A systematic review of restorative reproductive medicine practices

OBJECTIVE: To determine if RRM is associated with improved live birth compared to no treatment or standard of care. EVIDENCE REVIEW: This prospectively registered systematic review evaluated the impact of RRM interventions compared with standard of care or no treatment (CRD420251175446). Interventions included dietary modifications (including vitamins and supplements), routine operative laparoscopy for endometriosis, and fertility-based awareness methods. The primary outcome was LB. Secondary outcomes included clinical pregnancy rates and time to conceive. Only randomized controlled trials were included. Studies involving male-factor infertility or assisted reproductive technology were excluded. Risk of bias was assessed using the Cochrane risk-of-bias tool. RESULTS: A total of 5351 articles were screened, of which 15 met our inclusion criteria. These included 12 studies evaluating dietary interventions (including myo-inositol, probiotics, vitamin C, vitamin E, omega-3, N-acetyl cysteine, selenium, black cohosh and other nutritional supplements), three studies assessing routine operative laparoscopy for endometriosis, and one study evaluating fertility-based awareness methods. Most studies investigating dietary interventions reported negative findings or no statistically significant differences between the groups. In a similar vein, the three surgical studies yielded conflicting results. The single study evaluating fertility-based awareness methods reported a higher clinical pregnancy rate among participants using ovulation predictor kits (OPK) with self-reported pregnancy. Using the Cochrane risk-of-bias tool, 7/15 were judged to have a high risk of bias (47%), 6/15 were judged to have some concerns (40%), and 2/15 were judged to be low risk (13%). There are limited data supporting the impact of these interventions on our secondary outcomes. CONCLUSIONS: These findings highlight insufficient evidence to recommend the routine use of additional vitamins/supplements beyond those currently recommended by clinical guidelines. Similarly, the available evidence is insufficient to support the routine use of operative laparoscopy for endometriosis in women with infertility. Data to support the effectiveness of fertility-based awareness methods also remain limited.