,,ii #aahth ,,congress #b;d ,session ,s4 #decc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #ac1 #bjbd,mrs4 ,hyde-,smith 7for herself1 ,mr4 ,lankford1 ,mr4 ,cornyn1 ,mr4 ,wicker1 ,mr4 ,ricketts1 ,mr4 ,mullin1 and ,mr4 ,grassley7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to expand and promote research and data collection on reproductive health conditions1 to provide training opportunities for medical professionals to learn how to diagnose and treat reproductive health conditions1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,reproductive ,empowerment and ,support through ,optimal ,restoration ,act or the ,,restore ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,in vitro fertilization and other assisted reproductive technologies are not under threat at the ,federal level or in any ,state or territory of the ,united ,states4 7#b7 ,there is a growing interest among women to proactively assess their overall health and understand how factors such as age and medical history contribute to reproductive health and fertility4 7#c7 ,women are worthy of the highest standard of medical care1 including the opportunity to assess1 understand1 and improve their reproductive health4 ,unfortunately1 many women do not receive adequate information about their reproductive health and do not have access to restorative reproductive medicine4 7#d7 ,reproductive health conditions are the leading causes of infertility1 which affects #ae to #af percent of couples in the ,united ,states4 ,such conditions include the following3 7,a7 ,endometriosis1 a disease where tissue resembling endometrial lining tissue grows outside of the uterus4 ,the tissue often adheres to different organs1 disfiguring them and1 through scar tissue or adhesions1 can make the organs stick to one another or to the pelvic walls4 ,it has been found in the abdominal organs1 the bowel1 the diaphragm1 the lungs1 the brain1 and the eye4 ,it is a progressive disease and has been compared to growing like cancer4 ,endometriosis is often diagnosed in stages1 with ,stage ,i as the mildest form and ,stage ,,iv as the most severe and widespread form4 ,the average diagnosis delay for endometriosis is #f to #ab years4 ,endometriosis frequently goes undiagnosed1 and women may suffer for years with painful periods1 pelvic pain1 or infertility4 ,the cause of endometriosis is unknown4 7,b7 ,adenomyosis1 a disease that occurs when endometrial tissue 7tissue that would normally line the inside of the uterus7 grows into the muscle layer of the uterus4 ,adenomyosis is different from1 but can exist concurrently with1 endometriosis4 ,adenomyosis may increase the risk of miscarriage and preterm labor and may contribute to infertility4 ,the cause of adenomyosis is unknown4 7,c7 ,polycystic ovary syndrome1 a reproductive hormonal disorder that causes cysts to grow on the ovaries1 usually as a result of hormonal imbalances4 ,polycystic ovary syndrome affects approximately #ae percent of women overall but is more common among women with infertility4 ,it is more prevalent among women with obesity and insulin resistance4 ,women with polycystic ovary syndrome who are trying to achieve pregnancy are commonly prescribed oral ovulation medication and hormonal injections that stimulate ovulation4 ,effective diagnosis and treatment exist1 and should be made available for all women4 ,accurate and timely diagnosis and treatment can correct underlying hormonal imbalances1 critical for both long-term health improvements as well as for fertility outcomes4 7,d7 ,uterine fibroids1 which are muscular tumors that grow in the wall of the uterus4 ,while not all women will experience symptoms associated with fibroids1 if the tumors are large enough or embedded far enough in the uterine lining1 they can lead to pain and heavy bleeding4 ,treatment for fibroids may include assessment of underlying hormonal imbalances1 hysteroscopic myomectomy1 abdominal myomectomy1 uterine fibroid embolization1 and uterine artery embolization4 ,uterine fibroids can increase risks of preterm labor1 pregnancy complications leading to a cesarean section1 and placental abruption1 among other risks4 ,the cause of uterine fibroids is unknown4 7,e7 ,blocked fallopian tubes1 a condition where the fallopian tubes are blocked by tubal spasm1 scarring from inflammatory conditions1 debris1 tubal polyps1 tubal ligation1 prior ectopic pregnancy1 pelvic adhesions1 endometriosis1 prior pelvic infection 7pelvic inflammatory disease or ,,pid74 ,approximately #a in #d women with infertility have a tubal blockage4 ,this condition makes achieving pregnancy difficult1 if not impossible4 ,treatments for a blockage include fallopian tube recanalization1 tubo-tubal anastomosis 7tubal ligation reversal71 or neosalpingostomy_/fimbrioplasty4 7#e7 ,research shows #d or more conditions or factors are the cause of most male and female infertility4 7#f7 ,there is a gap in research and care for male and female reproductive health conditions1 which affect many ,americans struggling with unexplained infertility4 7#g7 ,restorative reproductive medicine aims to diagnose and treat underlying hormonal and other imbalances1 restore health where possible1 and improve women's health functioning and long-term outcomes4 7#h7 ,restorative reproductive medicine can eliminate barriers to successful conception1 pregnancy1 and birth4 ,it can also address some causes of recurrent miscarriages4 7#i7 ,restorative reproductive medicine often alleviates other difficult symptoms associated with reproductive health conditions1 including hormonal acne1 hormonal weight gain1 hormonal mood and depression1 painful periods1 painful flare-ups1 bloating1 inflammation1 heavy periods1 irregular periods1 nerve pain1 bowel symptoms1 pain during sexual intercourse1 and back pain4 #c4 ,definitions ,in this ,act3 7#a7 ,assisted reproductive technology ,the term assisted reproductive technology means any treatments or procedures that involve the handling of a human egg1 sperm1 and embryo outside of the body with the intent of facilitating a pregnancy1 including artificial insemination1 intrauterine insemination1 in vitro fertilization1 gamete intrafallopian fertilization1 zygote intrafallopian fertilization1 egg1 embryo1 and sperm cryopreservation1 and egg or embryo donation4 7#b7 ,fertility awareness-based methods ,the term fertility awareness-based methods means modern1 evidence-based methods of tracking the menstrual cycle through observable biological signs in a woman1 such as body temperature1 cervical fluid1 and hormone production in the reproductive system1 including luteinizing hormone 7,,lh7 and estrogen4 ,such methods include ,fertility ,education and ,medical ,management1 the sympto thermal method1 the ,marquette method1 the ,creighton method1 and the ,billings ovulation method4 7#c7 ,fertility education and medical management ,the term fertility education and medical management means the program developed in collaboration with the ,reproductive ,health ,research ,institute for medical research1 protocols1 and medical training for health care professionals in order to enable the clinical application of important research advances in reproductive endocrinology1 by providing education for women about their bodies and hormonal health and medical support1 as appropriate4 7#d7 ,infertility ,the term infertility means a symptom of an underlying disease or condition within a person's body that makes it difficult or impossible to successfully conceive and carry a child to term1 which is diagnosed after #ab months of intercourse without the use of a chemical1 barrier1 or other contraceptive method for women under #ce or after #f months of targeted intercourse without the use of a chemical1 barrier1 or other contraceptive method for women #ce and older1 where conception should otherwise be possible4 7#e7 ,natural procreative technology2 ,na,pro,t,e,c,h,n,o,l,o,g,y ,the term ,natural ,procreative ,technology or ,na,pro,t,e,c,h,n,o,l,o,g,y means an approach to health care that monitors and maintains a woman's reproductive and gynecological health1 including laparoscopic gynecologic surgery to reconstruct the uterus1 fallopian tubes1 ovaries1 and other organ structures to eliminate endometriosis and other reproductive health conditions4 7#f7 ,reproductive health conditions ,the term reproductive health conditions includes endometriosis1 adenomyosis1 polycystic ovary syndrome1 uterine fibroids1 blocked fallopian tubes1 hormone imbalances1 hyperprolactinemia1 thyroid conditions1 ovulation dysfunctions1 and other health conditions that make it difficult or impossible to successfully conceive a child where conception should otherwise be possible4 7#g7 ,restorative reproductive health ,the term restorative reproductive health includes empowering women and men to know and understand their bodies and appreciate the importance of natural reproductive health to overall health and well-being1 including through the use of body literacy programs that incorporate science-based charting methods1 teacher lead reproductive health education1 restorative reproductive medicine1 ,natural ,procreative ,technology1 fertility awareness-based methods1 and fertility education and medical management4 7#h7 ,restorative reproductive medicine ,the term restorative reproductive medicine-- 7,a7 means any scientific approach to reproductive medicine that seeks to cooperate with1 or restore the normal physiology and anatomy of1 the human reproductive system1 without the use of methods that are inherently suppressive1 circumventive1 or destructive to natural human functions2 and 7,b7 may include ultrasounds1 blood tests1 hormone panels1 laparoscopic and exploratory surgeries1 examining the man's or woman's overall health and lifestyle1 eliminating environmental endocrine disruptors1 and assessing the health and fertility of the individual's partner1 ,natural ,procreative ,technology1 fertility awareness-based methods1 and fertility education and medical management4 #d4 ,prohibiting discrimination against health care providers who do not participate in assisted reproductive technology ,notwithstanding any other law1 the ,federal ,government1 and any person or entity that receives ,federal financial assistance1 including any ,state or local government1 may not penalize1 retaliate against1 or otherwise discriminate against a health care provider on the basis that the provider does not or declines to-- 7#a7 assist in1 receive training in1 provide1 perform1 refer for1 pay for1 or otherwise participate in assisted reproductive technology2 or 7#b7 facilitate or make arrangements for any of the activities specified in paragraph 7#a7 in a manner that violates the provider's sincerely held religious beliefs or moral convictions4 #e4 ,implementing literature reviews on the standard of care for the diagnosis of infertility 7a7 ,in general ,the ,assistant ,secretary for ,health of the ,department of ,health and ,human ,services 7referred to in this section as the ,assistant ,secretary7 shall collect data on the topics described in subsection 7b7 and1 not later than #b years after the date of enactment of this ,act and every #c years thereafter1 issue a report on the standard of care for women who have been diagnosed with infertility4 7b7 ,topics ,in carrying out subsection 7a71 the ,assistant ,secretary shall-- 7#a7 assess peer-reviewed studies on referrals to restorative reproductive medicine that are given prior to referrals for or use of assisted reproductive technology2 7#b7 assess peer-reviewed studies related to access to patient and health care provider information and training for fertility awareness-based methods2 and 7#c7 assess the extent to which the treatments1 tests1 and training described in paragraphs 7#a7 and 7#b7 are covered under public and private health plans4 7c7 ,privacy requirements ,in carrying out subsection 7a71 the ,assistant ,secretary shall ensure that the privacy and confidentiality of individual patients are protected in a manner consistent with relevant privacy and confidentiality law4 #f4 ,implementing literature reviews on the standard of care for women seeking a reproductive health condition diagnosis 7a7 ,in general ,the ,assistant ,secretary for ,health of the ,department of ,health and ,human ,services 7referred to in this section as the ,assistant ,secretary7 shall collect data on the topics described in subsection 7b7 and1 not later than #b years after the date of enactment of this ,act and every #c years thereafter1 issue a report on the standard of care for women seeking reproductive health condition diagnoses4 7b7 ,topics ,in carrying out paragraph 7#a71 the ,assistant ,secretary shall-- 7#a7 assess peer-reviewed studies related to access to restorative reproductive medicine and restorative reproductive health1 including access to medical professionals trained in ,na,pro,technology and fertility education and medical management2 7#b7 assess peer-reviewed studies related to access to information and training on fertility awareness-based methods2 and 7#c7 assess the extent to which the treatments1 tests1 and training described in paragraphs 7#a7 and 7#b7 are covered under public and private health plans4 7c7 ,privacy requirements ,in carrying out subsection 7a71 the ,assistant ,secretary shall ensure that the privacy and confidentiality of individual patients are protected in a manner consistent with relevant privacy and confidentiality law4 #g4 ,expanding the national survey of family growth to include reproductive health conditions1 restorative reproductive medicine1 and fertility awareness-based methods 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention 7referred to in this section as the ,director7 shall evaluate the ,national ,survey of ,family ,growth conducted by the ,national ,center for ,health ,statistics of the ,centers for ,disease ,control and ,prevention and consider making modifications to the survey questions used for such purposes4 7b7 ,topics ,the evaluation by the ,director pursuant to subsection shall include consideration of adding questions related to-- 7#a7 restorative reproductive health2 7#b7 reproductive health conditions and infertility2 7#c7 restorative reproductive medicine availability and utilization2 and 7#d7 availability of1 and training on1 fertility awareness-based methods4 7c7 ,report ,the ,director shall submit to ,congress a report on the evaluation under subsection 7a7 not later than #c years after the date of enactment of this ,act and every #c years thereafter4 #h4 ,including access to title x award funds for restorative reproductive medicine grantees ,section #ajjf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;a-#d7 is amended by adding at the end the following3 7e7 7#a7 ,notwithstanding any other requirements relating to the experience required for an applicant to qualify for a grant or contract under this title1 an entity shall be deemed eligible for a grant or contract under this title on the basis of being primarily engaged in providing restorative reproductive medicine1 or providing training and education for medical students and professionals in restorative reproductive medicine1 provided that such entity is otherwise eligible for the grant or contract4 7#b7 ,in this subsection1 the term restorative reproductive medicine has the meaning given such term in section #c of the ,,restore ,act4 4 #i4 ,advancing education on reproductive health conditions and women's natural cycle 7a7 ,expanding grant access and application ,the ,deputy ,assistant ,secretary for ,population ,affairs of the ,department of ,health and ,human ,services 7referred to in this section as the ,deputy ,assistant ,secretary7 shall develop1 within the existing ,teen ,pregnancy ,prevention program1 access to1 and advertisement for1 applicants for grants under such program that specialize in restorative reproductive medicine1 restorative reproductive health1 and fertility awareness-based methods4 ,to be eligible to receive an award under this subsection1 an entity shall be primarily engaged in services or education relating to restorative reproductive medicine1 restorative reproductive health1 or fertility awareness-based methods4 7b7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,deputy ,assistant ,secretary shall submit to ,congress and make publicly available on the website of the ,office of ,population ,affairs a report on recipients of grants under the ,teen ,pregnancy ,prevention program and the services1 education1 and training provided by such recipients4 #aj4 ,advancing restorative reproductive medicine and fertility awareness-based methods training under the ,reproductive ,health ,national ,training ,center 7a7 ,in general ,the ,assistant ,secretary for ,health of the ,department of ,health and ,human ,services 7referred to in this section as the ,assistant ,secretary7 shall coordinate with the ,office of ,population ,affairs and the ,office on ,women's ,health to review1 revise1 and instruct the staff of the ,reproductive ,health ,national ,training ,center on reproductive health conditions1 restorative reproductive medicine1 restorative reproductive health1 and fertility awareness-based methods4 7b7 ,training ,beginning not later than #b years after the date of enactment of this ,act1 as a condition for receipt of a grant or contract under title ,x of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj et seq471 the staff of the ,reproductive ,health ,national ,training ,center shall provide training to staff working in other entities receiving grants or contracts under title ,x of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj et seq47 about reproductive health conditions1 restorative reproductive medicine1 restorative reproductive health1 and fertility awareness-based methods1 which may include providing toolkits and other information1 including online1 about peer learning opportunities1 ,na,pro,technology educational fellowships1 fertility education and medical management1 short videos on reproductive health conditions and restorative reproductive medicine1 and contract medical professional seminars and training4 #aa4 ,expanding research on reproductive health conditions1 fertility awareness-based methods1 and infertility 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in coordination with the ,assistant ,secretary for ,health1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,director of the ,advanced ,research ,projects ,agency for ,health1 the ,director of the ,centers for ,disease and ,control1 the ,director of the ,national ,institutes for ,health1 and the heads of other agencies and offices of the ,department of ,health and ,human ,services that are conducting research on reproductive health conditions1 infertility1 and maternal health1 shall expand and coordinate programs to conduct and support research on reproductive health conditions4 7b7 ,topics ,the research directed by the ,secretary pursuant to subsection 7a7 may include research on-- 7#a7 the causes of reproductive health conditions1 especially endometriosis1 adenomyosis1 uterine fibroids1 and polycystic ovary syndrome2 7#b7 ways to diagnose reproductive health conditions2 7#c7 restorative reproductive medicine and new treatment options for reproductive health conditions2 7#d7 endocrine disrupting chemicals in endometriosis1 the relationship of endometriosis and cancer1 prenatal and epigenetic influences on the risk for endometriosis2 7#e7 premenstrual syndrome1 hormone dysfunction1 ovulation defects1 abnormal uterine bleeding1 adhesion prevention1 tubal corrective surgery1 and preconception and pregnancy health2 7#f7 the growth and progression of reproductive health conditions and recurrence post-surgical procedures2 7#g7 the increasing prevalence of sexually transmitted infections and related effects on fertility in men and women2 7#h7 male mechanisms of infertility1 including low sperm count2 and 7#i7 the effectiveness of restorative reproductive medicine to achieve pregnancy4 7c7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall make an ongoing report on the research publicly available on the website of the ,department of ,health and ,human ,services4 #ab4 ,severability ,if any provision of this ,act1 or the application of such provision to any person1 entity1 government1 or circumstance1 is held to be unconstitutional1 the remainder of this ,act1 or the application of such provision to all other persons1 entities1 governments1 or circumstances1 shall not be affected thereby4