the executive order: “My Administration recognizes the importance of family formation, and as a Nation, our public policy must make it easier for loving and longing mothers and fathers to have children.”

A noble goal, to be sure, even if our nation weren’t currently facing an impending demographic winter (already a reality in Europe and Asia). But what the president may not realize is that IVF is not the only avenue for helping couples overcome infertility and achieve the families of their dreams—and it might not even be the most effective. While IVF can, indeed, help couples overcome infertility, it does not actually treat infertility. Only restorative reproductive medicine (RRM) can do that.

While there are many moral and ethical considerations to IVF, especially concerning the destruction and/or storage of embryos—to say nothing of the significant ethical quandaries posed by the use of donated gametes¹ and surrogacy²—for the scope of this article, I will compare IVF and RRM based on their medical and scientific merits in assisting couples to grow their families.

We Must Stop Calling IVF Infertility “Treatment”

In the same way that hormonal contraception does not treat³ the underlying causes of menstrual cycle issues (but rather shuts down the menstrual cycle entirely), IVF does not so much treat infertility, as circumvent it.

For many couples, infertility is often not a disease in itself, but a symptom of an underlying pathology. For example, women with endometriosis often struggle to get and stay pregnant, due to the lesions, inflammation, and hormonal imbalances that are hallmarks of this very prevalent disease. Some women do not even discover that they have endometriosis until they struggle to become pregnant, despite the common symptoms of heavy, painful periods they have likely been struggling with for most of their lives.

While women diagnosed with endometriosis are often encouraged to use IVF to conceive (and although IVF may sometimes successfully lead to conception), the procedure does nothing to correct the underlying disease itself. With IVF, conception happens in a lab, in an attempt to bypass the adverse health conditions in the woman’s body that make conception difficult to achieve. In contrast, RRM seeks to correct the adverse health conditions causing the infertility—such as endometriosis—via surgical interventions, hormone balancing, and other aspects of a holistic approach,⁴ so that both the woman’s general health and her fertility are improved. In other words, RRM treats the woman’s health conditions while concurrently allowing conception to occur “the old fashioned way.”

As someone who has experienced infertility and has overcome it with the help of RRM, I have dedicated my career to expanding public education about fertility health. That is why I believe an administration professing a desire to “Make America Healthy Again” (MAHA) should turn to RRM as the obvious answer to the question: “How do we help more people have babies?” As Patrick T. Brown pointed out in his March Commonplace article,⁵ “Trump’s IVF Order Betrays MAHA”:

MAHA may mean many things. But it has the most potential if it is understood as a truly radical movement, in the sense of returning to the root of our woes. Rather than opting for quick-fix band-aids or treating different parts of the body in isolation, an integrated, ground-up approach to well-being could be a welcome trend.

But “treating different parts of the body in isolation” is precisely what IVF does, since it looks primarily to ovaries for the eggs they can provide and to testes for their sperm, rather than to the whole persons from which these gametes come.

More than Ends and Means

To some, this might sound like mere semantics. What does it matter how one achieves a pregnancy, some might think, so long as it happens? And to a desperate couple in the throes of infertility, it can seem like it does not matter, as long as we get a baby. Again, as someone who has been there before,⁶ I can understand this feeling well.

And it must be acknowledged that for some individuals with biological structural abnormalities (for example, a rare complication of being a male carrier of the cystic fibrosis gene is that one is born without the part of the male reproductive system called vas deferens—the result being that one “shoots blanks,” as the saying goes), or for those who have had surgeries where reproductive parts have been damaged or removed (whether for therapeutic or sterilization purposes), RRM currently is unable to help. For such individuals, if the goal is to achieve a biological child, IVF may be the only means currently available.

Aside from these rarer, more difficult cases, RRM is the better choice. That is because RRM does not simply offer the possibility of a live baby, even for couples for whom IVF has previously failed,⁷ but it also often improves the health of the couples overall.

Although our culture has ingrained in us that our fertility is a nuisance to be suppressed with pills, injections, and devices (until we decide we would like our fertility to be turned on to produce a wanted baby), the fact is: Fertility is a sign of a healthy woman’s body that is functioning as it ought. Its absence, in an adolescent or adult woman, is therefore a sign of larger problems. We owe it to the men and women struggling with infertility to take seriously these warning signs of other issues that are impacting their overall health and well-being. It should concern us that IVF ignores these issues, leaving couples more strained—financially, emotionally,⁸ and physically—than they were at the start.

IVF Is Not Without Risks to Mothers and Babies

As President Trump’s executive order points out, IVF is extraordinarily expensive. Yet, as expensive as it is, IVF promises neither successful birth nor a risk-free experience for moms or babies. While birth rates resulting from IVF have improved over the years, they can still vary greatly with a woman’s age and across clinics, with at most a 50 percent chance per cycle of live birth if a woman is under 35 years old. For many women under 35, that can mean a minimum of two to three cycles before one achieves a live birth. Success rates drop considerably after age 35, and since the average American woman seeking IVF is 36.3 years old, according to the CDC’s 2024 National ART Summary,⁹ the national average percentage of live births per IVF cycle hovers around 37.5 percent.

Further, the unique risks inherent in the IVF process often go undiscussed in the media as well as between doctors and patients. While sperm retrieval is relatively straightforward (assuming a man has all his reproductive parts intact), egg retrieval is significantly riskier and more invasive. According to the Center for Bioethics and Culture’s 2022 Comprehensive Report on the Risks of Assisted Reproductive Technology:

[Egg retrieval] risks include, but are not limited to: Ovarian Hyper Stimulation syndrome (OHSS) due to superovulation, loss of fertility, ovarian torsion, stroke, kidney disease, premature menopause, ovarian cysts, and in some rare cases, death. OHSS is a life-threatening condition that can also cause stroke, ovarian torsion, organ failure, and psychological distress.

IVF pregnancies also present significantly more risk to mothers than spontaneous conception, for reasons that are not yet well-understood. As the fertility-health site Natural Womanhood¹⁰ states:

Perhaps due to the IVF procedures themselves, or to the unaddressed underlying causes of infertility, or to a combination of the two, IVF increases risk of pregnancy complications ranging from preeclampsia to ectopic pregnancy and multiple gestations to gestational diabetes. A large Swedish study found another risk in women who conceived via IVF: increased incidence of hypertension (high blood pressure).

What’s more, children conceived via IVF have long been known to experience increased risk of low birthweight and preterm birth (and the complications associated with those conditions), as well as increased risk of birth defects and childhood cancer,¹¹ compared to those conceived without IVF. And according to a 2023 report¹² on the long-term risks of IVF-conceived children: “Studies on cardiometabolic health in children born after ART are conflicting, and there may be an increased risk of high blood pressure, and early markers of later onset compromised cardiometabolic health may be present.”

RRM Also Carries Risk, but the Nature of the Risks Varies Significantly from IVF

I would be remiss to suggest RRM is entirely without risks. Certainly, RRM surgical interventions like endometrial excision¹³ and ovarian wedge resections¹⁴ do carry their own respective risks. However, unlike IVF procedures, RRM procedures are primarily therapeutic: Along with other interventions, these procedures have the potential to heal or to considerably lessen symptoms of underlying diseases like endometriosis and PCOS, while improving fertility in the process. Meanwhile, the successful birth rates for RRM are at least comparable to, and possibly better than, those of IVF. According to a 2022 study published in Human Reproduction Open:¹⁵

Several retrospective single-clinic studies from Canada, Ireland, and the USA, with subfertile couples receiving restorative reproductive medicine, mostly natural procreative technology, have reported adjusted cumulative live birth rates ranging from 29% to 66%, for treatment for up to 2 years, with a mean women’s age of about 35 years.

Children born to couples treated with RRM also have very good neonatal outcomes, with apparently little to no increased risk¹⁶ for preterm birth or low birthweight, despite (in one study) having mothers with “significant negative predictive characteristics for healthy live birth including: advanced reproductive age (average 37.2 years), an average of 5.8 years of infertility with 2.1 (range 1–9) previous IVF attempts, with only 5% having previously had a live birth from IVF.”

RRM studies like the above are small but promising, and couples report high satisfaction with the RRM process (especially those who’ve had prior experience with IVF).¹⁷ And, on the whole, most RRM interventions are likely to be significantly less expensive¹⁸ than IVF and other assisted reproductive technology procedures. What’s more, some couples have even overcome subfertility without RRM interventions, simply by learning how to chart their cycles¹⁹ and time intercourse according to the most fertile period. More research is needed to further explore the potential of the burgeoning field of restorative reproductive medicine, which gives due attention to the menstrual cycle as the fifth vital sign of women’s health, helping improve the health of couples and babies in the process.

To Make America Fertile Again, Look to RRM

This need for greater RRM research brings us back to President Trump’s executive order. Rather than throwing government money at the highly unregulated, multi-billion-dollar IVF industry, the administration would do better to take a RRM approach to infertility, not just to meet the goal of manufacturing more babies, but to address the underlying health issues behind infertility. Restorative reproductive medicine has the potential to do that, but more investment is needed. For example, more education and training of additional healthcare professionals²⁰ is vital, as is the creation of ICD diagnostic codes and CPT codes so RRM professionals can receive appropriate reimbursement for procedures like endometriosis excision surgery. Such reimbursement would both incentivize more professionals to be trained in and offer this kind of medicine, and lower costs of care for patients. Embracing the RESTORE Act²¹ would be an excellent step in this direction.

Proposing tax breaks for new parents on the campaign trail last August, President Trump said,²² “We want more babies, to put it very nicely.” His recent executive order expanding IVF access was delivered in the same spirit. More babies is a grand idea—for many reasons²³—but where IVF seeks to create more babies in labs, RRM aims to help more couples experience baby-making the most healthy and natural way possible. I’m willing to bet that, given the opportunity, the latter is how most couples would prefer to build their families.

NOTES

1. Them Before Us, “My Daddy’s Name Is Donor—Study,” (Feb. 7, 2023). https://thembeforeus. com/my-daddys-name-is-donor-study/

2. Grace Emily Stark, “Renting Wombs, Rending Hearts: The Dark Realities of Surrogacy” Verily (Jan. 26, 2021). https://verilymag.com/2021/01/surrogacy-altruistic-commercial-exploitationwomen-children-2021

3. Grace Emily Stark, “Birth Control’s Failed Promises,” Human Life Review (Spring 2022). https://humanlifereview.com/birth-controls-failed-promises

4. Melissa Buchan, “How to Get an Endometriosis Diagnosis and Find Truly Restorative Treatment,” Natural Womanhood (June 27, 2020). https://naturalwomanhood.org/endometriosisdiagnosis-and -treatment-not-birth-control-2020/

5. Patrick T. Brown, “Trump’s IVF Order Betrays MAHA,” Commonplace (March 4, 2025). https://commonplace.org/2025/03/04/trumps-ivf-order-betrays-maha/

6. Grace Emily Stark, “Remembering the Loss in Pregnancy Loss,” Verily (Oct 1, 2020). https:// verilymag.com/2020/10/grieving-miscarriage-abortion-pregnancy-loss-20

7. Phil C. Boyle, Theun de Groot, Karolina M. Andralocj, “Healthy Singleton Pregnancies From Restorative Reproductive Medicine (RRM) After Failed IVF,” Frontiers in Medicine (Volume 5, 2018). https://doi.org/10.3389/fmed.2018.00210

8. The Center for Bioethics and Culture Network (CBC), “Venus Rising with Stacy: What I Learned About the Predatory IVF Industry” (Apr. 11, 2023). https://cbc-network.org/2023/04/venusrising-with-stacy-what-i-learned-about-the-predatory-ivf-industry/

9. CDC Assisted Reproductive Technology (ART), National ART Summary (Dec. 10, 2024). https://www.cdc.gov/art/php/national-summary/index.html

10. Melayna Alicea, “Assisted reproductive technology (ART), heart disease, and stroke: What’s the connection?:What 2 research studies tell us,” National Womanhood (Oct. 31, 2024). https:// nationalwomanhood.org/art-heart-disease-stroke/

11. Barbara Luke, Morton B. Brown, Hazel B. Nichols, et al., “Assessment of Birth Defects and Cancer Risk in Children Conceived via In Vitro Fertilization in the US” (Oct. 29, 2020). https:// jamanetwork.com/journals/jamanetworkopen/fullarticle/2772342

12. Anja Pinborg, Ulla-Britt Wennerholm, Christina Bergh, “Long-term outcomes for children conceived by assisted reproductive technology,” Fertility and Sterility (Vol. 120, Issue 3, Part 1, Sept. 2023), pp. 449-456. https://doi.org/10.1016/j.fertnstert.2023.04.022

13. Taryn DeLong, “Considering endometriosis surgery? Here’s how to find a good endo surgeon,” Natural Womanhood (Sept. 17, 2021). https://naturalwomanhood.org/considering-endometriosissurgery-heres-how-to-find-a-good-endo-surgeon/

14. Grace Emily Stark, “Understanding the Surgical Techniques Used to Address PCOS,” Natural Womanhood (Nov. 7, 2019). https://naturalwomanhood.org/understanding-the-surgical-techniquesused-to-address-pcos/

15. Joseph B. Stanford, Tracey Parnell, Kristi Kantor, Matthew R. Reeder, Shahpar Najmabadi, Karen Johnson, Iris Musso, Hanna Hartman, Elizabeth Tham, Ira Winter, et al., “International Natural Procreative Technology Evaluation and Surveillance of Treatment for Subfertility (iNEST): enrollment and methods,” Human Reproduction Open (Vol. 2022, Issue 3). https://doi.org/10.1093/ hropen/hoac033

16. Phil C. Boyle, Theun de Groot, Karolina M. Andralocj, Tracey A. Parnell, “Healthy Singleton Pregnancies From Restorative Reproductive Medicine (RRM) After Failed IVF,” Pub Med Central, National Library of Medicine (July 31, 2018). doi: 10.3389/fmed.2018.00210

17. Leonora Butau, “When IVF fails, what’s next?,” Natural Womanhood (July 8, 2022). https://naturalwomanhood.org/ivf-fails-to-treat-underlying-reasons-for-infertility/

18. Grace Emily Stark, “An Infertility Treatment That May Work Without Breaking the Bank: HINT: It’s not IVF,” Verily (March 28, 2019). https://verilymag.com/2019/03/ttc-infertilitytreatment-that-is-cheaper-than-ivf-napro-technology-2019

19. P. Frank-Herrmann, C. Jacobs, E. Jenetzky, C. Gnoth, C. Pyper, S. Baur, G. Freundl, M. Goekenjan, T. Strowitzki, “Natural conception rates in subfertile couples following fertility awareness training,” Pub Med, National Library of Medicine, Arch. Gynecol. Obstet. (Feb. 9, 2017). doi: 10.1007/s00404-017-4294-z

20. Facts About Fertility. https://factsaboutfertility.org

21. Natalie Dodson, Emma Waters, “To Address Infertility, It’s Time to Give Real Reproductive Health Options,” Ethics and Public Policy Center (June 13, 2024). https://eppc.org/publication/toaddress-infertility-its-time-to-give-real-reproductive-options/

22. Joey D’Urso, “How Trump’s presidency could change where babies are born: It’s not just Elon Musk who is doing his bit to boost the birth rate,” The Times (March 3, 2025). https://thetimes.com/ us/american-politics/article/trump-birthrate-where-children-born-maps-charts/5mk2m0x2j

23. Grace Emily Stark, “Babies Make Families,” The American Conservative (Apr. 16, 2018).https://www.theamericanconservative.com/babies-make-families/

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Original Bio:

Grace Emily Stark, M.A., is the Editor of Natural Womanhood. She holds a M.A. in Bioethics & Health Policy from Loyola University Chicago and a B.S. in Healthcare Management & Policy from Georgetown University, and is an alumna of the Paul Ramsey Institute Fellowship at the Center for Bioethics and Culture.