Ari Schulman: Emma, you are a policy leader on the subject of restorative reproductive medicine, which, as I understand it, argues that something has gone wrong with conventional fertility treatments, especially in the prominence of IVF. It also has a different prescription, an idea of a sort of new scientific field and medical practice that still needs to be developed. Is that right? What is RRM?
Emma Waters: Restorative reproductive medicine is an umbrella term that refers to three distinct medical approaches to treating infertility: Natural Procreative Technology, NeoFertility, and Fertility Education and Medical Management. Some doctors and clinics just rely on the term “RRM,” and others prefer to identify with their given specialty. What a lot of people don’t realize is that the medical field of restorative reproductive medicine has been around since the 1980s and has continued to develop since then with many “offshoot” companies and clinics offering adjacent care that aims to restore the health of the body and enable natural conception to occur.
It only seems like a recent development because it wasn’t until 2024 that I, alongside a few other key players, developed the political strategy and advocacy agenda around RRM. The medical approach has been around almost as long as IVF, but unlike IVF, the RRM doctors have primarily focused on their medical care, with little political engagement.
So what sets RRM apart from IVF? Is it merely a watered-down ideological or religious option for those opposed to IVF? Far from it. RRM begins with the conviction that infertility is not a standalone disease, but instead that it is a symptom of underlying conditions or pathologies that make natural conception difficult or impossible to achieve. In this way, infertility isn’t a material condition such as a tumor, heart disease, or ruptured appendix. The diagnosis, properly understood, is a reflection that something isn’t as it should be in the man and/or the woman’s body. The causes of infertility tend to fall equally between both sexes, and, crucially, studies have found that there are typically four or more underlying conditions at play. For women, leading conditions may include endometriosis, polyendocrine metabolic ovarian syndrome, uterine fibroids, blocked fallopian tubes, and hormonal imbalances, while for men leading causes include low sperm count, low quality or motility of sperm, erectile dysfunction, or a host of lifestyle factors.
With that understanding of infertility in mind, RRM doctors act as sleuths to truly identify, treat, and restore a man’s or a woman’s health. Since a person’s reproductive health is a reflection of overall health and longevity, such treatments aim to optimize and restore the person’s body while also removing any barriers to natural conception. In this way, it goes far beyond what IVF offers.
While IVF bypasses the man’s and woman’s bodies to create human embryos — a process that doesn’t treat or improve their overall health or fertility — RRM relies on detailed cycle charting, targeted diagnostic assessments and lab work, lifestyle interventions, medical and hormonal therapies, and corrective surgeries. The result is that RRM care improves egg and sperm quality, decreases miscarriage rates, balances hormone levels, and optimizes a woman’s body to support the child in utero. I am very passionate about this approach to treating infertility precisely because it isn’t just an “IVF lite” but offers a distinct approach to treating infertility that honors and restores the health of the body. Plus, success rates are comparable to or slightly higher than IVF success rates and come at a fraction of the cost. It’s not hard to see why this option has gained so much political traction and popularity in a relatively short amount of time.
Moreover, RRM isn’t just for those focused on infertility. It helps restore overall reproductive health, whether or not one is trying to conceive, from addressing the root causes behind painful or inconsistent female cycles to low testosterone in men. Such care meets men and women throughout the course of their lives, not merely if they’re dealing with infertility.
And I think it’s important to address one obvious and fair question many people have: Don’t IVF clinics also start with diagnostic care? Don’t they only move on to IVF when nothing else works? Sadly, this isn’t the case. First, the recommended standards for clinical assessment prior to IVF are far narrower than what RRM pursues. Second, even the recommended tests and treatments prior to IVF often don’t happen. A study reviewing five million commercially insured patients found a massive care gap for patients who went on to pursue IVF. Patients started IVF much sooner and far more often than they received the basic tests and treatments. IVF use hit 28–39 percent by 3 months and 70–85 percent by 9 months, while recommended care lagged behind by 13–78 percent behind.
Schulman: What are the most important policy changes you’ve seen so far toward supporting RRM?
Waters: In 2025, Arkansas became the first state to enact the “RESTORE Act,” a bill mandating RRM coverage for infertility and reproductive health conditions. Arkansas already had an IVF mandate on the books, so lawmakers simply expanded the care options to include RRM. The new law also included access to information and training about infertility, and about fertility awareness–based methods, body literacy, and reproductive health conditions, alongside better infertility reporting. Crucially, it’s “budget neutral,” meaning that it simply expanded current programs rather than creating new ones. Since then, multiple states have introduced and are continuing to introduce versions of the RESTORE Act, alongside the bicameral federal version.
As you can imagine, there is a lot of overlap with the Make America Healthy Again (MAHA) movement, and the Department of Health and Human Services under this current Trump administration has advanced and continues to advance RRM care. The last twelve months have been a whirlwind. In November, the FDA began lifting the black-box warnings from menopausal hormone therapy. This spring, Title X’s FY2027 funding notice pushed the RRM program past contraception toward reducing overmedicalization and promoting body literacy, reproductive goals counseling, and family formation. In June, the money followed with $4 million for an Infertility Training Center built on root-cause diagnosis and referral, $8.3 million to rigorously evaluate body-literacy interventions for teens, and $500,000 for a Center of Excellence standardizing root-cause care for endometriosis, fibroids, and infertility. By July, teen pregnancy prevention grants required teaching the phases of the female cycle, ovulation as the primary indicator of hormonal health, and a renewed emphasis on root-cause care for cycle pain or problems, rather than just offering one-size-fits-all solutions that suppress ovulation altogether. It’s just the beginning, but I hope to see lasting impact from these policies.
While it is hard to escape the overly political and partisan nature of policy work in this day and age, what I find so striking is that many of these policy goals transcend politics and have been promoted by people who identify as liberal, Democrat, or on the left, broadly speaking. For many years, Democrats were doing more to raise awareness about specific reproductive health conditions than Republicans were, which is why it is frustrating that this space of “RRM” has been pigeonholed as right-wing or merely conservative.
Schulman: What drives you to work on this issue? Is there a story of how you became aware of it and decided to make it your work?
Waters: I joined Heritage in 2022 to build the conservative policy agenda around infertility, men and women’s health, and reproductive technology. I like to describe my work as the meeting of technology, human conception, and human development. At the time, this was an exceptionally niche policy portfolio, but I had a sense that these issues would only continue to grow in prominence and that without dedicated action on the front end, most conservatives and lawmakers would be caught flat-footed. Well, I didn’t have long to wait, as the 2024 Alabama decision on IVF launched the issue of infertility and IVF into the national spotlight. All of a sudden, both parties were rushing to claim the mantle of “pro-IVF,” and yet most had little understanding about the industry or the issue of infertility itself.
After a few months of non-stop briefings, papers, and speeches on IVF, I had two revelations that fundamentally changed the way I approached my policy and awareness work. First, even if conservatives were to enact all the pro-family and life-sparing policy recommendations governing IVF in the United States — a worthy goal that fared no better under George W. Bush’s President’s Council on Bioethics — we would still be failing to answer the larger and far more important question of how we help couples who are struggling with infertility to have the children they desire. Indeed, it isn’t a matter of debating whether we should have “more” IVF or “less” IVF. What approach to care truly heals infertility in the first place? Second, people will ultimately pursue what works best — bioethics has a rather limited audience when a sincere and worthy desire for a child is on the line. So, it was up to policymakers to find and promote access to those options. Likewise, truly effective policymakers don’t just articulate opposition or concerns — they find positive and proactive solutions that address the deeper needs to truly help advance human flourishing.
At that point in 2024, I only knew a little bit about RRM and was largely unfamiliar with the entire medical field. So I started reaching out to anyone who had published on it or was familiar with the topic, asking to meet, share resources, and be introduced to the medical leaders who could inform our policy work. The first federal RESTORE Act was introduced just six weeks later.
Schulman: A lot of public debates over science policy these days can feel pretty abstract: Did you put the “in this house we believe in science” poster in your yard or not? Do you think NSF funding should be higher or lower? Chronic medical problems seem different than this. A tick bite that gives you alpha-gal syndrome will change your life, and when that’s happening to a lot of people, it is inherently political. In doing this work, you must speak to a lot of people who are in that position. What are your observations of how their experience changes their relationship to doctors and scientists? And to the political process?
Waters: Since the 2020 pandemic, Americans broadly have begun to rethink the entire medical establishment and standard model of care. It is often colloquially referred to as “sick care”: a system that hands out pills to manage symptoms and decline rather than proactively promoting a healthier lifestyle.
That sentiment has bled over into the realm of infertility and reproductive health care. Well beyond traditionally conservative or religious circles, I have heard countless stories of women and men sharing their deep frustration about the “one-size-fits-all” model of care they received, whether they were prematurely pushed toward IVF or simply given a birth control pill to manage (and hide) a host of conditions that only continued to worsen beneath the surface. For a lot of people, it isn’t that they are inherently anti-IVF or anti–birth control, but that they want real answers and solutions to treat the underlying condition.
The polling bears this out. A 2026 survey from Carrot found that 89 percent of women would prefer a less invasive option prior to pursuing IVF, 78 percent say more information would make them more likely to pursue non-IVF options, and interest in metabolic health support tops out at 85 percent. Those are the kinds of numbers lawmakers look for when gauging public interest in a given topic, which is why President Trump’s administration has responded by shifting from a mere IVF mandate to offering fertility benefit packages that weigh root-cause care equally with IVF.
It’s hard to overstate how profound this shift is. Consider President Trump’s comment on this topic from the Oval Office this summer: “This will hopefully reduce the number of couples who ultimately need to resort to IVF because challenges can be identified and addressed very early in the process.”
Schulman: Here’s a related question, and I’m going to knowingly editorialize here, since I’ve also already put some of my views of the fertility tech debate on the public record. In your work, you do not pretend to have a view from nowhere, where you speak only about neutral-sounding concerns like risk, uncertainty, harm, and consent. You have a specific view of the human person, and of which kinds of medical treatment are oriented toward the good of that person and which are not. That makes it very easy for critics of your work to just dismiss it as out-of-step social conservatism, or say it’s foisting private morality on the public, and so on, without having to substantively respond to the moral claims you’re making. That’s a dynamic I’ve observed over and over in debates on issues like these.
But it also seems to me like fertility medicine has the potential to break this dynamic in interesting ways. The arguments you’re making echo a lot of ideas from left-wing feminist theorists, like Andrea Dworkin. Talk of the need for a revival of humanism has also become very suddenly in vogue over the last couple years as part of the backlash to AI. And I see a lot more attention in establishment media on ways that conventional medicine is failing to listen to the concerns of patients. At the same time, from the other direction, there is a really serious division brewing on the right over these issues: an important segment of evangelical and Protestant conservatives, and just about all of the tech right, defend IVF, want to expand it, and see opposition to it as a political liability. As of today, the public face of radical expansion of fertility tech — the startup Orchid, the major investments being made by Sam Altman, and, most of all, Elon Musk’s, uh, rather extensive personal use — is actually politically right-coded.
What is your view of the politics broadly of RRM? What are the coalitional lines for it right now? And what do you think may be possible in the future?
Waters: I love this question, and for all the complicated coalitional points of tension you articulated I find this moment even more interesting and important to engage in.
In college, I wrestled with whether I wanted to pursue academia and, to the best of my ability, position my work as a neutral resource for others to use in their advocacy, or whether I wanted to go straight into the policy realm myself. I, of course, chose the latter, and part of what solidified this for me was a paper I wrote my senior year on “The Myth of Moral Neutrality.” As the title implies, I argued that not only is there no such thing as moral neutrality in public engagement (in fact, the term was perhaps invented to encourage one side to keep their opinions to themselves while others advanced unabated), but that our political system was designed, as James Madison argued, to set faction against faction.
It strikes me that the dividing principle governing each of your above examples is whether one views the purpose of medicine, technology, and science as oriented toward treatments that restore the natural functioning of the human body, or toward treatments that subvert, replace, or circumvent it. Similarly, Joshua Mitchell has used the language of “substitute” versus “supplement,” while I, in a co-authored essay for The New Atlantis, framed this moment as a choice between efforts to “hack” or “heal” the human person — specifically their health and their ability to flourish in the body they were born with.
Politically, the RRM coalition consists of those within the broader MAHA movement, social conservatives, and certain Silicon Valley entrepreneurs and enthusiasts.
Take Bryan Johnson, who is, by all accounts, an aspiring digital transhumanist. He may also become responsible for some of the greatest breakthroughs in women’s reproductive health. After announcing that he would invest millions of dollars in detailed assessments of his girlfriend Kate Tolo’s health, he and his team are advancing our knowledge of endometriosis, including what it is and how to treat it, at speeds no one has seen before. Remember that while endometriosis is one of the leading causes of infertility, doctors still don’t even know what causes the disease, much less how to effectively prevent or treat it. While I don’t think most would view Johnson as part of the RRM coalition (and neither would he), he represents an interesting cohort of Silicon Valley entrepreneurs who truly want to see scientific advancements answer some of the most pressing health questions of our time.
Within the RRM coalition, the next biggest distinction lies between those who also prioritize efforts to honor and protect embryonic human life and those for whom that is not a driving priority. The treatments or solutions may not differ significantly, but there are certainly some issues that drive a wedge there.
Going forward, my hope is that the RRM “countermovement” will establish a new standard of medical care that emphasizes personalized precision medicine — something AI and genetic technology are primed to accelerate in ways nothing else can. The goal is that as patient awareness and demand grow, they will force mainstream fertility medicine to moderate and shift course to meet patients’ needs, rather than reflexively pushing for the same trifecta of IVF, birth control, and sterilization in response to complex medical conditions or desires.
Among conservative Protestant Christians, who are generally pro-IVF in their position, I think 2024 will prove to be for IVF what 1973 was for abortion: a wake-up call and the beginning of a massive social movement to consistently honor life from the moment of fertilization and promote restorative treatments for infertility and reproductive health conditions.
We are already seeing Protestants shift on this issue, and the more they learn about RRM, the more they are rethinking their entire approach to fertility care and the purpose of the human body. Taking off my policy hat for a moment, that is why I have recently launched a Substack, a podcast, and a website under the branding of “Rethinking Fertility” to tackle these questions of fertility, technology, and theology for a Protestant Christian audience. It is also the name of my forthcoming book with Crossway, a large evangelical publisher. This issue will define and play a key role in how the next generation views the purpose of technology and the meaning of the human body. I’m just excited to be a part of it.
Schulman: This dialogue series is about the state of science reform under President Trump. I wanted to talk to you as part of this series, mostly because I find your work promising and wanted to learn more about it, but also because it is distinctively not about the “science reform” we usually hear about, which is about fixing science as such.
Instead, there is a specific thing you’re trying to create, and you’re working to recruit medicine and science to do it. It’s an old-school idea of how politics should approach science: Science is a powerful tool that should serve us, rather than a godlike authority that we should serve. But it’s also refreshing for how unusual that kind of idea is right now.
Given all that, I want to ask a question that maybe isn’t entirely fair for what your actual role is in public debates but I think comes along with being part of the coalition you’re part of. A lot of what is happening in science reform under President Trump is about getting the scientific establishment in line. It’s rhetorically focused on the sins of DEI and Covid, which were real and grievous. But, if you’re a lay member of the public, the two things you’ve probably heard about are blanket grant cancellations at Ivy League universities, and proposals by the administration to massively cut research budgets, including repeated proposals to cut the NIH by about 40 percent. None of this is contradictory with the work you’re doing. And arguably, it is more about signaling than it is a story of real material change — those cuts haven’t passed.
But as signals they seem very significant. If you are a committed supporter of the president, you basically have to buy into them. And to me the message they are sending is still more “The old establishment needs to burn, and we’ll sort out what to build later” and only in a secondary way “We’re excited about these new things we’re trying to build, and here’s how we’re going to do it.” How do you build support among a coalition for funding ambitious new research areas at a moment when, yes, there is some talk about revitalization, but the dominant mood is to slash and reckon? And, likewise, how do you gain friends among the research community itself?
Waters: While many people may think of President Trump’s “science reform” as a DOGE-style “slash and cut,” from what I’ve seen the main focus has been on identifying and trimming areas of excess and ideological drift so that — and the “so that” is crucial — there are more opportunities to fund much-needed and innovative research. That is precisely what we have seen in the realm of women’s health and infertility. While many in the media have focused on the “cuts,” three observations tell a different story.
First, as you noted, singling out a program or research area for cuts does not necessarily mean it will be cut at the end of the day.
Second, much of the reporting has just been incorrect. In the realm of Title X, for example, much was made of the administration’s efforts to cut funding for contraception when the reality is that no cut to contraceptive services was enacted. Title X was appropriated at $286 million in 2025, and Congress put that same figure in the 2026 bill, even after President Trump’s budget request proposed zeroing it out. The notice of funding opportunity simply now includes more approaches related to fertility awareness and body literacy.
Third, whenever superfluous or outdated research grants have been singled out for cutting, it is for the sake of funding more relevant research. I mentioned earlier the millions of dollars now available to support RRM-based research, training programs, and services.
Take the issue of endometriosis. Endometriosis is a condition in which tissue resembling the lining of the uterus grows outside of it, causing severe pain and damaging a woman’s fertility and overall health. Researchers still do not know why it occurs, and as of 2022, for each woman who suffers from the condition the NIH devoted only about $2 annually to researching it. This is even worse when one realizes that it takes a woman up to ten years or more to receive a diagnosis, that one in ten women of reproductive age in the United States is estimated to have the condition, and that it is present in up to half of all cases of otherwise unexplained infertility, making it a driving cause of it. Perhaps it sounds like I am, as you suggested, just covering for the president, but it strikes me that when one looks at the actual studies that are being cut and those new research grant opportunities that are being continued or added, it is reform in the right direction.
And when it comes to making friends in the research community, it seems to me that many will follow the money. This hopefully also corresponds with their desire to make a difference and use their skill set, but it’s important to keep in mind that science is a fact-based industry and shouldn’t be approached as a values-driven passion project. Perhaps many researchers aren’t as ideological as they are perceived to be and instead were just responding to bad signals they were given by federal lawmakers and compromised institutions. Perhaps a good way to begin to restore the relationship with the scientific community is to provide more opportunities to fund exploratory research at higher rates for the sake of new discoveries.
Schulman: My last question for you is a related one, and it’s about how you build cultural power. One way to describe what you’re seeking to do is to inaugurate not only a new set of policies and research, but a new public health consensus. That requires a culture shift among researchers and also among the public. It sounds like an impossible task when I describe it that way, because “science” as we talk about it today is all about Respecting the Established Consensus. But in fact history offers us many examples of when what seemed impossible to do or understand under the present public health consensus eventually became the status quo. Do you have any past examples of that kind of paradigm shift, not just in technology and policy but culture and public buy-in, that you look to?
Waters: This is a great question. As I noted earlier, I think one of the major failures of the bioethics movement of the early 2000s — and I say this with all respect and gratitude for the work that was done — was that it remained largely within the realm of academia, policy, and scientific debate and did not permeate popular culture in a personal or relatable way. What I mean by that is that I think those debates — aside from folks already interested in those philosophical discussions — failed to convey a meaningful answer to the question of how it would improve, or really impact, a given person’s life on a day-to-day basis. People are largely motivated by self-interest — and I don’t mean that in a derogatory way, it is simply true — and often don’t have the bandwidth to consider issues beyond what affects them day-to-day. So a paradigm shift requires a grassroots, bottom-up component, and perhaps needs to be led from there.
Without the energy and fuel coming from the grassroots, it is unlikely to reach the point of a cultural shift, especially in the realm of science and health. I am on the younger side, and perhaps this answer will feel unsatisfying because of it, but I tend to look to the early and ongoing efforts of the Make America Healthy Again movement as a paradigm shift that has occurred and, to varying degrees, is still occurring. The MAHA movement, for all its baggage, has been a movement of the people and for the people, with the goal of equipping Americans to truly take a proactive and agency-driven approach to governing their own health. It has given language and research to the nagging feeling that many people have had that the standard approach to medicine and health — more interventions, more pills — isn’t working, and neither is the changing advice about what a healthy lifestyle is or isn’t.
The MAHA movement tapped into self-interest, rightly speaking, and gave people the tools to take control of their own health, or at least legitimized exploring alternative paths, in a way that clearly has resonated with many people. I think the same impulse and unmet need exist in the realm of infertility and reproductive health conditions. By meeting people where they are and helping them answer practical and yet deeply meaningful questions about their desire to have a baby, delay children, or address painful and intimate problems, we move far closer to a paradigm shift in science, health, and ethics than if we began with some of the broader and more philosophical questions. Case in point: You can argue “personhood” or IVF’s ethical risks until you’re blue in the face, but without a better alternative to the conditions fueling the use of the technology, the argument is already lost. It’s not that those issues don’t matter, but that’s not how one succeeds in crafting a paradigm-shifting culture, nor does it answer the bigger questions of how to help couples who are struggling with infertility in the first place.
Three smaller examples of this paradigm shift, when new models of care entered the mainstream, occurred in the twentieth century. First is the rise of childbirth reforms with Lamaze, the Bradley method, and the resurgence of midwifery care. Those options, while reflecting a much older model of childbirth, had been lost for many years in favor of a heavy-handed, over-medicalized, and even sedated approach to birth (forceps and all). Second, hospice and palliative care developed to provide patients a return to humane and home-based death with dignity. Third, chiropractic care really stands out as a model of success that current movements can learn a lot from. Not only did establishment medicine dismiss it, the AMA went so far as to call it “quackery,” an accusation now lodged against RRM. Despite the medical establishment’s clear disdain and distrust, patients were flocking to chiropractors and experiencing incredible results. The demand came from patients, and institutions later accommodated it such that it is now available in all fifty states, covered under Medicare, and used inside the VA and the military. As I think about it, that may be the strongest historical example that reflects the moment we are currently in and a winning strategy for shifting the culture and quality of care that men and women receive.