II 

118TH CONGRESS 

2D SESSION S. 4533 

To expand and promote research and data collection on reproductive health 

conditions, to provide training opportunities for medical professionals 

to learn how to diagnose and treat reproductive health conditions, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 13, 2024 

Mrs. HYDE-SMITH (for herself, Mr. LANKFORD, Mr. CORNYN, Mr. WICKER, 

Mr. RICKETTS, Mr. MULLIN, and Mr. GRASSLEY) introduced the following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A BILL 

To expand and promote research and data collection on 

reproductive health conditions, to provide training opportunities for medical professionals to learn how to diagnose and treat reproductive health conditions, and for 

other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Reproductive Em5 powerment and Support through Optimal Restoration 

6 Act’’ or the ‘‘RESTORE Act’’. 


ssavage on LAPJG3WLY3PROD with BILLS
2 

•S 4533 IS

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) In vitro fertilization and other assisted re4 productive technologies are not under threat at the 

5 Federal level or in any State or territory of the 

6 United States. 

7 (2) There is a growing interest among women 

8 to proactively assess their overall health and under9 stand how factors such as age and medical history 

10 contribute to reproductive health and fertility. 

11 (3) Women are worthy of the highest standard 

12 of medical care, including the opportunity to assess, 

13 understand, and improve their reproductive health. 

14 Unfortunately, many women do not receive adequate 

15 information about their reproductive health and do 

16 not have access to restorative reproductive medicine. 

17 (4) Reproductive health conditions are the lead18 ing causes of infertility, which affects 15 to 16 per19 cent of couples in the United States. Such conditions 

20 include the following: 

21 (A) Endometriosis, a disease where tissue 

22 resembling endometrial lining tissue grows out23 side of the uterus. The tissue often adheres to 

24 different organs, disfiguring them and, through 

25 scar tissue or adhesions, can make the organs 

26 stick to one another or to the pelvic walls. It 


ssavage on LAPJG3WLY3PROD with BILLS
3 

•S 4533 IS

1 has been found in the abdominal organs, the 

2 bowel, the diaphragm, the lungs, the brain, and 

3 the eye. It is a progressive disease and has been 

4 compared to growing like cancer. Endometriosis 

5 is often diagnosed in stages, with Stage I as the 

6 mildest form and Stage IV as the most severe 

7 and widespread form. The average diagnosis 

8 delay for endometriosis is 6 to 12 years. Endo9 metriosis frequently goes undiagnosed, and 

10 women may suffer for years with painful peri11 ods, pelvic pain, or infertility. The cause of 

12 endometriosis is unknown. 

13 (B) Adenomyosis, a disease that occurs 

14 when endometrial tissue (tissue that would nor15 mally line the inside of the uterus) grows into 

16 the muscle layer of the uterus. Adenomyosis is 

17 different from, but can exist concurrently with, 

18 endometriosis. Adenomyosis may increase the 

19 risk of miscarriage and preterm labor and may 

20 contribute to infertility. The cause of 

21 adenomyosis is unknown. 

22 (C) Polycystic ovary syndrome, a reproduc23 tive hormonal disorder that causes cysts to 

24 grow on the ovaries, usually as a result of hor25 monal imbalances. Polycystic ovary syndrome 


ssavage on LAPJG3WLY3PROD with BILLS
4 

•S 4533 IS

1 affects approximately 15 percent of women 

2 overall but is more common among women with 

3 infertility. It is more prevalent among women 

4 with obesity and insulin resistance. Women with 

5 polycystic ovary syndrome who are trying to 

6 achieve pregnancy are commonly prescribed oral 

7 ovulation medication and hormonal injections 

8 that stimulate ovulation. Effective diagnosis 

9 and treatment exist, and should be made avail10 able for all women. Accurate and timely diag11 nosis and treatment can correct underlying hor12 monal imbalances, critical for both long-term 

13 health improvements as well as for fertility out14 comes. 

15 (D) Uterine fibroids, which are muscular 

16 tumors that grow in the wall of the uterus. 

17 While not all women will experience symptoms 

18 associated with fibroids, if the tumors are large 

19 enough or embedded far enough in the uterine 

20 lining, they can lead to pain and heavy bleed21 ing. Treatment for fibroids may include assess22 ment of underlying hormonal imbalances, 

23 hysteroscopic myomectomy, abdominal 

24 myomectomy, uterine fibroid embolization, and 

25 uterine artery embolization. Uterine fibroids 


ssavage on LAPJG3WLY3PROD with BILLS
5 

•S 4533 IS

1 can increase risks of preterm labor, pregnancy 

2 complications leading to a cesarean section, and 

3 placental abruption, among other risks. The 

4 cause of uterine fibroids is unknown. 

5 (E) Blocked fallopian tubes, a condition 

6 where the fallopian tubes are blocked by tubal 

7 spasm, scarring from inflammatory conditions, 

8 debris, tubal polyps, tubal ligation, prior ectopic 

9 pregnancy, pelvic adhesions, endometriosis, 

10 prior pelvic infection (pelvic inflammatory dis11 ease or ‘‘PID’’). Approximately 1 in 4 women 

12 with infertility have a tubal blockage. This con13 dition makes achieving pregnancy difficult, if 

14 not impossible. Treatments for a blockage in15 clude fallopian tube recanalization, tubo-tubal 

16 anastomosis (tubal ligation reversal), or 

17 neosalpingostomy/fimbrioplasty. 

18 (5) Research shows 4 or more conditions or fac19 tors are the cause of most male and female infer20 tility. 

21 (6) There is a gap in research and care for 

22 male and female reproductive health conditions, 

23 which affect many Americans struggling with unex24 plained infertility. 


ssavage on LAPJG3WLY3PROD with BILLS
6 

•S 4533 IS

1 (7) Restorative reproductive medicine aims to 

2 diagnose and treat underlying hormonal and other 

3 imbalances, restore health where possible, and im4 prove women’s health functioning and long-term out5 comes. 

6 (8) Restorative reproductive medicine can elimi7 nate barriers to successful conception, pregnancy, 

8 and birth. It can also address some causes of recur9 rent miscarriages. 

10 (9) Restorative reproductive medicine often alle11 viates other difficult symptoms associated with re12 productive health conditions, including hormonal 

13 acne, hormonal weight gain, hormonal mood and de14 pression, painful periods, painful flare-ups, bloating, 

15 inflammation, heavy periods, irregular periods, nerve 

16 pain, bowel symptoms, pain during sexual inter17 course, and back pain. 

18 SEC. 3. DEFINITIONS. 

19 In this Act: 

20 (1) ASSISTED REPRODUCTIVE TECHNOLOGY.— 

21 The term ‘‘assisted reproductive technology’’ means 

22 any treatments or procedures that involve the han23 dling of a human egg, sperm, and embryo outside of 

24 the body with the intent of facilitating a pregnancy, 

25 including artificial insemination, intrauterine insemiVerDate Sep 11 2014 01:15 Aug 03, 2024 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4533.IS S4533

ssavage on LAPJG3WLY3PROD with BILLS
7 

•S 4533 IS

1 nation, in vitro fertilization, gamete intrafallopian 

2 fertilization, zygote intrafallopian fertilization, egg, 

3 embryo, and sperm cryopreservation, and egg or em4 bryo donation. 

5 (2) FERTILITY AWARENESS-BASED METHODS.— 

6 The term ‘‘fertility awareness-based methods’’ 

7 means modern, evidence-based methods of tracking 

8 the menstrual cycle through observable biological 

9 signs in a woman, such as body temperature, cer10 vical fluid, and hormone production in the reproduc11 tive system, including luteinizing hormone (LH) and 

12 estrogen. Such methods include Fertility Education 

13 and Medical Management, the sympto thermal meth14 od, the Marquette method, the Creighton method, 

15 and the Billings ovulation method. 

16 (3) FERTILITY EDUCATION AND MEDICAL MAN17 AGEMENT.—The term ‘‘fertility education and med18 ical management’’ means the program developed in 

19 collaboration with the Reproductive Health Research 

20 Institute for medical research, protocols, and med21 ical training for health care professionals in order to 

22 enable the clinical application of important research 

23 advances in reproductive endocrinology, by providing 

24 education for women about their bodies and hor25 monal health and medical support, as appropriate. 


ssavage on LAPJG3WLY3PROD with BILLS
8 

•S 4533 IS

1 (4) INFERTILITY.—The term ‘‘infertility’’ 

2 means a symptom of an underlying disease or condi3 tion within a person’s body that makes it difficult or 

4 impossible to successfully conceive and carry a child 

5 to term, which is diagnosed after 12 months of 

6 intercourse without the use of a chemical, barrier, or 

7 other contraceptive method for women under 35 or 

8 after 6 months of targeted intercourse without the 

9 use of a chemical, barrier, or other contraceptive 

10 method for women 35 and older, where conception 

11 should otherwise be possible. 

12 (5) NATURAL PROCREATIVE TECHNOLOGY; 

13 NAPROTECHNOLOGY.—The term ‘‘Natural Pro14 creative Technology’’ or ‘‘NaProTECHNOLOGY’’ 

15 means an approach to health care that monitors and 

16 maintains a woman’s reproductive and gynecological 

17 health, including laparoscopic gynecologic surgery to 

18 reconstruct the uterus, fallopian tubes, ovaries, and 

19 other organ structures to eliminate endometriosis 

20 and other reproductive health conditions. 

21 (6) REPRODUCTIVE HEALTH CONDITIONS.— 

22 The term ‘‘reproductive health conditions’’ includes 

23 endometriosis, adenomyosis, polycystic ovary syn24 drome, uterine fibroids, blocked fallopian tubes, hor25 mone imbalances, hyperprolactinemia, thyroid condiVerDate Sep 11 2014 01:15 Aug 03, 2024 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4533.IS S4533

ssavage on LAPJG3WLY3PROD with BILLS
9 

•S 4533 IS

1 tions, ovulation dysfunctions, and other health condi2 tions that make it difficult or impossible to success3 fully conceive a child where conception should other4 wise be possible. 

5 (7) RESTORATIVE REPRODUCTIVE HEALTH.— 

6 The term ‘‘restorative reproductive health’’ includes 

7 empowering women and men to know and under8 stand their bodies and appreciate the importance of 

9 natural reproductive health to overall health and 

10 well-being, including through the use of body literacy 

11 programs that incorporate science-based charting 

12 methods, teacher lead reproductive health education, 

13 restorative reproductive medicine, Natural Pro14 creative Technology, fertility awareness-based meth15 ods, and fertility education and medical manage16 ment. 

17 (8) RESTORATIVE REPRODUCTIVE MEDICINE.— 

18 The term ‘‘restorative reproductive medicine’’— 

19 (A) means any scientific approach to re20 productive medicine that seeks to cooperate 

21 with, or restore the normal physiology and 

22 anatomy of, the human reproductive system, 

23 without the use of methods that are inherently 

24 suppressive, circumventive, or destructive to 

25 natural human functions; and 


ssavage on LAPJG3WLY3PROD with BILLS
10 

•S 4533 IS

1 (B) may include ultrasounds, blood tests, 

2 hormone panels, laparoscopic and exploratory 

3 surgeries, examining the man’s or woman’s 

4 overall health and lifestyle, eliminating environ5 mental endocrine disruptors, and assessing the 

6 health and fertility of the individual’s partner, 

7 Natural Procreative Technology, fertility aware8 ness-based methods, and fertility education and 

9 medical management. 

10 SEC. 4. PROHIBITING DISCRIMINATION AGAINST HEALTH 

11 CARE PROVIDERS WHO DO NOT PARTICIPATE 

12 IN ASSISTED REPRODUCTIVE TECHNOLOGY. 

13 Notwithstanding any other law, the Federal Govern14 ment, and any person or entity that receives Federal fi15 nancial assistance, including any State or local govern16 ment, may not penalize, retaliate against, or otherwise dis17 criminate against a health care provider on the basis that 

18 the provider does not or declines to— 

19 (1) assist in, receive training in, provide, per20 form, refer for, pay for, or otherwise participate in 

21 assisted reproductive technology; or 

22 (2) facilitate or make arrangements for any of 

23 the activities specified in paragraph (1) in a manner 

24 that violates the provider’s sincerely held religious 

25 beliefs or moral convictions. 


ssavage on LAPJG3WLY3PROD with BILLS
11 

•S 4533 IS

1 SEC. 5. IMPLEMENTING LITERATURE REVIEWS ON THE 

2 STANDARD OF CARE FOR THE DIAGNOSIS OF 

3 INFERTILITY. 

4 (a) IN GENERAL.—The Assistant Secretary for 

5 Health of the Department of Health and Human Services 

6 (referred to in this section as the ‘‘Assistant Secretary’’) 

7 shall collect data on the topics described in subsection (b) 

8 and, not later than 2 years after the date of enactment 

9 of this Act and every 3 years thereafter, issue a report 

10 on the standard of care for women who have been diag11 nosed with infertility. 

12 (b) TOPICS.—In carrying out subsection (a), the As13 sistant Secretary shall— 

14 (1) assess peer-reviewed studies on referrals to 

15 restorative reproductive medicine that are given 

16 prior to referrals for or use of assisted reproductive 

17 technology; 

18 (2) assess peer-reviewed studies related to ac19 cess to patient and health care provider information 

20 and training for fertility awareness-based methods; 

21 and 

22 (3) assess the extent to which the treatments, 

23 tests, and training described in paragraphs (1) and 

24 (2) are covered under public and private health 

25 plans. 


ssavage on LAPJG3WLY3PROD with BILLS
12 

•S 4533 IS

1 (c) PRIVACY REQUIREMENTS.—In carrying out sub2 section (a), the Assistant Secretary shall ensure that the 

3 privacy and confidentiality of individual patients are pro4 tected in a manner consistent with relevant privacy and 

5 confidentiality law. 

6 SEC. 6. IMPLEMENTING LITERATURE REVIEWS ON THE 

7 STANDARD OF CARE FOR WOMEN SEEKING A 

8 REPRODUCTIVE HEALTH CONDITION DIAG9 NOSIS. 

10 (a) IN GENERAL.—The Assistant Secretary for 

11 Health of the Department of Health and Human Services 

12 (referred to in this section as the ‘‘Assistant Secretary’’) 

13 shall collect data on the topics described in subsection (b) 

14 and, not later than 2 years after the date of enactment 

15 of this Act and every 3 years thereafter, issue a report 

16 on the standard of care for women seeking reproductive 

17 health condition diagnoses. 

18 (b) TOPICS.—In carrying out paragraph (1), the As19 sistant Secretary shall— 

20 (1) assess peer-reviewed studies related to ac21 cess to restorative reproductive medicine and restor22 ative reproductive health, including access to medical 

23 professionals trained in NaProTechnology and fer24 tility education and medical management; 


ssavage on LAPJG3WLY3PROD with BILLS
13 

•S 4533 IS

1 (2) assess peer-reviewed studies related to ac2 cess to information and training on fertility aware3 ness-based methods; and 

4 (3) assess the extent to which the treatments, 

5 tests, and training described in paragraphs (1) and 

6 (2) are covered under public and private health 

7 plans. 

8 (c) PRIVACY REQUIREMENTS.—In carrying out sub9 section (a), the Assistant Secretary shall ensure that the 

10 privacy and confidentiality of individual patients are pro11 tected in a manner consistent with relevant privacy and 

12 confidentiality law. 

13 SEC. 7. EXPANDING THE NATIONAL SURVEY OF FAMILY 

14 GROWTH TO INCLUDE REPRODUCTIVE 

15 HEALTH CONDITIONS, RESTORATIVE REPRO16 DUCTIVE MEDICINE, AND FERTILITY AWARE17 NESS-BASED METHODS. 

18 (a) IN GENERAL.—The Director of the Centers for 

19 Disease Control and Prevention (referred to in this section 

20 as the ‘‘Director’’) shall evaluate the National Survey of 

21 Family Growth conducted by the National Center for 

22 Health Statistics of the Centers for Disease Control and 

23 Prevention and consider making modifications to the sur24 vey questions used for such purposes. 


ssavage on LAPJG3WLY3PROD with BILLS
14 

•S 4533 IS

1 (b) TOPICS.—The evaluation by the Director pursu2 ant to subsection shall include consideration of adding 

3 questions related to— 

4 (1) restorative reproductive health; 

5 (2) reproductive health conditions and infer6 tility; 

7 (3) restorative reproductive medicine availability 

8 and utilization; and 

9 (4) availability of, and training on, fertility 

10 awareness-based methods. 

11 (c) REPORT.—The Director shall submit to Congress 

12 a report on the evaluation under subsection (a) not later 

13 than 3 years after the date of enactment of this Act and 

14 every 3 years thereafter. 

15 SEC. 8. INCLUDING ACCESS TO TITLE X AWARD FUNDS FOR 

16 RESTORATIVE REPRODUCTIVE MEDICINE 

17 GRANTEES. 

18 Section 1006 of the Public Health Service Act (42 

19 U.S.C. 300a–4) is amended by adding at the end the fol20 lowing: 

21 ‘‘(e)(1) Notwithstanding any other requirements re22 lating to the experience required for an applicant to qual23 ify for a grant or contract under this title, an entity shall 

24 be deemed eligible for a grant or contract under this title 

25 on the basis of being primarily engaged in providing reVerDate Sep 11 2014 01:15 Aug 03, 2024 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S4533.IS S4533

ssavage on LAPJG3WLY3PROD with BILLS
15 

•S 4533 IS

1 storative reproductive medicine, or providing training and 

2 education for medical students and professionals in restor3 ative reproductive medicine, provided that such entity is 

4 otherwise eligible for the grant or contract. 

5 ‘‘(2) In this subsection, the term ‘restorative repro6 ductive medicine’ has the meaning given such term in sec7 tion 3 of the RESTORE Act.’’. 

8 SEC. 9. ADVANCING EDUCATION ON REPRODUCTIVE 

9 HEALTH CONDITIONS AND WOMEN’S NAT10 URAL CYCLE. 

11 (a) EXPANDING GRANT ACCESS AND APPLICA12 TION.—The Deputy Assistant Secretary for Population 

13 Affairs of the Department of Health and Human Services 

14 (referred to in this section as the ‘‘Deputy Assistant Sec15 retary’’) shall develop, within the existing Teen Pregnancy 

16 Prevention program, access to, and advertisement for, ap17 plicants for grants under such program that specialize in 

18 restorative reproductive medicine, restorative reproductive 

19 health, and fertility awareness-based methods. To be eligi20 ble to receive an award under this subsection, an entity 

21 shall be primarily engaged in services or education relating 

22 to restorative reproductive medicine, restorative reproduc23 tive health, or fertility awareness-based methods. 

24 (b) REPORT.—Not later than 18 months after the 

25 date of enactment of this Act, the Deputy Assistant SecVerDate Sep 11 2014 01:15 Aug 03, 2024 Jkt 049200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S4533.IS S4533

ssavage on LAPJG3WLY3PROD with BILLS
16 

•S 4533 IS

1 retary shall submit to Congress and make publicly avail2 able on the website of the Office of Population Affairs a 

3 report on recipients of grants under the Teen Pregnancy 

4 Prevention program and the services, education, and 

5 training provided by such recipients. 

6 SEC. 10. ADVANCING RESTORATIVE REPRODUCTIVE MEDI7 CINE AND FERTILITY AWARENESS-BASED 

8 METHODS TRAINING UNDER THE REPRODUC9 TIVE HEALTH NATIONAL TRAINING CENTER. 

10 (a) IN GENERAL.—The Assistant Secretary for 

11 Health of the Department of Health and Human Services 

12 (referred to in this section as the ‘‘Assistant Secretary’’) 

13 shall coordinate with the Office of Population Affairs and 

14 the Office on Women’s Health to review, revise, and in15 struct the staff of the Reproductive Health National 

16 Training Center on reproductive health conditions, restor17 ative reproductive medicine, restorative reproductive 

18 health, and fertility awareness-based methods. 

19 (b) TRAINING.—Beginning not later than 2 years 

20 after the date of enactment of this Act, as a condition 

21 for receipt of a grant or contract under title X of the Pub22 lic Health Service Act (42 U.S.C. 300 et seq.), the staff 

23 of the Reproductive Health National Training Center shall 

24 provide training to staff working in other entities receiving 

25 grants or contracts under title X of the Public Health 


ssavage on LAPJG3WLY3PROD with BILLS
17 

•S 4533 IS

1 Service Act (42 U.S.C. 300 et seq.) about reproductive 

2 health conditions, restorative reproductive medicine, re3 storative reproductive health, and fertility awareness4 based methods, which may include providing toolkits and 

5 other information, including online, about peer learning 

6 opportunities, NaProTechnology educational fellowships, 

7 fertility education and medical management, short videos 

8 on reproductive health conditions and restorative repro9 ductive medicine, and contract medical professional semi10 nars and training. 

11 SEC. 11. EXPANDING RESEARCH ON REPRODUCTIVE 

12 HEALTH CONDITIONS, FERTILITY AWARE13 NESS-BASED METHODS, AND INFERTILITY. 

14 (a) IN GENERAL.—The Secretary of Health and 

15 Human Services (referred to in this section as the ‘‘Sec16 retary’’), in coordination with the Assistant Secretary for 

17 Health, the Director of the Agency for Healthcare Re18 search and Quality, the Director of the Advanced Re19 search Projects Agency for Health, the Director of the 

20 Centers for Disease and Control, the Director of the Na21 tional Institutes for Health, and the heads of other agen22 cies and offices of the Department of Health and Human 

23 Services that are conducting research on reproductive 

24 health conditions, infertility, and maternal health, shall 


ssavage on LAPJG3WLY3PROD with BILLS
18 

•S 4533 IS

1 expand and coordinate programs to conduct and support 

2 research on reproductive health conditions. 

3 (b) TOPICS.—The research directed by the Secretary 

4 pursuant to subsection (a) may include research on— 

5 (1) the causes of reproductive health conditions, 

6 especially endometriosis, adenomyosis, uterine 

7 fibroids, and polycystic ovary syndrome; 

8 (2) ways to diagnose reproductive health condi9 tions; 

10 (3) restorative reproductive medicine and new 

11 treatment options for reproductive health conditions; 

12 (4) endocrine disrupting chemicals in endo13 metriosis, the relationship of endometriosis and can14 cer, prenatal and epigenetic influences on the risk 

15 for endometriosis; 

16 (5) premenstrual syndrome, hormone dysfunc17 tion, ovulation defects, abnormal uterine bleeding, 

18 adhesion prevention, tubal corrective surgery, and 

19 preconception and pregnancy health; 

20 (6) the growth and progression of reproductive 

21 health conditions and recurrence post-surgical proce22 dures; 

23 (7) the increasing prevalence of sexually trans24 mitted infections and related effects on fertility in 

25 men and women; 


ssavage on LAPJG3WLY3PROD with BILLS
19 

•S 4533 IS

1 (8) male mechanisms of infertility, including 

2 low sperm count; and 

3 (9) the effectiveness of restorative reproductive 

4 medicine to achieve pregnancy. 

5 (c) REPORT.—Not later than 2 years after the date 

6 of enactment of this Act, the Secretary shall make an on7 going report on the research publicly available on the 

8 website of the Department of Health and Human Services. 

9 SEC. 12. SEVERABILITY. 

10 If any provision of this Act, or the application of such 

11 provision to any person, entity, government, or cir12 cumstance, is held to be unconstitutional, the remainder 

13 of this Act, or the application of such provision to all other 

14 persons, entities, governments, or circumstances, shall not 

15 be affected thereby. 

Æ 


ssavage on LAPJG3WLY3PROD with BILLS