By Jess Downs
Editor’s Note: Students on the 4-week FACTS elective learn about fertility awareness-based methods (FABMs) and their applications for women to monitor their health, for couples to plan a family, and for physicians to diagnose common conditions and restore reproductive health. Medical student Jess Downs learned even more about this by summarizing Boyle et al’s study titled, “Healthy singleton pregnancies from restorative reproductive medicine (RRM) after failed IVF.” [1] Published in 2018, the study reported encouraging outcomes from using a restorative approach in couples who previously failed IVF treatment.
Introduction
Over the last four decades, infertility care has developed along two different paths. Conventional reproductive medicine uses assisted reproductive technologies (ART), such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), which often bypass the root cause of infertility. These treatments do not prioritize diagnosis or treating the underlying conditions impairing fertility. In contrast, restorative reproductive medicine (RRM) works to identify and treat the root causes of infertility while restoring normal reproductive function. The study by Boyle and colleagues [1] summarized below evaluated outcomes for couples who pursued RRM after unsuccessful IVF attempts, focusing on live birth rates and neonatal health. Conventional ART treatments result in a relatively high number of preterm deliveries with a modest success rate. The study aimed to evaluate RRM compared to ART to determine whether RRM could be used as an alternative treatment. The researchers analyzed live birth rates and pregnancy outcomes in patients treated with RRM who had a prior history of one or more rounds of IVF.
“Conventional reproductive medicine uses assisted reproductive technologies (ART) … which often bypass the root cause of infertility. … In contrast, restorative reproductive medicine (RRM) works to identify and treat the root causes of infertility while restoring normal reproductive function.”
Methodology
This was a clinical outcomes study conducted at two RRM outpatient clinics in Ireland from 2004 to 2010. [1] In total, 403 couples with a history of infertility and at least one prior IVF attempt were included in the study if they went beyond an initial consultation and entered treatment. Care followed a structured RRM protocol:
- Fertility charting with the Creighton Model
- Timed hormone testing and ultrasound monitoring
- Medications to optimize ovulation and luteal function
- Surgical, immunologic, or nutritional support when indicated
- Progesterone supplementation during pregnancy as needed
The primary outcome of the study was live birth per couple, measured using life-table analysis. Secondary outcomes included conception, miscarriage, multiples, birth weights, and prematurity. Data were routinely collected from patients and recorded in their medical charts, with additional information obtained through phone, mail, or email communication and added for evaluation.
Results
Despite poor prognostic factors—average female age of 37, almost 6 years of infertility, and > 2 prior IVF attempts—RRM outcomes were encouraging:
-
- Live birth rate: 32.1% (adjusted life-table), 18.4% crude
- Age groups: 37% live birth for women ages 35 to 37; 27% live birth for women > 40
- Birth outcomes: 92% delivered at ≥ 37 weeks; average birth weight 3374g
- Multiple gestations: one twin pregnancy (1.4%); no higher-order multiples
- Low birth weight: None below 1500g; singleton low birth weight rate 5.5%
Discussion
This study highlights the potential role of restorative reproductive medicine as an alternative pathway for couples who have undergone unsuccessful IVF cycles. Its relevance to women’s health and family planning is clear: instead of bypassing underlying causes of infertility, RRM emphasizes restoring health and normal reproductive function. This focus not only provides hope for couples who may feel they have exhausted their options but also offers safer outcomes for mothers and infants, with significantly fewer multiples, lower risk of prematurity, and healthier birth weights compared to what is often seen with IVF. [1]
From the perspective of fertility awareness–based methods (FABMs), the study demonstrates how charting the female cycle can be a diagnostic and therapeutic tool beyond its use in pregnancy prevention. FABMs provide detailed insight into hormonal health and cycle patterns, which can guide patients in making more informed decisions with the help of an FABM-trained physician. In this study by Boyle et al, the Creighton Model was central to treatment, allowing for individualized interventions and patient engagement. FABMs serve not only as a way to achieve or avoid pregnancy but also as a window into overall health and a foundation for restorative treatment.
“FABMs provide detailed insight into hormonal health and cycle patterns, which can guide patients in making more informed decisions with the help of an FABM-trained physician.”
When compared to other studies, these results build on earlier work showing that natural procreative technology (NaProTechnology), an RRM approach, can lead to live birth rates between 52% and 66% in broader infertility populations. [2][3] Even in this group of women with advanced age and multiple failed IVF cycles, live birth rates of 32% were achieved, suggesting RRM remains a viable and meaningful option. The consistently low rates of multiples across RRM studies further highlight its strengths in terms of maternal and neonatal safety. The authors estimated potential healthcare savings of nearly $285,000 through prevention of multiple births. [1] Other research has also emphasized the psychological impact of infertility and the desire for less invasive, patient-centered care, which makes RRM appealing for many couples. [4]
“Even in this group of women with advanced age and multiple failed IVF cycles, live birth rates of 32% were achieved, suggesting RRM remains a viable and meaningful option.”
Strengths of this study include its large sample size, real-world clinical application, and detailed reporting on neonatal outcomes. By focusing on live birth per couple rather than per cycle, it provides a more realistic measure for patients considering treatment. However, the limitations must also be acknowledged. The study was retrospective, lacked randomization, and did not directly compare outcomes to repeat IVF cycles. Additionally, selection bias may have influenced the results, as couples who chose RRM after IVF may represent a more motivated or health-conscious group.
This article raised several insights and questions. One insight is how managing infertility as a chronic condition, with cycle-by-cycle improvements, contrasts sharply with the episodic, procedure-based model of IVF. It also raised questions of ways to integrate RRM more widely into mainstream practice given the potential barriers, such as medical professional training, patient awareness, and healthcare coverage. It also raised the question of how patients are counseled about their options after IVF failure and whether RRM is routinely offered as part of that conversation.
There is a clear need for future research in this area. Randomized controlled trials directly comparing RRM to IVF would provide stronger evidence. Long-term follow-up studies on maternal and child outcomes would also help determine whether RRM’s restorative approach confers health benefits beyond pregnancy. Additionally, cost-effectiveness studies at a larger scale could help make the case for policy changes in healthcare systems where IVF dominates infertility treatment.
Overall, this study reinforced that charting the female cycle using fertility awareness-based methods is not merely a planning tool; it is an essential part of medical care. It showed how FABMs can be integrated into treatment in a way that empowers patients, respects natural physiology, and achieves outcomes comparable to high-tech alternatives while reducing risks.
References
[1] Boyle PC, de Groot T, Andralojc KM, Parnell TA. Healthy singleton pregnancies from restorative reproductive medicine (RRM) after failed IVF. Front Med. 2018;5:210. doi:10.3389/fmed.2018.00210
[2] Stanford JB, Parnell TA, Boyle PC. Outcomes from treatment of infertility with natural procreative technology in an Irish general practice. J Am Board Fam Med. 2008;21(5):375–84.
[3] Tham E, Schliep K, Stanford J. Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice. Can Fam Physician. 2012;58(5):e267–74.
[4] Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007;21(2):293-308. doi:10.1016/j.bpobgyn.2006.12.003
About the Author
Jess Downs
Jess Downs is a fourth-year medical student at Pacific Northwest University in Yakima, WA. She earned her undergraduate degree in Lewiston, Idaho, where she also competed as a collegiate volleyball player. Jess plans to pursue residency in family medicine with a focus on holistic patient-centered care. She enrolled in the FACTS course to deepen her understanding of FABMs and hopes to integrate them into her future practice, using the cycle as a vital sign to help patients achieve pregnancy, avoid pregnancy, and uncover underlying health concerns.
Inspired by what you read?
You can support the ongoing work of FACTS here. To connect with a member of our team, please email development@FACTSaboutFertility.org. Interested in becoming an individual or organizational member? You can learn more and register here. To discuss with a member of our team, please email membership@FACTSaboutFertility.org.
