On October 19, President Donald Trump signed an executive order directing the Department of Health and Human Services (HHS) to create a Women's Health Division at the National Institutes of Health within 90 days, with infertility featuring heavily on the agenda.
The announcement highlighted an HHS infertility initiative and a proposed "first-of-its-kind pathway for fertility benefits" with the Departments of Labor and Treasury, focused on preventing infertility, identifying its underlying causes, pursuing "non-IVF (in-vitro fertilization) treatments," and researching male-factor infertility.
If you don't want to provide IVF, if you don't want to have IVF, you shouldn't. But you should not deceive patients who might need IVF services
Sean Tipton, chief advocacy and policy officer, American Society for Reproductive Medicine
Much of the administration's health agenda, shaped by the Make America Healthy Again (MAHA) movement, mirrors the principles of restorative reproductive medicine (RRM), coined as a holistic approach to infertility care that focuses on diagnosing and treating underlying health conditions instead of relying on assisted reproductive technologies like IVF. However, recent research indicates that there is "insufficient evidence" that RRM works, and leading medical organizations, such as the American College of Obstetricians and Gynecologists, have described it as a nonmedical, costly, and potentially detrimental approach that can delay access to effective fertility treatments, especially when presented as a sole or primary option.
The state of Arkansas has been at the forefront of the national RRM movement, becoming the first state to write it into law, in 2025, with its RESTORE Act. The law requires insurers to cover RRM and even extends to the state's Medicaid expansion program, according to a state Medicaid official. The law does not require providers to discuss or refer patients for IVF, and it protects clinicians who decline fertility treatment for religious or moral reasons.
Arkansas Fertility Doctors Worry RRM Bill Will Harm Patients
Leaders in the fertility space in Arkansas are concerned about the effect of this law on their patients seeking infertility care. Christopher Moutos, a physician trained in reproductive endocrinology and infertility (REI) in private practice in Arkansas, worries about delays in evidence-based care if patients try RRM for two or three years before seeing a specialist. "If you're 39 when you start [RRM], and we see them at 42," he said, "it's a lot tougher [to conceive]."
Moutos and his father, Dean Moutos, are the only two fellowship-trained physicians providing the full scope of assisted reproductive technologies who are living in their home state of Arkansas. Nationally, about 1,250 reproductive endocrinologists are actively practicing, and states with higher uninsured and low-income communities have fewer of them relative to their number of women of childbearing age. Arkansas, for instance, is among the states most thinly served by reproductive endocrinologists.
Christopher and Dean Moutos coauthored a publication in the New England Journal of Medicine criticizing an Arkansas bill, proposed in the same session the RRM bill passed, for defining infertility as a "symptom of an underlying disease or condition" instead of as a "disease in itself," which is the consensus among leading medical organizations. The RRM bill, which the publication also discusses, uses similar language. The father-son duo was not consulted on either bill.
Globally, the United States is drifting in a different direction from peer countries. The World Health Organization's first global infertility guideline, which was issued in November 2025, includes 40 evidence-based recommendations, including artificial insemination and IVF care.
"That whole [RRM] movement is ideologically driven," said Sean Tipton, chief advocacy and policy officer at the American Society for Reproductive Medicine, explaining that it is backed by conservative think tank The Heritage Foundation, which claims that RRM is a substitute for IVF care. "If you don't want to provide IVF, if you don't want to have IVF, you shouldn't. But you should not deceive patients who might need IVF services," Tipton said.
What RRM Entails
According to the International Institute for Restorative Reproductive Medicine, RRM is "a specialized field of medicine that focuses on identifying the underlying health conditions that contribute to reproductive dysfunction and suboptimal reproductive health, treating them to restore the natural functions of the reproductive system."
One of the components of RRM is NaPro technology, or natural procreative technology. It can involve cycle tracking, supplements, hormones, and even dietary changes. The idea is that a patient tracks signs they can observe like their own temperature, cervical mucus, and bleeding patterns. "[Doctors] then run tests on the right days of her cycle and treat the underlying condition with medication or surgery. Examples include endometriosis, ovulation disorders, low progesterone, thyroid disease and blocked tubes," said Dr. Naomi Whittaker, an ob-gyn who founded RRM Academy, a nonprofit organization that trains clinicians and patients.
Fertility specialists say some of those steps are already part of standard care. "Patients have already done all that usually before they've ever seen us," said Dean Moutos. What RRM guidelines leave out, he said, are the treatments proven to work, including artificial insemination and IVF. "It's a backhanded approach to limit IVF."
For Whittaker, however, RRM offers women more options for addressing infertility, and she argues that it isn't a partisan issue. "If attention and money go mostly to IVF," Whittaker says, "I worry that endometriosis surgery and research will be crowded out, and women's choices will narrow."
Mobilizing Patients
Every other winter, Christopher and Dean Moutos find themselves fighting against bills that could potentially hinder access to IVF. Arkansas lawmakers are able to begin prefiling bills on November 16, ahead of a regular session every two years that will convene this January. In between patient visits, the Moutoses read each reproductive health bill as it lands. In past years, Dean Moutos has seen fetal personhood measures as well as a bill where IVF patients would have had to transfer (place in the uterus) their frozen embryos instead of discarding or donating them, but these bills didn't pass. "They try every two years," Moutos said, "so I fully expect we'll have to fight against this again."
Moutos explained that in his clinic, prior to an IVF cycle, couples have to sign lengthy consent paperwork detailing what happens to their frozen embryos if they get divorced or pass away, and a disclaimer that a future law could narrow their future choices. When these non-evidence-based bills come up, Moutos attempts to get in touch with legislators opposing them, but he says they never respond.
In an effort to advocate, Moutos has turned to the people lawmakers may be more likely to hear: his patients. Last legislative session, his clinic posted signs in its waiting room and on its website urging patients to contact their representatives to oppose these bills. At the Moutoses' facility, patients also leave their appointment with a sheet listing committee members and their email addresses so they can write to their lawmakers who can vote no on these bills.
Most Arkansans support access to assisted reproductive technologies, Christopher Moutos believes, even if their lawmakers do not, and his father, Dean, has been encouraging them for years to use their voice. "That's our biggest asset," Dean Moutos said, "to mobilize our patients."
