As Trump Weighs I.V.F., Republicans Back New ‘Natural’ Approach to Infertility

Less than two weeks after an Alabama Supreme Court decision upended in vitro fertilization in the state and prompted a national backlash, over 100 conservative congressional staff members and I.V.F. skeptics crammed into a meeting room a few blocks from the U.S. Capitol. They lined the walls and spilled into the hallway, straining to hear the advice of the 25-year-old woman who would help them figure out how to respond.

Some in the room that day harbored deep moral and ethical reservations about a procedure that involved discarding human embryos. But I.V.F. was overwhelmingly popular, and many Republicans, including Donald J. Trump, were racing to denounce the Alabama ruling and embrace the procedure.

Emma Waters, then a senior research associate at the conservative Heritage Foundation, would offer another way.

Over the next 18 months, Ms. Waters and other conservatives would work behind the scenes to chart a new path, building a coalition within Mr. Trump’s base to push what they describe as a “natural” approach to combating infertility. Called “restorative reproductive medicine,” the concept addresses what proponents describe as the “root causes” of infertility, while leaving I.V.F. as a last resort.

Today, an approach long confined to the medical fringe has unified Christian conservatives and proponents of Robert F. Kennedy Jr.’s Make America Healthy Again movement — and is suddenly at the forefront of the fertility conversation in the Trump administration and the broader Republican Party.

Legislation that would fund restorative reproductive medicine has been proposed by Republicans in both the Senate and the House. Arkansas passed a law this spring that requires insurance companies in the state to cover this alternative approach to infertility. The Department of Health and Human Services will soon incorporate restorative reproductive medicine into government-funded health clinics for low-income women.

And the approach has featured prominently in an intense series of conversations inside the White House, as top Trump aides have wrestled with what to recommend in a highly anticipated I.V.F. report.

“All of a sudden it has gotten into the discussion,” said Kaylen Silverberg, a leading I.V.F. doctor who has been consulting with the White House. While he has been in the infertility field for over three decades, he said he had never heard the term “restorative reproductive medicine” until four months ago.

The field of restorative reproductive medicine, which dates back to the early 2000s, is grounded in the idea that infertility is a symptom of an underlying “root cause.” Physicians who specialize in the approach analyze patients’ diet and exercise habits, while helping them “chart” their menstrual cycles, a process that can help expose certain reproductive health conditions, like endometriosis, that may lead to infertility. Practitioners treat reproductive health conditions but do not offer I.V.F., a posture that has prompted harsh criticism from leading medical associations.

On the campaign trail, Mr. Trump did everything he could to signal his full backing for I.V.F., a procedure supported by 70 percent of Americans. Within a week of the Alabama ruling, which declared that frozen embryos are children, he called on the State Legislature to pass a law protecting I.V.F. Later that year, he referred to himself as the “father of I.V.F.” and pledged to make the procedure free, without offering any specifics on how he would do so.

Since the president took office, his aides have met with representatives from both sides of the I.V.F. debate, discussing what should be in the final report. Many involved in those discussions are now waiting to see what the president’s team will recommend. I.V.F. proponents are hoping the president will work with Congress to require insurance companies to cover the procedure, while moving unilaterally to extend coverage to members of the military, veterans and federal employees. Christian conservatives, on the other hand, want the administration to invest in research and education related to restorative reproductive medicine.

A White House spokesman, Kush Desai, said in a statement that the administration was working on multiple fronts to address infertility.

“President Trump pledged to expand I.V.F. access for Americans who are struggling to start families, and the administration is exploring every available tool to deliver on this pledge,” Mr. Desai said. “Further, we are working tirelessly to address the root causes of infertility and chronic diseases as part of our broader mandate to Make America Healthy Again.”

Leading medical organizations have weighed in over the last few months. The American College of Obstetricians and Gynecologists called restorative reproductive medicine “unproven” and “not a medical term,” stressing that many patients have already tried to chart their cycles, treat underlying conditions and make lifestyle changes by the time they arrive at an infertility clinic. While those methods may work for some, several leading I.V.F. doctors said people experiencing infertility often required more help — and months or years spent on restorative reproductive medicine could delay the I.V.F. they would ultimately need in order to conceive. Because female fertility declines with age, doctors said those delays could jeopardize a woman’s ability to get pregnant.

“They’re underestimating how hard we try to avoid I.V.F.,” said Eve Feinberg, a medical director of fertility and reproductive medicine at Northwestern Medicine. “When people walk into my clinic, we don’t do I.V.F. tomorrow. We try to figure out other things.”

In the weeks after the standing-room-only meeting on Capitol Hill, Ms. Waters joined forces with several other young conservative women, including Natalie Dodson, who now works as a senior adviser at the Department of Health and Human Services. A small group began reaching out to physicians who practice restorative reproductive medicine, eager to learn more about the field and what kind of support the practitioners could use from the federal government.

“Honestly, it was a little surprising,” said Monica Minjeur, the U.S. director of communications for the International Institute for Restorative Reproductive Medicine, a professional body created by a small group of physicians who coined the term in 2000. Dr. Minjeur and others had been working for years toward getting the field officially recognized by the American Board of Medical Specialties, but the term was still largely unknown.

“I had a Google alert set up for ‘restorative reproductive medicine’ for a few years,” she said. “And honestly forgot I even had it.”

Then Dr. Minjeur and her colleagues learned that the approach was the subject of legislation proposed in the Senate.

The legislation fizzled. But it took on symbolic importance among those pushing for a new approach to infertility, prompting conversations on Capitol Hill that were intensely personal and emotional — as well as overwhelmingly female.

At a briefing on the topic organized by the Senate Pro-Life Caucus and the Values Action Team last summer, several congressional staff members cried while sharing their experiences with reproductive health conditions and infertility, according to several people who attended. One person in the audience said, “I think I have endometriosis,” after hearing the presentation, multiple people recalled.

“People came up to me after that and said: ‘Can you help me? Can you help my friend?” said Marguerite Duane, a family physician who specializes in restorative reproductive medicine and has worked with Ms. Waters and Ms. Dodson. “There are babies that are here now because of that briefing,” she said, adding that she was referring to “people who became patients of mine or who I connected to other R.R.M. physicians.”

When Mr. Trump promised last August to make I.V.F. free if he became president, people at the center of the restorative reproductive medicine effort began to view their work with new urgency. They took Mr. Trump’s statements as evidence of an “education gap,” several people said: Like much of the country, he thought I.V.F. was the only way to treat infertility. They hoped their movement would show him that there was another option, the people recalled.

Once in office, the Trump administration moved swiftly to signal its continued support for I.V.F., issuing an executive order in February that promised to lower costs and expand access. The order offered no specifics on how the administration would achieve that goal, but promised that a detailed report with recommendations on the topic would be prepared by late May. Three months later, the report has not been released.

The coalition backing restorative reproductive medicine was diverse but organized, including leading members of the MAHA movement, antiabortion groups and representatives from the medical field. Connected through regular calls and meetings at the Heritage Foundation’s Washington headquarters, led by Ms. Waters, they presented a unified vision for what the administration could do on infertility. Many who met with the White House directed Trump aides to the legislation proposed the previous year by Senators Hyde-Smith and Lankford, according to several people at those meetings.

Inside the Senate offices, staff members worked throughout the spring to prepare a new version of that bill that incorporated the priorities of each faction of the new coalition — eager for the White House to review it before the administration issued its report, according to the person involved in early stages of the effort. The updated version of the legislation includes a greater emphasis on lifestyle changes as a solution to infertility, reflecting the priorities of MAHA leaders involved in the conversations.

While those central to the restorative reproductive medicine effort say they see potential for bipartisanship, leading Democrats are opposed to Ms. Hyde-Smith’s legislation. Senator Tammy Duckworth, Democrat of Illinois, said she felt “sick to my stomach” when she considered the implications of Ms. Hyde-Smith’s bill.

“They want to delay and delay and delay and essentially come up with fake science and ways to delay so that people can never actually get to the I.V.F. solution,” said Ms. Duckworth, who has had two children through I.V.F.

Ms. Duckworth, meanwhile, has been working to expand I.V.F. access. She recently added coverage for military families into a draft of the annual defense policy bill. It is not clear whether that provision will survive. Last year, Ms. Duckworth added similar language to the same bill and it was stripped out by Republicans.

Ms. Hyde-Smith said in a statement that she believed leaders could “get past the politics” and “come together in support of genuine solutions.”

Her legislation, she added, “is not in opposition to I.V.F., it is a separate and potentially complementary effort to address fertility concerns in a cost-effective manner that focuses on healing couples and empowering them with autonomy over how they build their families.”

At a recent event on women’s fertility in downtown Washington, Ms. Waters expressed optimism that the administration would prioritize the alternative approach she had been pushing for.

“This is a historic political moment,” Ms. Waters said at the event, co-hosted by the Heritage Foundation and the MAHA Institute. “For the first time, the White House and top political leaders are directly spotlighting family formation, real reproductive health and root case infertility care as national priorities.”

Tyler Pager contributed reporting.