Glossary of Restorative Reproductive Medicine (RRM)
- RRM Academy
- May 5
- 16 min read
Updated: Jun 5
I. Core Concepts
Restorative:
Focuses on repairing and optimizing the reproductive system's function.
Aims to return the body to its natural, healthy state.
Emphasizes healing underlying pathology rather than symptom management alone. Also includes removing problematic devices or reversing prior procedures (like tubal ligation) to restore health or fertility potential.
Supports “in vivo” conception
Avoids gamete removal, suppressive medical therapies, irreversible procedures such as organ removal.
Root Cause:
Prioritizes identifying and treating the fundamental causes of infertility, subfertility, recurrent miscarriage, gynecologic pain, abnormal bleeding, and other reproductive health issues. These conditions are viewed as symptoms of underlying problems (e.g., hormonal imbalances, endometriosis, PCOS, tubal disease, uterine abnormalities like isthmoceles, pelvic adhesions, male factor issues, inflammatory conditions, autoimmune disorders, or complications from prior interventions like C-sections).
Seeks to correct the core problem(s) to improve overall and long-term reproductive health.
Healing:
Aims to restore health and proper physiological function.
Contrasts with approaches that mask symptoms (e.g., hormonal suppression for pain/bleeding) or bypass natural biological processes (like typical IUI/IVF protocols).
II. Key Differences from Bypass/Suppressive Therapies (e.g., IUI, IVF, Hormonal Contraception for symptom management, Hysterectomy for device issues)
Natural Cycle Cooperation vs. Artificial Manipulation/ Bypass/ Suppression:
RRM works with the woman's natural cycle and reproductive physiology, often using biomarkers identified through standardized fertility charting (using NFP or FABM methods).
Many conventional treatments override, bypass (IVF/IUI for tubal blockage or other issues), or suppress (hormonal contraceptives) natural hormonal cycles and processes, often just managing symptoms without correcting the cause. Conventional approaches may also recommend more drastic solutions like hysterectomy.
Corrective vs. 'Bypass & Bandaid':
RRM aims to correct underlying medical or surgical issues contributing to infertility (e.g., tubal repair/reversal, adhesion removal, isthmocele repair), recurrent miscarriage, or other reproductive dysfunctions, including removing problematic devices.
Bypass therapies circumvent infertility problems (IVF is often the only option offered for tubal blockage or post-ligation); suppressive therapies mask symptoms; standard surgical approaches may fail to fully address the disease or lead to high recurrence/reformation rates; hysterectomy removes the organ entirely.
Health-Focused vs. Procedure/ Symptom-Oriented:
RRM focuses on improving the patient's overall reproductive health and systemic well-being. Successful pregnancy, resolution of symptoms, and restoration of function are often results of restored health.
Bypass therapies are primarily procedures focused on achieving pregnancy; suppressive therapies focus on managing symptoms; hysterectomy is a definitive but major intervention.
III. Key Methodologies and Approaches in RRM
Comprehensive Evaluation:
Involves detailed biomarker tracking via standardized fertility charting systems, particularly the Creighton Model FertilityCare System (an NFP method foundational to NaProTechnology) or various Fertility Awareness-Based Methods (FABMs).
Utilizes targeted hormonal assessments (blood tests) timed to the cycle phases identified through charting.
Employs diagnostic imaging (follicle ultrasound series, Hysterosalpingogram - HSG including specialized techniques like selective salpingography, Saline Infusion Sonohysterogram - SIS / "bubble test" - key for diagnosing isthmocele and measuring residual myometrium) to assess uterine cavity and tubal patency.
Includes assessment for male factors (semen analysis) when relevant.
Utilizes diagnostic surgical procedures (diagnostic hysteroscopy, diagnostic laparoscopy) when indicated to directly visualize and assess pelvic/uterine conditions, crucial for definitive diagnosis of endometriosis and pelvic adhesions, and for assessing/treating isthmoceles.
May include testing for autoimmune conditions, blood-clotting disorders, inflammatory markers, genetic testing, and ruling out conditions with overlapping symptoms. Includes taking a detailed history regarding prior surgeries (C-sections, tubal ligations) or devices.
Personalized Treatment:
Develops individualized treatment plans based on the specific root causes identified during the comprehensive evaluation.
May involve targeted medical management (NaPro Medical approaches), lifestyle changes, nutritional support, and/or specialized surgical interventions (NaPro Surgery / Advanced Reproductive Surgery). Treatment choice for isthmocele (hysteroscopic vs. laparoscopic) depends on symptoms, muscle thickness, and future fertility desires.
Fertility Awareness & Body Literacy:
Empowers individuals to understand their own cycles and reproductive health through systematic observation and charting (Fertility Charting using NFP methods like the Creighton Model, or FABMs like Billings, FEMM, Sympto-Thermal, etc.).
Uses identified biomarkers to time diagnostics and treatments effectively, monitor treatment response, identify the fertile window, and potentially identify symptoms earlier (e.g., isthmocele bleeding pattern).
Specialized Surgical Techniques (Advanced Reproductive Surgery):
Utilizes advanced, often minimally invasive (laparoscopic, hysteroscopic, robotic-assisted, mini-laparotomy, or specialized non-anesthetic procedures like tubal cannulation), surgical techniques focused on restoring anatomy and function, or removing problematic devices.
Aims to precisely diagnose and simultaneously correct conditions like endometriosis (via excision), pelvic adhesions (via meticulous adhesiolysis with adhesion prevention strategies), uterine fibroids, adenomyosis, blocked fallopian tubes (via fallopian tube recanalization, tubo-tubal anastomosis for reversal or repair, or neosalpingostomy/fimbrioplasty), uterine septum, isthmoceles (via hysteroscopic shaving/cautery or laparoscopic excision and reconstruction), and complications from PCOS (e.g., ovarian wedge resection).
Emphasizes meticulous surgical methods like near contact laparoscopy, systematic pelvic mapping (S-MAP), excision surgery (using tools like CO2 laser), microsurgical techniques for repair (essential for tubal anastomosis), multi-layer closure for isthmocele repair, and specific strategies to minimize adhesion reformation (e.g., hemostasis, anti-adhesion barriers like Gore-Tex). Performed with the goal of preserving or restoring fertility, resolving symptoms, and often avoiding hysterectomy.
Holistic Approach:
Considers the interconnectedness of bodily systems (endocrine, immune, metabolic, inflammatory etc.) and their impact on reproductive health.
Addresses factors like genetics, lifestyle, prior interventions, and overall wellness.
IV. Goal: Reproductive Health Optimization, Symptom Resolution & Natural Conception/ Restored Function
The primary aim is to improve and optimize the overall health and function of the reproductive system by correcting underlying problems or removing sources of symptoms/dysfunction.
Achieving pregnancy naturally (when desired, e.g., after tubal reversal or isthmocele repair), resolving symptoms (like pain, heavy bleeding, recurrent loss, isthmocele bleeding), and promoting long-term gynecologic health are key goals.
V. Benefits of RRM Approach
Effective Treatment:
Addresses root causes, leading to successful treatment of infertility, recurrent miscarriage, pain, bleeding disorders, and other reproductive issues. Offers effective alternatives to IVF (e.g., tubal repair/reversal often have high success rates) and less invasive options than hysterectomy (e.g., isthmocele repair). Provides real solutions with lower recurrence/reformation rates compared to standard approaches.
Long-Term Health:
Promotes lasting improvements in overall gynecologic and reproductive health, extending benefits beyond achieving pregnancy or temporary symptom relief. Isthmocele repair can reduce risks in future pregnancies.
Patient Empowerment:
Enhances body literacy and involves patients actively in understanding their health and treatment options beyond commonly offered procedures like IVF or hysterectomy.
Hope & Solutions:
Provides answers and corrective/restorative solutions for complex conditions often inadequately addressed, symptomatically managed, or only offered bypass/definitive options by conventional approaches.
Minimally Invasive & Specialized Preference:
Often utilizes advanced minimally invasive surgery (laparoscopic excision, hysteroscopy, robotic surgery, specialized tubal procedures), leading to safer procedures and faster recovery compared to open abdominal surgeries or less effective techniques. Employs specialized techniques aimed at optimal healing and function restoration.
Glossary of RRM Terminology
I. Core RRM Principles & Concepts
Restorative Reproductive Medicine (RRM): A medical approach focused on identifying and treating the underlying causes of reproductive health issues (including infertility, recurrent miscarriage, pain, bleeding disorders) to restore normal function and fertility, working cooperatively with the natural reproductive cycle. Also encompasses procedures aimed at removing problematic devices or reversing prior interventions (tubal ligation) to improve health or restore fertility potential.
Restorative: Pertaining to the goal of repairing, healing, and optimizing the natural function of the reproductive system.
Root Cause Diagnosis: The process of identifying the fundamental underlying medical, hormonal, structural (e.g., tubal blockage, adhesions, uterine issues like isthmoceles), inflammatory, autoimmune, genetic reasons, or iatrogenic factors (e.g., C-section scar issues) for reproductive dysfunction. RRM views conditions like infertility or abnormal bleeding as symptoms, not final diagnoses.
Healing: The process of returning the body to a state of health and normal physiological function, addressing pathology rather than just managing symptoms.
Natural Fertility: The inherent biological capacity for reproduction without artificial intervention; RRM aims to restore or optimize this, including via procedures like tubal reversal.
Reproductive Health Optimization: The goal of improving the overall health and function of the reproductive system, encompassing fertility, cycle regularity, absence of pain/abnormal bleeding, and long-term gynecologic wellness.
Body Literacy: An individual's understanding of their own body's signs and functions, particularly related to the reproductive cycle, often gained through systematic fertility charting.
Holistic Approach: Considering the whole person and the interplay of various bodily systems and lifestyle factors in reproductive health.
Comprehensive Evaluation: A thorough assessment process in RRM designed to identify root causes. Typically includes detailed cycle charting (using standardized NFP methods like the Creighton Model or FABMs), timed hormonal blood tests, various ultrasounds (including SIS for isthmocele diagnosis/measurement), HSG (potentially selective salpingography), semen analysis, testing for relevant endocrine, immune, clotting, or genetic factors, and potentially diagnostic/operative hysteroscopy and/or laparoscopy (essential for endometriosis/adhesion diagnosis, isthmocele assessment/treatment).
Personalized Treatment: Tailoring medical and/or surgical interventions to the specific root causes identified, considering patient goals (e.g., fertility desire influences isthmocele repair method).
II. RRM vs. Bypass/Suppressive Therapies (IUI/IVF/Hormonal Suppression/Hysterectomy)
Natural Cycle Cooperation vs. Artificial Manipulation/Suppression: Emphasizes working with the observed patterns of a woman's cycle versus overriding, replacing, or suppressing it.
Corrective vs. Symptom Bypass/Bandaid: Focuses on fixing the underlying problem(s) (e.g., surgical repair of tubes/isthmocele, removal of adhesions) versus circumventing them (IVF), masking symptoms (hormonal suppression), using less effective surgical techniques, or removing the organ (hysterectomy).
Health-Focused vs. Procedure/Symptom-Focused: Prioritizes restoring overall reproductive health versus focusing primarily on the outcome of a specific procedure or managing symptoms without addressing the cause.
Fertility Restoration: The aim of RRM is to restore the natural ability to conceive and carry a pregnancy to term, often through corrective surgery (e.g., tubal reversal, isthmocele repair).
Minimally Invasive Surgery (MIS): Surgical techniques (often laparoscopic, hysteroscopic, robotic-assisted, mini-laparotomy) used in RRM that minimize tissue trauma, used for diagnosis and corrective treatment (e.g., endometriosis excision, isthmocele repair, fibroid removal, tubal repair/reversal, septum resection, adhesiolysis, ovarian wedge resection). Often allows for fertility preservation.
Alternatives to IVF/IUI & Hormonal Suppression/Hysterectomy: RRM provides a diagnostic and corrective treatment framework, including specialized surgical repairs and reversals, as an alternative approach often managed solely with bypass, suppressive, or definitive (hysterectomy) methods conventionally. RRM surgeries often have high success rates and may be less costly or less invasive than alternatives.
Patient-Centered Care: Emphasizes the patient's understanding, involvement, and overall health throughout the diagnostic and treatment process.
III. Fertility Awareness-Based Methods (FABM) or Charting
Fertility Awareness-Based Methods (FABM): An umbrella term for scientific methods used to monitor and interpret biological signs of fertility (biomarkers) throughout the menstrual cycle. These methods can be used for health monitoring, timing diagnostic tests and treatments in RRM, achieving or avoiding pregnancy. Examples include the Billings Ovulation Method, Sympto-Thermal Method, and FEMM.
Fertility Charting: The systematic recording of fertility biomarkers (e.g., cervical mucus, basal body temperature, hormonal levels) according to a specific standardized method (such as an NFP method like Creighton, or an FABM like Billings, FEMM, Sympto-Thermal). Essential for RRM diagnosis and management.
Biomarkers: Observable biological signs indicating different phases of the reproductive cycle (e.g., cervical mucus changes, temperature shifts, hormonal profiles detected via blood tests or urine strips).
Natural Family Planning (NFP): Methods used to achieve or avoid pregnancy based on identifying the fertile window through observation of biological signs. The Creighton Model FertilityCare System is a specific, standardized NFP method. The term NFP is sometimes used more broadly, similarly to FABM.
Creighton Model FertilityCare System (CrMS): A standardized prospective method of Natural Family Planning (NFP) focused on detailed observation and classification of cervical mucus patterns and other biological markers. It provides information for monitoring gynecologic health and fertility, and forms the diagnostic foundation for NaProTECHNOLOGY, allowing precise timing of diagnostic tests and medical treatments. Its developers distinguish it from the broader FABM category.
Billings Ovulation Method: An FABM focused primarily on the sensation and appearance of cervical mucus at the vulva to identify the fertile window.
FEMM (Fertility Education and Medical Management): An FABM program integrating hormonal understanding with cycle charting and providing a framework for medical management based on cycle data.
Sympto-Thermal Method: cycle charting combining biomarkers like mucus and temperature
Peak Day: In mucus-based methods (like Creighton, Billings), the last day of fertile-type (clear, stretchy, lubricative) mucus, correlating closely with the time of ovulation.
IV. Specific RRM Tool, Approaches & Techniques
NaProTECHNOLOGY (Natural Procreative Technology): A specific women's health science focused on reproductive and gynecologic health, developed by Dr. Thomas Hilgers. It utilizes the Creighton Model FertilityCare System (an NFP method) for precise cycle monitoring to guide targeted medical (NaPro Medical) and surgical (NaPro Surgery / Advanced Reproductive Surgery) treatments based on identified abnormalities, working cooperatively with the reproductive system.
NaPro Medical: The medical management component of NaProTECHNOLOGY, using timed medications/supplements based on Creighton Model charting.
NaPro Surgery / Advanced Reproductive Surgery: Specialized surgical component of NaProTECHNOLOGY employing meticulous, often minimally invasive techniques to restore anatomy/function or remove problematic devices. Emphasizes excision, microsurgery, adhesion prevention, multi-layer repair (e.g., for isthmocele), and fertility preservation.
Near Contact Laparoscopy: Specialized laparoscopy for close visualization.
S-MAP (Systematic Mapping of the Pelvis): Methodical examination during laparoscopy.
Excision Surgery: Gold standard surgical removal of abnormal tissue (endo, adhesions), often using CO2 laser. Contrasted with fulguration.
Adhesiolysis: Surgical removal of adhesions, performed meticulously in RRM with prevention strategies.
Anti-Adhesion Barriers: Materials (fluids, membranes like Gore-Tex) used during surgery to minimize adhesion reformation.
Fulguration (or Ablation/Cauterization): Superficial destruction of tissue, less effective than excision for deep disease. Not preferred in RRM.
Laparoscopic Ovarian Wedge Resection: Surgery for some PCOS cases.
Fallopian Tube Recanalization (or Cannulation): Procedure to open proximal tubal blockage.
Tubo-tubal Anastomosis: Microsurgical reconnection of fallopian tube segments, used for Tubal Ligation Reversal or mid-segment repair. Can be performed laparoscopically, robotically, or via mini-laparotomy.
Neosalpingostomy / Fimbrioplasty: Laparoscopic repair of distal tubal blockage/hydrosalpinx.
Follicle Maturation Study (Follicle Tracking): Ultrasound series to monitor follicle growth.
Saline Infusion Sonohysterogram (SIS) / "Bubble Test": Ultrasound with saline infusion to visualize uterine cavity. Key diagnostic tool for Uterine Isthmocele, allowing measurement of the defect and residual myometrial thickness. Also detects polyps, fibroids. Can assess tubal patency.
Hysterosalpingogram (HSG): X-ray with contrast dye to assess uterine cavity and tubal patency.
Selective Salpingography: Specialized HSG injecting dye into each tube individually.
Diagnostic/Operative Hysteroscopy: Visualization of uterine cavity via hysteroscope. Can be used for diagnosis and treatment (e.g., polyp/fibroid removal, septum resection, hysteroscopic isthmocele treatment by shaving/cauterizing the defect - suitable for bleeding symptoms if muscle wall is thick and future pregnancy not desired).
Diagnostic/Operative Laparoscopy: Visualization/treatment of pelvic organs via laparoscope. Used for diagnosis/treatment of endometriosis (excision), adhesions (adhesiolysis), fibroids (myomectomy), tubal disease (repair/reversal), ovarian issues (cystectomy, wedge resection), laparoscopic isthmocele repair (excision of defect and multi-layer reconstruction - preferred for fertility or thin walls).
Mini-laparotomy: Small "bikini" incision surgery, sometimes used as an alternative to laparoscopy for procedures like tubal ligation reversal in suitable patients.
V. Key Conditions Addressed by RRM
Infertility: Symptom of underlying treatable conditions.
Recurrent Miscarriage (RPL): RRM seeks and treats underlying causes.
Heavy Menstrual Bleeding (Menorrhagia) / Painful Periods (Dysmenorrhea): RRM diagnoses and treats root causes (fibroids, adeno, endo, PCOS, isthmocele, etc.).
Endometriosis: Chronic inflammatory disorder. RRM focuses on laparoscopic excision surgery.
Endometrioma: Endometriosis cyst on ovary.
PCOS (Polycystic Ovary Syndrome): Hormonal/metabolic disorder. RRM uses multi-faceted approach.
Ovulation Disorders: RRM diagnoses cause and restores/induces ovulation medically.
Tubal Factor Infertility (Blocked/Damaged Tubes): Affects ~25% of infertile women. RRM offers corrective surgical alternatives to IVF (recanalization, anastomosis, neosalpingostomy).
Hydrosalpinx: Fluid-filled blocked tube. Requires repair or removal.
Pelvic Adhesions (Scar Tissue): Can cause pain/infertility. RRM uses specialized laparoscopic adhesiolysis with prevention strategies.
Uterine Abnormalities: Structural issues.
Uterine Fibroids (Leiomyomas): Benign tumors. RRM often involves myomectomy.
Uterine Septum: Congenital wall. Corrected hysteroscopically.
Adenomyosis: Endometrial tissue in uterine muscle.
Uterine Isthmocele: Niche/defect in a C-section scar, affecting ~20% post-C-section. Caused by incomplete healing. Symptoms include secondary infertility and abnormal bleeding (typically post-menstrual brown spotting). Mechanism involves trapped blood causing inflammation hostile to sperm/implantation. Can also increase miscarriage/rupture risk due to thin wall. Diagnosed definitively via SIS (identifies defect, measures residual myometrial thickness). Treatment depends on symptoms, wall thickness, and fertility goals:
Hysteroscopic treatment: Shaving/cauterizing the defect internally. Best for bleeding if wall >5mm and no future pregnancy desired. Faster recovery but less likely to resolve bleeding fully and doesn't thicken wall.
Laparoscopic repair: Excision of the defect and multi-layer reconstruction of the uterine muscle wall. Preferred method for fertility desire or thin wall (<5mm). More likely to resolve bleeding and restores wall integrity for safer future pregnancy, but longer recovery.
Tubal Ligation Reversal: Surgical procedure (tubo-tubal anastomosis) to restore fertility after a woman has had her "tubes tied." Performed using microsurgical techniques via laparoscopy, robotic assistance, or mini-laparotomy. Offers high success rates (70-75% pregnancy chance) as an alternative to IVF, often more cost-effective.
Cervical Factor Infertility: Issues with cervix or mucus. RRM optimizes mucus via hormonal balance.
Hormonal Abnormalities: Imbalances disrupting cycle/fertility. Diagnosed via timed blood tests, treated with NaPro Medical.
Chronic Endometritis: Chronic inflammation of uterine lining. Diagnosed via hysteroscopy/biopsy, treated medically.
Autoimmune / Blood Clotting Disorders: Can cause RPL. Diagnosed via blood tests, treated medically.
Male Factor Infertility: Issues with sperm. RRM may involve medical treatment for the male partner.
Low Sperm Counts (Oligospermia) / Motility / Morphology: Reduced sperm parameters.
Luteal Phase Deficiency (LPD): A reproductive condition characterized by inadequate progesterone production or action during the luteal phase of the menstrual cycle, which can impact fertility and early pregnancy. In the context of Restorative Reproductive Medicine (RRM), understanding and addressing LPD is essential for diagnosing and treating infertility and recurrent pregnancy loss.
Luteal Phase (LP): The period after ovulation and before menstruation or pregnancy, during which the corpus luteum produces progesterone to prepare the uterus for possible implantation.
Corpus Luteum (CL): A temporary endocrine structure formed after ovulation from the ovarian follicle.
Progesterone: A steroid hormone produced by the corpus luteum.
Thyroid Disorders: Thyroid disorders are among the most common endocrine diseases, affecting individuals across all age groups. These conditions can significantly impact metabolism, growth, development, and various organ systems, with their prevalence and manifestations influenced by factors such as iodine intake, genetics, and autoimmunity.
Hypothyroidism: Is often caused by autoimmune Hashimoto’s thyroiditis in iodine-sufficient regions, leading to symptoms of slowed metabolism.
Hyperthyroidism: Most commonly due to Graves’ disease, another autoimmune disorder, resulting in symptoms of increased metabolism.
Thyroid Dysgenesis: Disorders in thyroid development, such as agenesis, ectopy, and hypoplasia (collectively called thyroid dysgenesis), can be genetic and are linked to mutations in regulatory genes
Autoimmune Thyroid Diseases (AITD): AITDs, including Graves’ disease and Hashimoto’s thyroiditis, result from immune system dysregulation and are associated with both organ-specific and systemic autoimmune conditions
Hyperprolactinemia: A common endocrine disorder characterized by elevated levels of prolactin, a hormone produced by the anterior pituitary gland. It can arise from a variety of physiological, pharmacological, and pathological causes, and has significant effects on reproductive, metabolic, and bone health.
Premature Ovarian Insufficiency (POI): A condition where the ovaries lose normal function before the age of 40, leading to infertility, hormonal deficiencies, and various long-term health risks. POI affects about 1% of women under 40 and can have profound physical and psychological impacts.
Diminished Ovarian Reserve (DOR): Refers to a reduction in the quantity and quality of oocytes (eggs) in the ovaries, leading to decreased fertility potential. DOR is a significant concern in reproductive medicine, affecting both natural conception and outcomes with assisted reproductive technologies
Immune Dysregulation: Immune dysregulation refers to an imbalance or malfunction in the immune system’s normal regulatory processes, leading to inappropriate immune responses. This can manifest as autoimmunity, autoinflammation, immunodeficiency, or a combination of these, and is increasingly recognized as a key factor in a wide range of diseases
Insulin Resistance and Metabolic Dysfunction: Common in PCOS and independent contributors to infertility and miscarriage. RRM addresses through dietary management, exercise, targeted supplements (e.g., myo-inositol), and medications like metformin when indicated.
Vitamin and Nutritional Deficiencies: Key nutrients (vitamin D, folate, B12, iron, zinc) are essential for fertility. RRM routinely screens for deficiencies and prescribes repletion protocols tailored to individual needs.
Adrenal Dysfunction: Adrenal health impacts hormonal balance and stress response. RRM evaluates adrenal function (salivary cortisol testing, ACTH stimulation test if needed) and treats underlying dysfunction to restore normal cycles.
Adrenal Fatigue: These studies suggest that "adrenal fatigue" is not supported by scientific evidence and is considered a fabricated condition, while true adrenal insufficiency is a rare but serious disorder that can cause fatigue and other symptoms.
Cushing’s Syndrome: A rare but serious disorder caused by chronic excess cortisol, leading to severe complications and increased mortality—especially from cardiovascular disease—and requires early diagnosis and treatment, usually surgical, to improve outcomes and quality of life.
Chronic Pelvic Pain Syndromes: These studies suggest chronic pelvic pain syndromes are complex, often involve multiple overlapping causes (such as gynecologic, urologic, gastrointestinal, musculoskeletal, neuropathic, and psychosocial factors), and are best managed with individualized, interdisciplinary, and multimodal approaches rather than single therapies.
Unexplained Infertility: A diagnosis given when no obvious cause is found through standard evaluation. RRM does not accept "unexplained" as a diagnosis but continues deeper investigation (hormonal patterns, subtle anatomical issues, immunologic factors) to find and treat hidden causes.
Secondary Infertility: Difficulty conceiving after a prior pregnancy. RRM re-evaluates for new issues that may have developed (e.g., scar tissue, isthmocele, endometritis, hormonal shifts).
Postpartum Fertility Issues: Sometimes related to lactational amenorrhea, retained placenta fragments, thyroid shifts, or uterine scar defects. RRM offers specialized postpartum evaluations and treatments.
Stress-Related Reproductive Dysfunction: Chronic stress can suppress ovulation and impair fertility. RRM incorporates stress-reduction strategies, lifestyle counseling, and sometimes medical therapy to normalize cycles.
Perimenopausal Fertility: Perimenopause is the transitional time before menopause, typically beginning in the 40s (but sometimes earlier). Fertility declines but pregnancy is still possible, and RRM (Restorative Reproductive Medicine) aims to optimize chances by identifying and treating specific underlying issues rather than assuming infertility.
Shortened Luteal Phase: Characterized by inadequate progesterone production, is associated with infertility and poor endometrial maturation, may result from hormonal imbalances or ovulation induction, and occurs in a minority of menstrual cycles, including among regularly menstruating and physically active women.
Luteinized Unruptured Follicle (LUF) Syndrome: A form of anovulation where the follicle matures and luteinizes without releasing an egg, often causing unexplained infertility despite normal menstrual cycles and ovulation signs, and is linked to hormonal imbalances and subtle ovulatory dysfunction.
Anovulatory Cycles: Are menstrual cycles in which ovulation does not occur, can happen even in women with regular periods, are associated with conditions like polycystic ovary syndrome, obesity, excessive exercise, and hormonal imbalances, and may present as irregular or absent periods, infertility, or abnormal uterine bleeding.
Ovarian Aging / Diminished Ovarian Reserve (DOR): A progressive decline in the number and sometimes quality of oocytes due to genetic, mitochondrial, inflammatory, epigenetic, and lifestyle factors, leading to reduced fertility and increased infertility risk as women age.
High FSH / Low Estradiol Early in Cycle: Typically seen in anovulatory cycles, diminished ovarian reserve, or the menopausal transition, reflecting reduced ovarian follicle numbers and impaired ovarian function. RMM aims to regulate FSH signaling and support healthier follicular development.
Low Progesterone Production: Is linked to reduced implantation, pregnancy, and live birth rates in both natural and assisted reproductive cycles, but individualized progesterone supplementation can improve these outcomes.
Low Progesterone Production: Linked to infertility, recurrent miscarriage, impaired embryo implantation and development, abnormal placentation, and lower pregnancy and live birth rates, especially in assisted reproduction and animal models.
Poor Cervical Mucus Production: Can be caused by age, hormonal imbalances (especially low estrogen or altered progesterone), genetic or receptor deficiencies, impaired bicarbonate secretion (such as in cystic fibrosis), and may reduce fertility by limiting sperm survival and transport. RRM uses hormonal support to enhance fertile mucus.
Subclinical Hypothyroidism: Associated with increased risks of cardiovascular disease, coronary heart disease, all-cause mortality, metabolic syndrome, and reduced kidney function, especially in those with higher TSH levels or existing risk factors, while the benefits of routine thyroid hormone treatment remain uncertain except in specific cases.
Autoimmune Activation: Occurs when genetic and environmental factors disrupt immune tolerance, leading to inappropriate activation of immune cells—especially T and B cells—through mechanisms such as molecular mimicry, bystander activation, and innate immune triggers, resulting in chronic inflammation and tissue damage.
Early Perimenopause / Premature Ovarian Insufficiency (POI): Are managed by timely diagnosis, hormone replacement therapy to alleviate symptoms and prevent long-term complications, fertility restoration strategies (such as PRP), and individualized care.
Perimenopausal Menorrhagia (Heavy Bleeding): These studies suggest that reproductive medicine management (RRM) for perimenopausal menorrhagia includes effective medical therapies such as the levonorgestrel intrauterine system, oral progestogens, tranexamic acid, and combined oral contraceptives, as well as individualized hormonal and non-hormonal options, with surgical interventions like dilatation and curettage or hysterectomy reserved for refractory cases.
Uterine Structural Changes: Include alterations in smooth muscle, endometrial glands, vasculature, and epithelial layers due to hormones, pregnancy, disease states like endometriosis or PCOS, and that these changes can impact fertility, implantation, and uterine function.
Cycle Irregularity (Oligomenorrhea / Polymenorrhea): Are common, especially in adolescents and women with conditions like PCOS or acromegaly, are not strongly linked to age at menarche or BMI, may be associated with hormonal and metabolic disturbances, and can increase risks for cardiovascular disease and certain ovarian cancer subtypes.
Oligomenorrhea: a common menstrual disorder associated with factors such as obesity, hormonal imbalances, polycystic ovarian morphology, stress, high exercise volume, and increased risks of infertility, metabolic disturbances, and asthma, and may be managed with personalized treatments including traditional Chinese medicine.
Polymenorrhea: Defined as menstrual cycles occurring less than 21 days apart, is commonly associated with hormonal imbalances, stress, metabolic or psychological factors, and can be a frequent menstrual irregularity especially in adolescents and after certain triggers like COVID-19 vaccination.
“Silent” Endometriosis / Recurrence: Unlike RRM excision surgery, standard endometriosis surgeries often have a high recurrence rate, and use post-operative hormones to suppress symptoms and pain. Standard care tracks biomarkers like miR-20a to detect recurrence, and requires regular monitoring to prevent “silent” organ damage in deep endometriosis.
Age-Related Embryo Aneuploidy: Increases significantly with maternal age due to errors in chromosome segregation during oocyte meiosis, leading to higher rates of infertility, miscarriage, and complex chromosomal abnormalities, while paternal age has little to no effect.
AMH (Anti-Müllerian Hormone): Hormone indicating ovarian reserve.
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