EBSA-2026-0232-0001, International Institute for Restorative Reproductive Medicine

The proposed rule is an important step toward expanding access to fertility care. Employees need access to restorative reproductive medical care that seeks to diagnose, mitigate, and treat underlying causes of infertility provided by recognized RRM medical professionals. Including RRM within Excepted Fertility Benefits would advance patient choice, employer flexibility, cultural and religious inclusivity, rural access, cost containment, informed consent, and public health. It would also align the rule with the stated purpose of covering diagnosis, mitigation, and treatment of infertility and infertility-related reproductive health conditions. For these reasons, we urge the Departments to explicitly recognize restorative reproductive medicine within the final Excepted Fertility Benefits rule. Recommendations We respectfully recommend that the final rule: 1. Accept the following definition of infertility as proposed by IIRRM after extensive consultation: a) Infertility is a clinical condition that presents with the symptom of inability to conceive or sustain a pregnancy from sexual intercourse, which points to underlying male and/or female pathology. 2. Avoid defining infertility solely by access to ART or by the need for laboratory intervention. Infertility should be recognized as a medical condition that may reflect underlying male and/or female pathology. 3. Explicitly include restorative reproductive medicine as an eligible fertility benefit category, encompassing the diagnosis, mitigation, and treatment of infertility and infertility-related reproductive health conditions, including pathophysiology-directed, root-cause-directed medical and surgical care for both male and female partners. Expressing recognition of restorative reproductive medicine in the final rule is important to provide employers, plan sponsors, benefit administrators, clinicians, and employees with clear notice that RRM may be offered and covered as an excepted fertility benefit. Without explicit inclusion, benefit designers may default to equating fertility benefits with IVF or ART alone, and employees may not recognize RRM as an available covered pathway. Clear reference to RRM would reduce ambiguity, support informed benefit design and patient choice, and help ensure that medically appropriate evaluation and treatment of underlying reproductive conditions are not unintentionally excluded. 4. Provide a practical mechanism for recognizing healthcare professionals with appropriate RRM training, experience, and qualifications. The final rule should allow recognition of clinicians through training and credentialing pathways supported by dedicated RRM organizations, including IIRRM and national chapters such as IRRM-US. Such a framework would give patients, employers, payers, and policymakers a clearer way to identify care teams practicing restorative reproductive medicine and to distinguish them from teams providing ART or other fertility services. 5. Include fertility awareness-based methods, cycle charting, fertility education, RRM medical professional referred apps and cycle-timed evaluation when used for medical diagnosis or treatment. 6. Recognize interdisciplinary care teams, including RRM-trained physicians, advanced practice clinicians, fertility educators, nurses, and allied health professionals. 7. Permit employer benefit designs that cover RRM as a first-line, parallel, or alternative pathway to ART. 8. Preserve employer flexibility to exclude procedures that raise ethical, religious, or cultural concerns, while still oKering meaningful fertility care through RRM. 9. Encourage registry-based outcome tracking and transparent informed consent across fertility benefit models. Respectfully submitted, Monica Minjeur, DO Director of Communications and Development USA Tracey A. Parnell, MD, MRM Global Director of Communications and Development On behalf of the Board of Trustees International Institute for Restorative Reproductive Medicine