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Patients come to the Vitae Clinic to become moms.
The peaks and valleys of the wooden wall art depict cardiac activity on an ultrasound. The waiting room of the third-floor clinic is full of toys and soft books for babies. To one side is a large box of formula that visitors are encouraged to take. And in the lobby, a sculpture of one of the world’s most famous mothers: the Virgin Mary holding a fetus inside a bowl.
The promise of motherhood is everywhere — even in the name, Latin for life.
Signs around the room boast the offerings of Vitae Clinic. There’s obstetrics and gynecology, provided by two doctors on staff. A contract physician offers psychiatric care focused on areas like postpartum and perinatal mental health, but also the emotional toll of infertility.
Vitae in Austin, Texas, is a Catholic-aligned health center that specializes in infertility without offering its most effective treatment. Though the clinic feels familiar to other medical facilities, it represents the new frontier of the anti-abortion movement. National anti-abortion activists have called it a model of what reproductive health care should look like in the post-Roe v. Wade landscape.
The clinic is housed in an anti-abortion center, a facility often funded by the state that discourages people from terminating their pregnancies. Counselors work with people who have unplanned pregnancies, connecting them with services like rental support so that they can stay home after giving birth. On the first floor, expectant parents can sort through a room of donated clothes, toys and supplies — the sort of necessities they otherwise might not be able to afford.
And though Vitae, which opened in 2010, provides medical care, this fertility clinic makes a point not to provide or recommend in vitro fertilization. That’s not because of any medical concerns, but because of moral objections embraced by a growing conservative coalition.
Prominent social conservatives have criticized IVF because not all of the embryos developed in the process will be healthy enough to use. They equate any discarded embryos with abortion. Some abortion opponents have embraced that argument since the fall of Roe, leading the Alabama state Supreme Court to briefly outlaw the procedure in 2024. As abortion opponents gear up for a broader national effort to dissuade people from using IVF and limit insurance coverage of it, clinics like Vitae are poised to play a vital role.
Vitae specializes in restorative reproductive medicine, a regimen that conservatives increasingly hope will supplant mainstream fertility care. The clinic — and the movement at large — both promise to address the “root causes” of infertility, language echoed by the president and in reports from Health and Human Services Secretary Robert F. Kennedy Jr.
Facilities emphasizing restorative reproductive medicine exist around the country — in conservative-led states with severe abortion restrictions and in liberal strongholds such as Massachusetts and California. One directory identifies almost 200 providers, including Vitae Clinic. The government has expressed interest in helping that number grow: This summer, the Department of Health and Human Services posted a grant opportunity that would use federal funds to support “root cause infertility diagnostic treatments and referrals.” The department has not yet begun seeking applications for that program.
On the campaign trail, President Donald Trump promised to make IVF free to all Americans. What he has delivered has fallen far short: A recent initiative allows employers to offer standalone fertility benefits, which Trump touted as making IVF more affordable. The move also includes an option for plans that would not cover IVF — ones that focus on addressing the “root causes” of infertility, which can include hormonal imbalances, nutrition and insufficient awareness of fertility cycles. Many of these components are basic gynecological services that fertility specialists already offer.
Still, conservatives celebrated the announcement.
“It expands access to infertility cures that treat root causes & should cover restorative reproductive medicine. That’s huge and very MAHA,” Roger Severino, a vice president at the conservative Heritage Foundation, posted on the social media platform X. A spokesperson for Heritage did not respond to a request for further comment.
Trump’s retreat from his campaign promise — and his administration’s pivot to include restorative reproductive medicine — underscores the movement’s reach.
Activists are not necessarily pushing to outlaw IVF, an approach that remains broadly unpopular, per polling from The 19th News and SurveyMonkey. Only 10 percent of Americans wanted lawmakers to restrict IVF, compared to 48 percent who wanted protections for it. But they are hoping to shift public resources and interest into something they find less morally objectionable.
“I don’t think anybody is out there trying to fully ban IVF, but the question is, ‘Should we put a lot of federal money in it?’” said Patrick Brown, a fellow at the conservative think tank the Ethics and Public Policy Center.
He suggested one outcome could be that ultimately, patients experiencing infertility are first directed toward restorative reproductive medicine doctors rather than being referred to specialists who offer IVF — ”making them part of the mainstream medical approach.”
That mirrors recent successful pushes at the state level. Legislators in Arkansas passed a law this year requiring that health insurance cover restorative reproductive medicine. Many doctors in the state have criticized the policy, saying it inaccurately implies that IVF is ineffective, or that patients must try the restorative approach — which can take months or even years — first before turning to IVF, which could cut into a patient’s fertility window.
A spokesperson for the American Society for Reproductive Medicine said the organization anticipates other state legislatures weighing similar policies in coming years. Linda Ruf, CEO of Vitae Clinic, has spent time in Washington, D.C., this year, meeting with staff from the White House and HHS, an effort to encourage more federal support for the movement.
That’s raised concern among some physicians, who worry that a heightened state or federal investment in restorative reproductive medicine — or positioning it as an equivalent alternative to IVF — could mean fewer resources go into making IVF more affordable. Already, patients without insurance coverage often take on debt or dip into their retirement savings to pay for the treatment.
“I worry this will impede the expansion of coverage for reproductive services people already need,” said Dr. Sigal Klipstein, a reproductive endocrinologist based in Chicago and a former ethics chair for the American College of Obstetrics and Gynecology. “Putting this first step in legislation isn’t really helpful because this is the low-hanging fruit: inexpensive things we already do. It’s being packaged as something new and shiny, but it’s really bread and butter OBGYN.”
Vitae Clinic and its partner, the anti-abortion center, St. John Paul II Life Center, have been part of early discussions in Texas over whether and how the state legislature could work to promote restorative reproductive medicine, said Amy O’Donnell, the acting executive director for Texas Alliance for Life.
“The Vitae Clinic and JPII and the many hats they wear are a beautiful example of what it is to serve women from a pro-life perspective,” O’Donnell said.
The national climate — and in particular the growing interest in non-pharmaceutical health care popularized by figures like Kennedy — has driven new patients to visit Vitae Clinic, Ruf said. Some oppose IVF because of their religious beliefs. Others are “crunchy” types seeking “natural reproductive care.” And for still others, it’s a matter of cost: IVF can cost more than $10,000 and often isn’t covered by insurance.
Infertility patients at Vitae Clinic are at varying stages of trying to become pregnant; some have been trying for years, said Dr. Blake Weidaw, an OBGYN and the center’s medical director. Though research shows that only one-third of infertility cases are the result of female infertility alone, Vitae — and clinics like it — focus on cisgender women in heterosexual relationships. Men at the clinic will receive a semen analysis, but if anything looks amiss, they will be referred to a urologist.
New patients undergo a lengthy diagnostic process, starting with a few months of what staff call “charting”: attempting to track their fertility by monitoring their cervical mucus to understand when they are ovulating. After that, patients may monitor a few more menstrual cycles, testing hormone levels at different points of a cycle and getting ultrasounds to measure the size of their ovarian follicles. Sometimes, they may receive hormone therapy. If a patient’s menstrual cycle fluctuates even by a few days — say, 37 days instead of exactly four weeks — there may be something wrong that merits hormone supplements, Weidaw said.
If after testing and hormone therapy a patient is still not pregnant, doctors may try surgery to check for and treat endometriosis, a condition in which uterine tissue grows outside the uterus. Close to half of patients at Vitae turn out to have either polycystic ovarian syndrome (PCOS) or endometriosis — conditions that can make it harder to get pregnant and that can often go undiagnosed. Patients with endometriosis will undergo surgery at the clinic.
In treating infertility, Weidaw said, “we have good success rates, but ours sometimes takes longer.”
Though the government has recently discouraged pregnant people to avoid effective forms of medical care, including antidepressants, acetaminophen and COVID-19 vaccines, doctors at Vitae Clinic take a different approach. They advise their pregnant patients to continue with antidepressants rather than risk leaving mental health conditions untreated during pregnancy, and encourage them to use acetaminophen to treat fevers. Patients aren’t required to receive a COVID-19 vaccine, but employees of the clinic have still made a point of getting the shot themselves.
Many of the clinic’s treatments — for instance monitoring hormones, measuring follicle size — are similar to the medical care offered at typical fertility clinics.
“Root causes of infertility are things we are already looking at,” said Dr. Angela Kelley, a reproductive endocrinologist at Aspire Fertility, an Austin-based clinic half a mile away from Vitae. “When a patient comes to us, they tell us their story, we listen, we ask perhaps more pointed questions.”
That includes those same elements staff at Vitae might probe, she said, including the possibility of undiagnosed endometriosis, irregular periods or hormonal imbalances, or a patient’s knowledge of their ovulation cycles.
Several physicians said health centers like Vitae are more limited in terms of their ability to help patients become pregnant. The clinic routinely suggests cutting out gluten or dairy to help with infertility, especially if linked to endometriosis or PCOS, though there is little evidence linking them specifically to pregnancy outcomes. Menstrual cycles can fluctuate for reasons other than hormonal imbalance; factors like stress or diet or fatigue can play a role as well. The monitoring of cervical mucus, some doctors said, is no more precise than using an at-home ovulation kit, which tests one’s hormone levels.
“This is a fine approach for people wanting to use it and it’s one of the many tools we have but it’s a small one, and not the only one,” Klipstein said.
And at Vitae, the most effective fertility treatment, IVF, isn’t on the table even for patients who are older than 35, whose window to get pregnant is shrinking. Depending on their individual hormone levels and egg quality, these patients may not have months to spend on diagnostic care before attempting more involved fertility treatments.
“If you focus too much on this, you take away from other things that might have been more successful,” Klipstein said. “If you’re 22 and trying to get pregnant and try for two years, whatever, it’s OK. But if you’re 38, you just totally closed the window.”
That time crunch is an acute concern for Kristin, a 39-year-old consultant in Austin. She’s spent the past two years trying to get pregnant — now going through egg retrieval cycles as quickly as she can, so that she has the best chances of a healthy pregnancy. She would love to have multiple children. But she isn’t sure if that’s possible unless she acts quickly.
“I’m busting out these cycles back to back, but if I get to 40, it’s another loss of chance,” said Kristin, who asked that her last name be withheld because she fears harassment for speaking about her experience with IVF.
Kristin never considered a restorative clinic like Vitae. But she expressed concern about how the model would work for women like her, with a shrinking window for healthy pregnancy.
“My first thought was, this is going to be extremely misleading to women, especially if they’re over 35,” she said. “The older you are the less likely you are to have a viable pregnancy even with IVF or other reproductive health care.”
(Emily Scherer for The 19th)
As the push for restorative reproductive medicine grows, Vitae Clinic is expanding its presence. John Paul II Life Center recently relocated to a new, larger building, its growth fueled by a combination of private donations, billing for medical services and some state support for its anti-abortion services. Vitae Clinic is in the process of hiring more doctors and midwives to serve a growing clientele. Eventually, Ruf said, the combination clinic and anti-abortion center — now largely housed on one level of a three-story building — will occupy the entire space.
IVF’s hefty price-tag — and the fact that it often is not covered by insurance — can make the restorative option more appealing to some. That was the case for Jordan, a 33-year-old who lives in San Antonio with her husband. The couple had been trying for close to two years to get pregnant before turning to restorative reproductive medicine, though at a different clinic from Vitae.
Jordan, who asked that her full name be withheld because she wants to keep her medical history private, followed a strict diet, losing more than 100 pounds and finally developing regular menstrual cycles. A semen analysis found that her husband’s sperm count was low enough that they would need specialized fertility care. The specialist retested her husband’s sperm and used diagnostic imaging to check her fallopian tubes.
But when Jordan started looking toward what fertility treatment might cost, including IVF, she quickly realized they couldn’t afford it. And she felt confident there was more they could do to figure out what, exactly, was keeping her from getting pregnant.
“I was like well we’re not going to spend however many thousands of dollars on an IVF cycle when I feel like there’s more we could uncover here,” she said.
In late 2022, her rabbit hole led her to a clinic that promised its gynecologist would help her treat the root causes of her infertility. She spent months monitoring her cervical mucus, working with a fertility coach, receiving an endometriosis diagnosis and surgical treatment, and even taking hormones meant to stimulate her ovulation.
She felt better, she said — more in touch with her body. But none of those treatments helped her get pregnant. That was only possible when, three years later, she had finally saved up enough money to pursue IVF at another medical center. This January, she finally gave birth to a son. Though she didn’t regret her experience with restorative reproductive medicine, Jordan said, she wouldn’t recommend it to patients with complex medical needs.
“For more intense fertility cases it may not work,” she said, adding, “I feel like it’s better for women who don’t have complex issues like I have.”
The question of timing is critical, said Kelley, the fertility doctor. That’s one of the reasons why, in some cases, spending months or years attempting to diagnose a cause of infertility may not benefit a patient.
“Even when we identify those root causes, there’s certain situations where we can’t actually fix it, or there’s not really enough time to fix it if the priority is to help the people in front of us have a biological child,” she said. “Especially in patients who are older — and for reference, older in our population is the female partner is in her late 30s or early 40s.”
At Vitae, the staff also considers a patient’s age, especially as Americans increasingly pursue pregnancy later in life.
Their answer is to offer a kind of health care model they hope patients, particularly women, can use at all stages — starting before they begin planning their pregnancies. It means teaching them to study their fertility even when they are in college. And it means expanding the use of their ovulation tracking approach, not just as a tool to pursue pregnancy, but also a means of contraception.
“Another thing that we’re really trying to help with is, ‘Learn about your body literacy. Learn about your body earlier and younger,’” Ruf said. “‘Don’t wait until you’re 35 and now you want to start your family.”
Great Job Shefali Luthra & the Team @ The 19th Source link for sharing this story.
