It is quite legitimate, indeed praiseworthy, to try to find ways to overcome infertility. The problem causes great pain and anguish for many married couples. Since children are a wonderful gift of marriage, it is a good thing to try to overcome the obstacles which prevent children from being conceived and born.
Scripture is filled with accounts of women who suffered from infertility. The sorrow they felt at not being able to have a child could not be diminished even by a husband’s love. In the Old Testament Elkanah says to his wife who was unable to conceive, “Hannah, why do you weep? And why do you not eat? And why is your heart so sad? Am I not more to you than ten sons?” Of course Elkanah’s wife loved him, but she wanted to bear their child. Such stories in the Bible are told to show the power of God; most end happily as the women become pregnant even in their old age. There is Sarah, the wife of Abraham and the mother of Isaac; Hannah, wife of Elkanah, who becomes the mother of the prophet Samuel; and Elizabeth, the mother of John the Baptist. But the Bible tells us there are limits to acceptable methods for conceiving a child. Recall the story of Noah’s unmarried daughters who tried to get their father drunk so that they might have children by him! Obviously not any means can be used to achieve pregnancy.
In our day many techniques and therapies have been developed to overcome infertility. In the United States an entire “industry” has emerged with little or no governmental or professional regulations to protect the inter-ests of the men, women or children who become involved. Women receive fertility drugs which can result in their conceiving four, five or six children at once, risking their own health and the health of their children. Some have several eggs fertilized in vitro (in a glass dish) without realizing that this may lead to the destruction of these embryos or their being frozen for later experimental use.
The many techniques now used to overcome infertility also have profound moral implications, and couples should be aware of these before making decisions about their use. Each technique should be assessed to see if it is truly moral, that is, whether or not it promotes human good and human flourishing. All these technologies touch in some way on innocent human life.
In 1987 the Sacred Congregation for the Doctrine of the Faith issued a document known as Donum Vitae (“The Gift of Life”), which addressed the morality of many modern fertility procedures. The document did not judge the use of technology to overcome infertility as wrong in itself. It concluded that some methods are moral, while others – because they do violence to the dignity of the human person and the institution of marriage – are immoral. Donum Vitae reaffirmed an obligation to protect all human life when married couples use various technologies to try to have children. Without questioning the motives of those using these techniques, Donum Vitae pointed out that people can do harm to themselves and others even as they try to do what is good, that is, overcome infertility. The fundamental principle which the Church used to assess the morality of various means of overcoming infertility was a rather simple one, even if its application is sometimes difficult.
Donum Vitae teaches that if a given medical intervention helps or assists the marriage act to achieve pregnancy, it may be considered moral; if the intervention replaces the marriage act in order to engender life, it is not moral.
In Vitro Fertilization
One reproductive technology which the Church has clearly and unequivocally judged to be immoral is in vitro fertilization or IVF. Unfortunately, most Catholics are not aware of the Church’s teaching, do not know that IVF is immoral, and some have used it in attempting to have children. If a couple is unaware that the procedure is immoral, they are not subjectively guilty of sin. Children conceived through this procedure are children of God and are loved by their parents, as they should be. Like all children, regardless of the circumstances of their conception and birth, they should be loved, cherished and cared for.
The immorality of conceiving children through IVF can be difficult to understand and accept because the man and woman involved are usually married and trying to overcome a “medical” problem (infertility) in their marriage. Yet the procedure does violence to human dignity and to the marriage act and should be avoided. But why, exactly, is IVF immoral?
In vitro fertilization brings about new life in a petri dish. Children engendered through IVF are sometimes known as “test tube babies.” Several eggs are aspirated from the woman’s ovary after she has taken a fertility drug which causes a number of eggs to mature at the same time. Semen is collected from the man, usually through masturbation. The egg and sperm are ultimately joined in a glass dish, where conception takes place and the new life is allowed to develop for several days. In the simplest case, embryos are then transferred to the mother’s womb in the hope that one will survive to term.
Obviously, IVF eliminates the marriage act as the means of achieving pregnancy, instead of helping it achieve this natural end. The new life is not engendered through an act of love between husband and wife, but by a laboratory procedure performed by doctors or technicians. Husband and wife are merely sources for the “raw materials” of egg and sperm, which are later manipulated by a technician to cause the sperm to fertilize the egg. Not infrequently, “donor” eggs or sperm are used. This means that the genetic father or mother of the child could well be someone from outside the marriage. This can create a confusing situation for the child later, when he or she learns that one parent raising him or her is not actually the biological parent.
In fact, the identity of the “donor,” whether of egg or sperm, may never be known, depriving the child of an awareness of his or her own lineage. This can mean a lack of knowledge of health problems or dispositions toward health problems which could be inherited. It could lead to half brothers and sisters marrying one another, because neither knew that the sperm which engendered their lives came from the same “donor.”
But even if the egg and sperm come from husband and wife, serious moral problems arise. Invariably several embryos are brought into existence; only those which show the greatest promise of growing to term are implanted in the womb. The others are simply discarded or used for experiments. This is a terrible offense against human life. While a little baby may ultimately be born because of this procedure, other lives are usually snuffed out in the process.
IVF is also expensive, costing at least $10,000 per attempt. Over 90% of the embryos created perish at some point in the process. In a desire to hold down costs and enhance the odds of success, doctors sometimes implant five or more embryos in the mother’s womb. This may result in more babies than a couple wants. In Canada, one woman gave birth to five children engendered by IVF. She had wanted only one, so she sued her doctor for “wrongful life,” demanding that he pay for the cost of raising the four children she did not want.
To avoid the problems of carrying and rearing “too many” babies after several have been implanted, doctors sometimes engage in something euphemistically called “fetal reduction” or “selective reduction.” Here they monitor the babies in utero to see if any have defects or are judged to be not as healthy as the others. Then they eliminate those “less desirable” babies by filling a syringe with potassium chloride, maneuvering the needle toward the “selected” baby in the womb with the aid of ultrasound, and then thrusting the needle into the baby’s heart. The potassium chloride kills the baby within minutes, and he or she is expelled as a “miscarriage.” If it cannot be determined that one baby is less healthy than the others, some doctors simply eliminate the baby or babies who are easiest to reach. Again we see the unspeakable diminishing of the value of human life which can arise from this procedure.
Not everyone who has had a child through IVF has used donor eggs or sperm, collected the sperm through masturbation, or killed “extra” unwanted babies in the course of the pregnancy. Yet there is still a moral problem with the procedure itself. Why?
Why IVF is Wrong
Human beings bear the image and likeness of God. They are to be reverenced as sacred. Never are they to be used as a means to an end, not even to satisfy the deepest wishes of an infertile couple. Husbands and wives “make love,” they do not “make babies.” They give expression to their love for one another, and a child may or may not be engendered by that act of love. The marital act is not a manufacturing process, and children are not products. Like the Son of God himself, we are the kind of beings who are “begotten, not made” and, therefore, of equal status and dignity with our parents.
In IVF, children are engendered through a technical process, subjected to “quality control,” and eliminated if found “defective.” In their very coming into being, these children are thoroughly subjected to the arbitrary choices of those bringing them into being. In the words of Donum Vitae: “The connection between in vitro fertilization and the voluntary destruction of human embryos occurs too often. This is significant: through these procedures, with apparently contrary purposes, life and death are subjected to the decision of man, who thus sets himself up as the giver of life and death by decree.” The document speaks of “the right of every person to be conceived and to be born within marriage and from marriage.” To be within and from marriage, conception should occur from the marriage act which by its nature is ordered toward loving openness to life, not from the manipulations of technicians.
The dehumanizing aspects of some of these procedures is evident in the very language associated with them. There is the “reproductive technology industry.” Children are called the “products” of conception. Inherent in IVF is the treatment of children, in their very coming into being, as less than human beings.
Following reports of the cloning of “Dolly” the sheep in Scotland, there is increasing speculation about cloning human beings. Cloning is a complex procedure by which scientists take a body cell such as a skin cell (somatic cell) and render the cell’s nucleus into a primitive state so it is capable of guiding the development of another human being under the right conditions. The nucleus of an egg is removed and replaced by the nucleus of the somatic cell. The egg is then given an electrical charge, and new life begins to grow.
No one has yet engendered a human being through cloning, but many scientists believe that this is only a question of time.
There are a number of reasons why someone would try to engender a new human life through cloning. None would be morally legitimate. For example, a couple may want to use a cell from a dying child to clone another baby as a way of perpetuating the life of the first child. Obviously, this would not be a continuation of the dying child, but the bringing into being of a new child. The dying child would become the “progenitor” of a new life without having agreed to it; the new child would not be treated as a unique individual with his or her own identity, but as an extension of another person.
A man or woman might also want to have a baby without getting married or involving a parent of the opposite sex. Some homosexual people have said that cloning would be a perfect way to have children, because they would not have to marry someone of the opposite sex. This would be terribly unfair to the child, depriving him or her of a natural father and mother.
Some may want to clone themselves, thinking that they are so intelligent and successful that a child with their attributes would be a great gift to society. This would be an act of supreme selfishness that would also deprive a child of a mother and a father. Anticipating that one day the cloning of a human being might be attempted, Donum Vitae said this: “[A]ttempts or hypotheses for obtaining a human being without any connection with sexuality through ‘twin fission,’ cloning or parthenogenesis are to be considered contrary to the moral law, since they are in opposition to the dignity both of human procreation and of the conjugal union.”
Most disturbing of all, some researchers want to use cloning to create human beings solely for experimentation and destruction. They propose to supply genetically matched tissues for treating various diseases by making human embryos from patients’ body cells, then dissecting these developing embryos for their “spare parts.” Some even speak of growing genetically altered “headless” or “brainless” human clones as organ farms, arguing that such creatures could be exploited for any needed organs because they would not have the status of “persons.”
Moral Interventions to Overcome Infertility
Any number of morally acceptable interventions may be used to overcome infertility. For example, surgery can overcome tubal blockages in the male or female reproductive system which prevent fertilization from taking place. Fertility drugs may also be used, with the caution that large multiple pregnancies may put mother and infants at risk. There are also many ways of tracking natural reproductive rhythms to enhance the chances for achieving pregnancy. The Pope Paul VI Institute at Creighton University in Omaha, Nebraska has been successful in helping couples overcome infertility using natural methods.
Most theologians consider the procedure known as LTOT, or Lower Tubal Ovum Transfer, to be morally acceptable. This involves transferring the wife’s egg beyond a blockage in the fallopian tube so that marital relations can result in pregnancy. Another method, more morally controversial, is called GIFT, or Gamete Intra-Fallopian Transfer. It involves obtaining a husband’s sperm following marital relations and aspirating an egg from the wife’s ovary. Egg and sperm are placed in a tiny tube separated by an air bubble, and the contents of the tube are then injected into the wife’s fallopian tube with the hope that fertilization will occur. Some theologians consider this to be a replacement of the marital act, and therefore immoral. Other theologians see it as assisting the marital act, and therefore permissible. Because the teaching authorities of the Church “the Pope and bishops” have not made a judgment about GIFT, Catholic couples are free to choose it or reject it depending on the guidance of their own conscience. If the teaching authority of the Church should judge the procedure to be immoral, however, GIFT should no longer be used.
The Church has great compassion for those who suffer from infertility. Out of love for all human life and respect for the integrity of marital relations, however, the Church teaches that some means of trying to achieve pregnancy are not licit. Some of these means actually involve the taking of innocent human life, or treating human life as a means toward an end or a “manufactured product.” They do violence to the dignity of the human person.
In America we have a tendency to think that we can solve all problems with the right “technology.” But children are not engendered by technology or produced by an industry. Children should arise from an act of love between a husband and wife, in cooperation with God. No human being can “create” the image of God. That is why we say that human beings “procreate” with God. Engendering children is a cooperative act among husband, wife, and God himself. Children, in the final analysis, should be begotten not made.
Dr. Haas is President of the National Catholic Bioethics Center, Boston, Massachusetts and a consultant to the NCCB Committee for Pro-Life Activities. E-mail us at firstname.lastname@example.org