Infertility is a medical condition shaped by biology, timing, and access to care. But in the U.S., reproductive health education has largely been focused on preventing pregnancy, not helping people become pregnant. Male factors contribute to nearly half of infertility cases, but as Cosmopolitan revealed in an exclusive survey, men are already much less likely to be talking to doctors about their fertility until it’s too late. Now, shifts in federal policy, especially around the Title X program, risk widening this gap.
When it comes to infertility, our system doesn’t just fall short; it often fails to show up at all. Many health plans don’t cover infertility. Medicaid coverage is inconsistent and often minimal. Even basic testing, imaging, and diagnosis can be out of reach financially because patients face out-of-pocket costs that make care out of reach, so people delay or never seek it at all.
Title X is the only federal program dedicated to comprehensive family planning and preventive health services, including basic infertility care for women and men, and it primarily serves low-income, uninsured, and underinsured patients. About 60 percent of people who receive care at Title X–funded clinics say it’s their only source of health care. But the program has been flat-funded since 2014. A recent federal estimate found it would need $1.38 billion annually to meet patient needs.
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Instead of strengthening Title X, new federal priorities issued this month are elevating “restorative reproductive medicine,” or RRM, as a preferred approach to fertility care. The concept sounds promising: focus on identifying root causes and supporting the body’s ability to conceive. Many of its tools, like hormone tracking and diagnostic testing, are already standard components of care.
But an RRM approach often does not include evidence-based treatments like in vitro fertilization, intrauterine insemination, and fertility preservation. It also focuses primarily on female infertility, overlooking male factors and excluding LGBTQIA+ couples and solo parents.
If RRM is prioritized within programs like Title X, it would steer limited public funding toward narrower, less inclusive models of care and limit access to evidence-based treatments that help people get pregnant.
This would mean low-income patients without insurance won’t be able to receive this care. It would reinforce the idea that infertility is a personal failure, primarily a women’s issue, or can be solved through lifestyle changes alone. And it would also further sideline male infertility—overlooking conditions like low sperm count or abnormal sperm shape—by centering care almost entirely on women and delaying accurate diagnosis and effective treatment for men.
Patients deserve support in understanding their bodies and exploring every path to building a family. If fully funded and grounded in evidence-based care, Title X could expand access to basic fertility care for those who need it most, including men, low-income patients, LGBTQIA+ people, and the underinsured. If reshaped to advance an ideological agenda, it risks falling even further short of that promise.
Reproductive health care should be guided by science and patient choice, and that includes the ability not just to prevent pregnancy but to build a family.
