Every woman struggling with infertility deserves to know what’s wrong with her body before someone sells her a $30,000 workaround. That conviction is my life’s work. Yesterday, it landed my homemade butter in The New York Times.
The profile made sure to note my homemade raw milk butter — a “MAHA elixir,” as they called it — alongside our sourdough, Vivaldi’s Four Seasons, and my request to be called “Mrs. Waters.”
My actual work promoting root-cause care for infertility received less airtime, unless you count the academic naysayers quoted throughout. Restorative reproductive medicine (RRM), something I “evangelize,” was framed as a scare-quote “natural” approach that “many medical experts argue may give false hope.” One reproductive endocrinologist dismissed it as “essentially a repackaging” of standard fertility care, while others allege RRM is a backdoor scheme to steer couples away from IVF “until it is too late.”
Notice the trick. RRM is simultaneously an ideology with no clinical basis and care that fertility clinics already provide. Both cannot be true. Either it’s just an ideology, or they already offer it. The reality is neither: RRM is not an ideology (the medical approach has been around since the 1970s, or so), and fertility clinics are not offering it, which is perhaps why more and more patients are rethinking the “one-size-fits-all” model of IVF in favor of personalized approaches to treating the underlying causes of their infertility.
When I joined Heritage in 2022, I pitched them on the idea of building out a conservative policy platform addressing reproductive technology, infertility, and promoting the health of men, women, and babies. At the time, it was a niche issue, to say the least. I had an intuition that it would become a major one, and in 2024, right as the presidential election cycle reached a fever pitch, that hunch paid off.
With the Alabama Supreme Court decision — which declared frozen human embryos are persons in the case of a Wrongful Death of a Minor suit — IVF moved to the forefront of the political debate, with both parties positioning themselves as the “pro-family, pro-IVF” side. What quickly became apparent then, and is the basis of my work now, is that even if social conservatives managed to enact protections for parents and human embryos undergoing IVF, or even if others managed to enact an IVF mandate, both approaches would fail to answer the deeper and far more consequential question: how do we help couples who are dealing with infertility have the children they desire?
To unpack this, it is helpful to begin with what infertility is. Infertility is not a standalone disease or condition. It doesn’t present itself like a cancer tumor, heart disease, or a ruptured appendix. Infertility is a symptom of underlying conditions such as endometriosis, PMOS, thyroid dysfunction, insulin resistance, and hormonal imbalances in women, or low sperm count, low sperm motility, and other lifestyle factors in men. And, unlike the impression one often has, the burden is shared roughly equally between men and women, with research finding an average of four or more such conditions in one or both partners when a couple is diagnosed.
That’s why restorative reproductive medicine works with the body to diagnose and treat these underlying causes, relying on cycle tracking, targeted lab testing, lifestyle interventions, medical and hormonal therapies, and corrective surgeries to restore natural fertility for both men and women. And, unlike IVF, which bypasses the body to create human embryos, RRM works to improve egg and sperm quality, decrease miscarriage rates, balance hormone levels, and optimize a woman’s body to support the child in utero.
And, despite the claims made by dissenters in the article, there is a large and growing body of clinical evidence to back this up. In an Irish general-practice study of 1,239 couples, most of whom had been trying to conceive for over a year, such restorative treatment produced a 52.8% live-birth rate over two years. An international study spanning 10 clinics in four countries found 44% of couples achieved a live birth despite averaging nearly five diagnoses per couple. In one of the largest cohorts studied, 62.1% of couples took home a baby after a median of 11 months. In another study, among women who had already failed IVF, restorative care achieved a 32.1% live-birth rate, with 92% of those babies delivered at term, with a single twin pregnancy in the entire cohort.
Compare the incumbent: $15,000 to $30,000 per IVF cycle, a live-birth rate of roughly 32% per cycle, according to the Centers for Disease Control and Prevention, an average of more than two cycles per baby, and success rates below 10% for women over 40. Indeed, cost estimates for RRM range from $2,000 to $16,000, depending on surgery and insurance, but with success rates comparable to or higher than IVF. And, if a couple’s natural fertility is restored, they don’t have to restart more cycles if they want to have more kids. Moreover, while IVF bears much higher risks for the mom and baby — including higher rates of preterm birth, low birth weight, and multiples — RRM is the only approach that actually improves the health of mom, dad, and baby.
Which brings us back to Dr. Kallen’s claim in the New York Times that this is all “repackaging” of standard care, to the detriment of patients who cannot conceive with these kinds of treatments.” If restorative medicine were already standard, Arkansas would not have needed to pass a first-in-the-nation law to get it covered. RRM physicians would not be forced out-of-network because insurance coding has no language for the diagnostic work they do. And medical residencies would presumably teach it, and yet researchers reviewing training programs found that “knowledge of fertility does not change throughout residency training.”
As for the claim that RRM delays essential care (i.e., IVF), it is important to keep two things in mind. First, given that infertility is a symptom of underlying conditions or pathologies, targeted treatments to restore health are the treatment. And second, even if a couple later decides to move on to IVF, their success rates will likely be higher, as their own bodies are much healthier than if they had just done IVF first.
Indeed, what I appreciate about RRM is that restorative physicians don’t promise a baby. They do, however, emphasize and work exceptionally hard to improve the overall and reproductive health of men and women, including their ability to conceive and birth children. As journalist Madeleine Kearns found in her reporting, couples told her it was the IVF doctors who tended to make promises they couldn’t keep, whereas restorative physicians were more honest: no guaranteed baby, but no stone left unturned in figuring out and treating the problem.
For example, a March 2026 survey from Carrot found that 89% of women would prefer to try a less invasive option for treating infertility before anything else, and 78% said they would choose these options first if they simply had better information about them. Other polling shows that nearly 80% of Americans want personalized care that treats the root causes of infertility. The demand is clearly there; what has been missing is access and awareness.
The Times also noted my view that IVF, egg freezing, and delayed marriage could mean more women “[run] out of time.” I stand by it, because this is the deeper problem with treating access to reproductive technology as the solution: the promise of these technologies’ shapes when — and whether — we marry and have children at all.
Indeed, one of the most common and unsupported claims in modern discourse is that more IVF will raise the birth rate. But as Lyman Stone at the Institute for Family Studies has argued, IVF subsidies don’t boost fertility; they change who has babies, and when. Younger women become slightly less likely to have children, older women slightly more, and the net effect is a wash, except that the woman who might have had three children starting in her late 20s now has one or two starting at 40. The numbers bear it out: IVF accounted for about 2.3% of first births in 2022, but only 1.8% of second births and 0.9% of third. A technology sold as insurance against the biological clock could, in practice, have the unintended consequence of further delaying fertility.
That is why expanding real access and awareness is what my work focuses on, and it has been succeeding at every level of government. In the last year and a half alone, Arkansas became the first state to enact the RESTORE Act (promoting such root cause care), with other states following suit. The Texas GOP even included Natural Procreative Technology (part of RRM) in its party platform.
Federally, Congress has introduced a bicameral RESTORE (Reproductive Empowerment and Support Through Optimal Restoration) Act, with the Department of Health and Human Services advancing several grants this year alone, promoting innovative root-cause approaches to infertility, fertility tracking, and body literacy.
Moreover, the Departments of Labor, HHS, and Treasury proposed a rule allowing employers to offer standalone fertility benefits covering diagnosis and treatment of infertility’s root causes. The deadline to submit a public comment closes on Monday, July 13.
Even President Trump, the self-described father of IVF, now says such root-cause care “will hopefully reduce the number of couples who ultimately need to resort to IVF.” He’s right. It’s not about being “anti-IVF” or trying to limit options. Quite the opposite. It is about ensuring couples have more options than ever before to treat their infertility, starting with the least invasive root cause approaches first. And, as for the birth of more “beautiful babies,” one recent simulation found that expanding restorative care could raise the U.S. fertility rate from 1.77 toward 2.02, which is within reach of the fertility replacement rate.
Meanwhile, the associations dismissing all this as “ideology” are the same ones that recently redefined infertility to include a person’s relationship status, meaning that two men or a single woman could be deemed “infertile” despite their own bodies, if properly united with the opposite sex, bearing no causes for infertility. Let that sink in. No two men, no matter how hard they try, can conceive a child, and yet certain states and leading fertility organizations redefined infertility to include them.
So, while the Times wonders what to make of a 28-year-old who likes raw-milk butter, I am far more interested in empowering men and women with access to real fertility care. Besides, if it’s just an ideology, doesn’t work, or is already being offered, Big Fertility should explain why it finds it so threatening.
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Emma Waters is a senior policy analyst at the Heritage Foundation and the author of “Lead Like Jael: Seven Timeless Principles for Today’s Women of Faith” and host of the new podcast Rethinking Fertility.
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