TREATING INFERTILITY AND ASSISTING REPRODUCTION Guidance from the Catholic Moral Tradition

 
 Janine Marie
Idziak, Ph.D.
 
 Health Care Consultant
 
Archdiocese of Dubuque, Iowa
 
January 2001
 
 
 
I remember going to a first
birthday party for my best friend�s son.
My husband and I had been trying to conceive, but had met with no
success.  I knew it was going to be
uncomfortable at times, but I thought I could handle it.
After all I had been in worse situations.  Or so I thought.  As
other one-year-old children filled her backyard, I found myself creeping toward
the corner.  When the cake was
brought out, I looked into my friend�s eyes.
They were filled with joy.  It
was one of the happiest moments of her life, and unfairly, one of my saddest.
After quickly sneaking out, I sat in my car and cried my eyes out, I�d
never realized the intensity of my pain.  I
hadn�t allowed myself to feel it, until it exploded out of me.
 




 —Eileen, age 30   (1)
 
 
I remember driving home from work
on the freeway a couple of days after I learned
that my wife�s IVF procedure was not successful.
A news broadcast came on the radio.
Another baby was found in a dumpster in New York.
I lost it.  I started
screaming at the radio like a lunatic.  �Are
you…kidding, you threw it away!�  It
was incredible to me.  Here I was
doing everything I could in life to get my wife pregnant,
and some sick person threw away their baby.
Their own flesh and blood.  How
could it be that they could have it and discard it like a piece of trash,
something we wanted more than anything in the whole world?
Preoccupied with the broadcast, I got too  close to the car in front of me.
Fortunately, I still had a split second to slam on my brakes.
Otherwise, that little broadcast could have put me over the top.
 

—Matthew, age 40
(2)
 
 
  Experiencing
infertility  is emotionally
stressful, for both women and men.  People
faced with a diagnosis of infertility often �experience the same deep sense of
loss that they would feel with the death of a loved one� (3), and they may go
through stages similar to what is felt by persons dealing with a terminal
illness. (4)  Their shock
and disbelief when learning of a diagnosis of infertility may be
followed by denial of having a
problem, finding excuses to rationalize why attempts to have a child have been
unsuccessful. They may go through a stage of isolation in which they withdraw from family and friends who have
children.  The partner who has a
physical problem causing infertility may feel guilty about depriving his or her spouse of children.
A couple may feel  a sense of unfairness about their infertility, and react with
anger. (5)  In fact, �just
looking at another pregnant woman, seeing a woman breast-feeding a baby,
watching a baby pushed in a stroller, or running into a person buying disposable
diapers in the market can create resentment.� (6)
 
 
The anxiety and desperation of
couples dealing with infertility can lead them to seek professional medical help
with their problem.  Some
infertility problems can be treated and corrected surgically or
with drugs. In addition, various assisted reproductive technologies (ART) have
been developed to aid couples in having a child.
 
 
A couple who visit  a fertility clinic will be given factual information about
their problem and about the reproductive options available to them.
However, counselors may not explore with them the moral
dimensions of possible courses of treatment. But just because it is possible
to do something, this does not mean that it is in the best interest of all
concerned.
 
   The
purpose of  this pamphlet is to
provide information about the teachings of the Catholic Church on medical
methods of treating infertility and assisting reproduction.
 
   
Back to top
GUIDING MORAL PRINCIPLES
 
   In
1987 the Instruction on Respect for Human
Life in its Origin and On the Dignity of Procreation (Donum Vitae) was
released by the Vatican Congregation for the Doctrine of the Faith. (7)
This document sets out principles for distinguishing morally permissible
from morally illegitimate means of assisting reproduction.
These principles embody values that are important to preserve with
respect to marriage and with respect to having children.
 
(1) The conception of a child should take place within
a marital relationship.  (8)
 
  This
principle has to do with the very meaning of marriage.
A child is meant to be �the sign of the mutual self-giving of the
spouses.� (9)  He or she is meant to be the �living image� of the
love of the spouses for each other and of their fidelity to each other. (10)
 
  This
principle also concerns the welfare of the child himself or herself. (11)
As theologian  William May
points out, �Practically all civilized societies rightly regard as utterly
irresponsible the generation of new human life through the random union of
unattached men and women.� (12) This is because a child needs a certain type
of environment in which to develop.  Nonmarried
men and women should not generate new human life because they have not prepared
themselves �to receive  such life
lovingly, nourish it humanely, and educate it in the love and service of God and
neighbor.� (13)
 
(2) Using sperm or ova from a person outside the
marriage to conceive a child is never permissible.
(14)
  When
a man and a woman marry, they give themselves exclusively to each other.
The selves they give are sexual and procreative beings.
A husband and wife violate their marital commitment
if they give themselves to another in sexual union.
Similarly, they dishonor their marital covenant
if they choose to exercise their procreative powers with someone other
than their spouse. (15) In sum, using donor sperm or ova to conceive a child
violates the unity of the marriage. (16)
 
(3) The conception of a child should be brought about
through an act of sexual intercourse between spouses.
Conception should not occur as the direct result of a technological
process which replaces the personal act of sexual intercourse. (17)
 
  An
act of sexual intercourse is an expression of love between husband and wife.
It is a way of strengthening the bond between them.
At the same time, sexual intercourse is the means by which children are
conceived.  Thus the act of sexual
intercourse has both a unitive purpose
and a procreative purpose.
These two purposes are naturally found in the same act.  Methods
of bringing about the conception of children apart from a personal act of sexual
intercourse violate our God-given human nature.  For this reason, the Catholic Church judges them to be
impermissible. (18)
 
  In
an address at the University of Chicago, the late Joseph Cardinal Bernardin
noted that human sexual activity, unlike the sexual activity of animals, is part
of human intimacy.
In other words, human sexual activity is part of our ability and our
desire to enter into relationships
with other people. (19) This dimension of human sexuality is taken away when
purely technological procedures are used to have a child.
Consider the comments of one couple who used a reproductive technology to
have a child:
 
…few,
I believe, would have qualms about the sort of artificial insemination that Lisa
and I have undertaken and yet perhaps the most difficult part of AIH for us has
been the struggle to maintain a degree of intimacy in the process of
reproduction in the midst of a clinical environment designed to achieve results.
…the ideology of technology that fuels this commodification…is
a way of thinking of ourselves and our world in �mechanical, industrial
terms,� terms that are incompatible with intimacy.
Interestingly, the Roman Catholic Church has rejected AIH precisely
because it separates procreation from sexual intercourse and the expression of
love manifest in the conjugal act. …there is an insight here that should not
be overlooked.  Once procreation is
separated from sexual intercourse, it is difficult not to treat the process of
procreation as the production of an object to which one has a right as a
producer.  It is also difficult
under these circumstances not to place the end above the means; effectiveness in
accomplishing one�s goal can easily become the sole criterion by which
decisions are made.
 
This,
anyway, has been my experience.  Although
Lisa and I tried for a time to maintain a degree of intimacy during the process
of AIH by remaining together during all phases of the procedure as well as after
the insemination, we quickly abandoned this as a charade.
The system neither encourages nor facilitates intimacy.
…A conception, if it takes place, will not be the result of an act of
bodily lovemaking,  but a result of
technology.  We have come to accept
this.  Yet, such acceptance comes at
a price, for our experience of reproduction is discontinuous.  A
child conceived by this method is lovingly willed into existence, but it is not
conceived through a loving, bodily act. (20)
 

Regarding
the Catholic Church�s rejection of certain reproductive technologies, Cardinal
Bernardin pointed out that the Church �speaks against these procedures not
because it is opposed to the generation of life or to scientific knowledge and
application, but because it seeks to protect what it sees as an essential
connection between the creation of life and faithful, committed marital
intimacy.� (21)
 

In
addition, the laboratory generation of human life can easily turn babies into commodities. This was noted by the couple who used artificial
insemination: �Once procreation is separated from sexual intercourse, it is
difficult not to treat the process of procreation as the production of an object
to which one has a right as a producer.�
In the opinion of theologian William May, �the most straighforward
argument against resorting to the laboratory generation of
human life� is  the fact
that  �bringing new human life
into being in the laboratory is a form of production and depersonalizes
human life by treating it as if it were a product…�.
(22) Making a child into an �object of production� does not respect
the �personal dignity of the child, who is just as equally a person as are his
or her parents.� (23)
 
(4) From the time of conception, the life of the new
human being must be safeguarded. Methods of reproduction may not be used which
involve the deliberate destruction or wastage of embryos.
(24)
 
  The
Catholic Church regards human life as beginning at the time of conception.
This view is based on biological evidence.
At the time of conception, the genetic instructions for a new individual
are put together. These instructions determine that the new being who is
developing is a human being and
underlie at least some of the  individual characteristics this person will have.
The fact that the identity of a new human individual is established at
conception is taken as evidence that we have a complete human being—body and
soul—present from the time of conception. (25)
 
  Hence
the new human being must be respected as a person from conception, and his or
her life must be protected:
 
Thus
the fruit of human generation, from the first moment of its existence, that is
to say from the moment the zygote is formed, demands the unconditional respect
that is morally due to the human being in his bodily and spiritual totality.
The human being is to be respected and treated as a person from the
moment of conception; and therefore from that same moment his rights as a person
must be recognized, among which in the first place is the inviolable right of
every innocent human being to life.
 
This
doctrinal reminder provides the fundamental criterion for the solution of the
various problems posed by the development of the biomedical sciences in this
field: since the embryo must be treated as a person, it must also be defended in
its integrity, tended and care for, to the extent possible, in the same way as
any other human being  as far as
medical assistance is concerned. (26)
 
  Destroying
a zygote or embryo is not morally permissible because it is killing a human
being.  It is the equivalent of
abortion. (27) Similarly, it is not morally permissible to create a number of
embryos to try to maximize the chances of achieving a pregnancy when it is
unlikely that all of the embryos will implant in the woman�s uterus and
develop.  When someone knows in
advance that some embryos will be wasted in the procedure, he or she knowingly
engages in an action bringing about the death of the embryos.
 
(5) A married couple may use methods of assisting
reproduction which facilitate an act of sexual intercourse or which assist the
act to achieve its objective of conceiving a child once the act has been
naturally performed. (28)
 
  A
method of assisting reproduction which meets these conditions would respect the natural
connection between an act of sexual intercourse and the conception of
children.  It would also respect the
personal nature of the conjugal act
and of human procreation. (29)

 
 
PERMISSIBLE
METHODS OF TREATING INFERTILITY
 
 AND
ASSISTING REPRODUCTION
 
 
  Physical
problems causing infertility can sometimes be corrected through surgery.
For example, in the case of  women
surgerical procedures may be used for blocked fallopian tubes, pelvic adhesions,
and the more advanced stages of endometriosis. (30) In the case of men, varicose
veins of the scrotum can be treated surgically. (31) A man may suffer from a
blockage in the tubes that store his sperm prior to ejaculation. A surgical
procedure can be performed moving sperm past
this blockage.  This
procedure is then followed by a normal act of sexual intercourse to try to
conceive a child. (32)  None
of these procedures violates the moral principles presented above.
Indeed, the last surgical procedure is in accord with the fifth principle
in facilitating an act of sexual
intercourse.
 
  Drugs
can also be used in the treatment of fertility problems.  For example, drugs may be given to a woman to cure a pelvic
infection in its early stages (33), and hormones can be administered for
cervical mucus production. (34) Progesterone may be administered to help support
a pregnancy by making the lining of the uterus more receptive to embryo
implantation. (35)  In the
case of men, drug treatment can be used to alleviate Kallman�s
syndrome, a condition affecting sperm production and the development of
secondary sexual characteristics. (36) Again, these
medical practices are in accord in with Catholic moral teaching on
reproduction.
 
  Since
the birth of the McCaughey septuplets in Iowa, fertility
drugs which regulate or induce  ovulation
have come to public attention.  These
drugs may result in a number of ova maturing and being released at one time.
This, in turn, can lead to a number of ova being fertilized at one time
and hence to multifetal pregnancies—twins,
triplets, quadruplets, or even higher numbers. (37)
 
  Multifetal
pregnancies bring risks for the mother of �premature labor, premature
delivery, pregnancy-induced high blood pressure or pre-eclampsia (toxemia),
diabetes, and vaginal/uterine hemorrhage.� (38)
Such pregnancies also pose risks for the fetuses, including �an
increased chance of miscarriage, birth defects, premature birth, and the mental
and/or physical problems that can result from a premature delivery.� (39)
When four or more fetuses present, some healthcare professionals will
recommended pregnancy reduction (that is, the selective abortion of some of the
fetuses) in order to reduce these risks.  (40)
 
  Catholic
moral teaching about reproductive practices does not exclude the use of
fertility drugs.  However, several
cautions are in order.
 

�
If a multifetal pregnancy does result from
the use of fertility drugs, aborting some
of the fetuses is never permissible.
 

�
The risk of a multifetal pregnancy
occurring varies with the type of fertility drug used. (41)
Therefore, a couple should take time to become informed about the risk
factor for the particular drug being recommended for their use.
 

�
Some measures can be taken to reduce the
risk of multifetal pregnancies.  For
example, if a woman requires the injection of a particular drug to trigger
ovulation and examination   shows
that too many ova have developed, she and her physician can decide to withhold
the injection of the drug. (42) Healthcare professionals have noted, however,
that �for many couples, the desire to become pregnant overrides concerns about
conceiving multiple babies.�  (43)
Morally, a couple should  take
into account the health risks of multifetal pregnancies for both the
mother and the fetuses when making these decisions.
This is part of our general moral obligation to avoid actions which can
bring significant harm to people. 
 
  The
assisted reproductive technology (ART) of Gamete
Intrafallopian Transfer (GIFT)  is
advertised by some fertility services as �an alternative for patients whose
religious beliefs prohibit conception outside the body.� (44)
In this procedure ova and sperm are collected and then inserted by
catheter into the woman�s fallopian tube. Fertilization can then take place in
its natural location within the woman�s body. (45)

 
  Although
an explicit statement has not yet been made by the Vatican about GIFT, some
Catholic theologians are arguing in favor of its permissibility, with
certain restrictions on how it is practiced.
Specifically, rather than collecting the husband�s sperm through
masturbation, the procedure would have to begin with a natural act of sexual
intercourse during which sperm are collected by morally acceptable means (e.g.,
in a perforated condom).  This would
then be followed by retrieval of ova from the
wife, with the reinsertion of ova and sperm into the fallopian tubes.
During this procedure, care should be taken to avoid the possibility of
extracorporeal conception, for example, by having air spaces between the sperm
and ova when they are placed in the catheter for reinsertion into the woman�s
body.  Practiced in this way, GIFT can be seen as a repositioning of
ova and sperm in the fallopian tubes which assists the natural act of
intercourse to achieve its objective of conceiving a child. (See Principle 5 above).  (46)
 
  
 
 METHODS OF ASSISTING REPRODUCTION WHICH ARE NOT PERMISSIBLE
 
   An
assisted reproductive technology (ART) commonly used today is in vitro fertilization (IVF).
This procedure involves obtaining ova from a woman and sperm from a man,
and combining them in a petri dish in a laboratory where fertilization takes
place.  The fertilized ova are then
transferred to a solution which nourishes them and where the cells begin to
divide.  In two to six days, two,
three, or four of the developing embryos are transferred to a woman�s uterus
to try to achieve a pregnancy.  Remaining
embryos may be frozen for later use should a pregnancy not be achieved on the
first try. (47)
 
  The
ova and sperm used in the IVF procedure may come from a man and a woman who are
married.  But ova or sperm can also
be donated to a married couple.  Donor ova or sperm may be used if the wife is unable to
produce usable ova, or if the husband is unable to produce usable sperm, or to
prevent the transmission of a genetic disorder to children. (48)
 
  Respecting
the unity of the marriage makes it impermissible for a couple to use IVF when it
involves donor sperm or ova. (See Principle
2 above)  However, according to
Catholic moral principles, using IVF to have a child is wrong even when a
married couple use their own ova and sperm for the procedure.
The reason is that the child is conceived solely through a laboratory
procedure.  No personal act of
sexual intercourse between spouses takes place or is needed. (See Principle 3 above)
 
  The
fact that embryos are wasted in the IVF procedure is yet another reason why
using this procedure is morally wrong. (See Principle
4 above)  Usually between two
and four developing embryos are transferred to a woman�s uterus.
The reason is that �it has been generally observed that only one out of
three embryos will implant.� (49)  But
this means that the other embryos which have been transferred—embryos which
are human beings with a right to life—are simply wasted.
Moreover, it sometimes happens that none of the transferred embryos will
implant.  In this case, frozen
embryos are thawed and transferred to the woman�s uterus in the hope of
achieving a pregnancy.  And this
process may continue through any number of attempts to achieve a pregnancy and
carry it through delivery. (50)
 
  Further,
frozen embryos may be left after a couple has achieved a pregnancy or become so
discouraged with a lack of success that they simply give up trying.
Some fertility clinics have established programs allowing infertile
couples to adopt such �spare� frozen embryos.
(51) However,  spare frozen embryos may simply be disposed of after a
certain time period (52), or they may be used for
research purposes in ways which involve the death and destruction of the
embryo. (53)
 
 
  Applying
the principles of Catholic moral theology presented above, use of the following
assisted reproductive technologies must likewise be judged to be morally
impermissible:
Intracytoplasmic Sperm Injection (ICSI)is
a laboratory procedure achieving fertilization through the injection of a single
motile sperm into an ovum.
 
Pronuclear Stage Embryo Transfer
(PROST)
involves fertilization of ova in a laboratory followed by transfer of embryos to
the woman�s fallopian tube shortly after fertilization is confirmed, at the
stage when the embryo has one pronucleus representing genetic material from the
sperm and one pronucleus representing genetic material from the ovum.
 
Zygote Intrafallopian Transfer (ZIFT)
involves
fertilization of ova in a laboratory followed
by transfer of embryos to the woman�s fallopian tubes the day after
fertilization, when the embryo is at the one-cell or zygote stage.
 
Tubal Embryo Transfer (TET)
involves fertilization of ova in a
laboratory followed by transfer of embryos to the woman�s fallopian tubes two
days after fertilization, when the embryo is at the two to four cell stage.
 
Assisted Hatching of Embryos, used
in conjunction with in vitro fertilization, involves creating a small hole in
the zona pellucida surrounding the embryo prior to transferring the embryo into
a woman, in order to assist the embryo in implanting in the uterine wall. 
 
Donor Sperm
refers to the use of sperm in a reproductive technology which comes from someone
other than the woman�s husband.
 
Donor Ova refers
to the use of  ova in a reproductive
technology which come from someone other than the man�s wife.
 
Artificial Insemination by Donor
(AID)
is the attempt to achieve a conception by transferring into a woman�s genital
tract sperm previously collected from a man other than her husband.
 
Artificial Insemination by Husband
(AIH)
which replaces the conjugal act
occurs, for example, when sperm is collected from the husband by masturbation
and then inserted into his wife�s genital tract by catheter to achieve a
conception.
 
Surrogate Motherhood
involves a woman carrying in pregnancy an embryo to whose conception she has
contributed her own ovum, fertilized through artificial insemination using the
sperm of a man other than her husband.  She
carries the pregnancy with a pledge to surrender the child, once it is born, to
the party who made the agreement for the pregnancy.
 
Gestational Surrogacy (Host Uterus)
involves a woman carrying in pregnancy an embryo created by another man and
woman, with a pledge to surrender the child, once it is born, to the party who
made the agreement for the pregnancy.
 
Ericsson Method
is a laboratory technique for separating sperm carrying a Y chromosome (which
causes a male child to be conceived) from sperm carrying an X chromosome (which
causes a female child to be conceived), followed by artificial insemination of
the woman with Y-sperm in an attempt to conceive a male child.
 
 
MicroSort is a
laboratory technique for separating X-sperm from Y-sperm, followed by artificial
insemination or in vitro fertilization using sperm for the desired sex of the
child.  It has been used to conceive
female children.  (54)
 
 
YET OTHER PROCEDURES…
 
  Not
all methods of treating infertility or assisting reproduction have necessarily
been mentioned in this pamphlet.  And,
with continuing medical research, new methods are being developed all the time.
The use of any method not
explicitly discussed in this pamphlet should be evaluated according to the moral
principles presented above.
 
 
 ACCEPTING LIMITATIONS
 
 
In
their desperation to have a child, some couples suffering from infertility may
find it very difficult to accept limitations on the methods of assisting
reproduction which they can legitimately use. However, we must be cautious about
falling into the mentality of saying that persons have a �right� to a child
by any means whatever:
 
But
is a married couple, in which one or both partners are infertile, justified in
acquiring a child by any biological means?
Is the unremitting desire for a child a longing for personal fulfilment
and marital wholeness, or is it an example of an inordinate desire?
 
…�On
what rational ground is it urged that while sexual desires ought not to be
indulged at will, parental desires may be?… If we persuade ourselves that
because we want a thing so much it must be right for us to have it, do we not
thereby reject in principle…the very idea of limitation, acceptance, of a
given natural order and social frame…the creatureliness of man?� (55)
 
  The
Vatican Instruction reminds us that a
child should be viewed �not as an object to which one has a right� but as
�a gift, the �supreme gift� and the most gratuitous gift of marriage.�
(56) Thus, as one theologian has pointed out, �each spouse should understand
that the marriage covenant, �for better or for worse,� encompasses also the
unfortunate possibility that infertility may characterize their union.� (57)
 
 
  From
a purely practical point of view, infertile couples have to recognize that the
use of assisted reproductive technologies will not guarantee them a child.
The failures, disappointments, and costs which accompany the use of
assisted reproductive technologies have been described in a feature article in Newsweek:
 
Jodi
Peterson, 36, still can�t believe it has come to this.
After eight months of failing  to
conceive right after her 1991 marriage, she found herself in the maw of the
infertility machine.  She and her
husband, who live in suburban Maryland, endured a year of tests, from semen
analysis to injection of a dye to see if her fallopian tubes were blocked.
Their clean bill of health was, in the mirror world of infertility,
perhaps the worst news they could have received: it meant the doctor had no idea
why Peterson wasn�t conceiving.  So
she went through months of daily infertility drugs.  She put up with nine intrauterine inseminations (IUIs), in
which sperm are shuttled by catheter directly to the uterus.
Her bills had topped $40,000, and insurance covered nothing.
Then her doctor discovered that Peterson�s tubes, contrary to what  she had been told, were hopelessly blocked: she had undergone
a year of treatments that can work only with healthy tubes.
So Peterson tried in vitro fertilization (IVF), in which eggs are
retrieved with an ultrathin needle, fertilized in the lab and inserted into the
uterus, bypassing the tubes.  That
resulted in a potentially fatal ectopic pregnancy.
She has now had three more IVFs.  �Do
I have second thoughts?� Peterson asks.  �You
bet — every time I write out a $2,500 check for fertility drugs.
Now I accept that we�re not going to have biological children.
I�ve grieved enough.  I
have to move on.� 
 
First
they live by the unbending rule of the calendar, keeping their doctor-ordered
appointments for conjugal relations on the prescribed three days of every
month…even though it now brings them all the joy of taking out the trash.
Then they become human pincushions, their rear ends sore from twice-a-day
hormone shots that sometimes make their ovaries inflate to the size of
baseballs.  They spend at least $10,000, and as much as $100,000, on
diagnostic tests and fertility drugs and the crapshoot known as asssited-reproductive
techniques — a.k.a. test-tube babies.  They
cringe when freinds counsel them to �give it time� when time is their
relentless foe.  They fume at
insurers who regard inferility treatments as experimental, or even
as a frivolity on a par with a nose job.
They are childless.  And more
and more of them are mad — fighting, suing, e-mail flaming mad — at an
infertility industry that offers a lot of hype, a lot of hope and not enough
babies.  After 20 years of
scientific advances, nearly three out of four couples seeking assisted
reproduction still go home to an empty crib. (58)
 
 
  While
experiencing infertility is psychologically stressful, so is the use of assisted
reproductive 
 
technologies.
Couples report feelings of being on an �emotional roller coaster�
because of the hopes  held out to them and the disappointments which occur. (59)
Couples can also experience grief over  the
loss of embryos.  This reaction is
noted in the aforementioned Newsweek
article: �Carolyn and Craig May tried IVF in May.  When it failed, says Craig, �it was like losing a child you
never really had.�� (60) As noted by Jodi Peterson in the same article,
couples may eventually have to accept failure, which may also involve a grieving
process: �Now I accept the fact that we�re not going to have biological
children.  I�ve greived enough.
I have to move on.� (61)
 
 
But acceptance of infertility �can be for spouses the occasion for
other important services to the life of the human person.� (62) Here is a
story from a priest in Wisconsin which illustrates this:
 
I
know such a couple who very much longed for children of their own.
After years of trying to conceive and unsuccessful attempts at corrective
surgeries, they adopted two boys with severe disabilities.
It seems that the Lord has endowed them with the special gifts that they
need to care for these boys.  Few
people could care for them as they do.  Because
they were unable to conceive, they discovered their unique vocation to share
God�s life and love in a manner that few could.
Those unable to conceive have not been forgotten by God, rather they have
a unique vocation that only they can fulfill.
May they listen to God�s voice as He calls them to share his life and
love. (63)
 
 
TALKING WITH PARISH STAFF
 
 An Invitation
 
   Couples
struggling with infertility problems and exploring treatment options may find it
helpful to talk with a member of their parish staff — a priest, deacon,
pastoral associate, or parish health minister.
Parish staff members can discuss the teaching of the Church set out in
this pamphlet as well as offer personal guidance and support in making the
difficult decisions surrounding  infertility.
 
 
NOTES
 
  1.
Richard Marrs, M.D., Lisa Friedman Block, & Kathy Kirtland Silverman, Fertility
Book (NewYork: Dell, 1998), p. 376.
 
  2. Ibid.,
p. 385.
 
  3. Ibid.,
p. 378.
 

4. Ibid., p. 378.
 
  5. Ibid.,
pp. 378-86.
 
  6. Ibid.,
p. 384.
 
  7.
Congregation for the Doctrine of the Faith, Instruction
on Respect for Human Life in its Origin and On the Dignity of Procreation [Donum Vitae] (Washington, DC: United States Catholic Conference,
1987).
 
  8. Ibid.,
II.1.
 
  9. Ibid.,
II.1.
 
  10.
Ibid., II.1.
 
  11.
Ibid., II.1.
 
  12.
William E. May, �Donum Vitae: Catholic
Teaching Concerning Homologous In Vitro Fertilization� in Kevin William Wildes, S.J., Infertility:
A Crossroad of Faith, Medicine, and Technology (Boston: Kluwer, 1997), p.
79.
 
  13.
Ibid.
 
  14.
Congregation for the Doctrine of the Faith, Instruction,
II.2.
 
  15.
May, �Donum Vitae,� p. 74.
 
  16.
Congregation for the Doctrine of the Faith, Instruction,
II.2.
 
  17.
Ibid., II.4.
See also the National Conference of Catholic Bishops, Ethical
and Religious Directives for Catholic Health Care Services 1994, no. 38
(Washington, DC: United States Catholic Conference, 1995).
 
  18.
Jean Porter, �Human Need and Natural Law� in Kevin William Wildes, S.J., Infertility:
A Crossroad of Faith, Medicine, and Technology (Boston: Kluwer, 1997), pp.
96-7.
 
  19.
Joseph Cardinal Bernardin, �Science and the Creation of Human Life,� Origins
17/2 (May 28, 1987): 21, 23-6 at 24.
 
  20.
Paul Lauritzen, �What Price Parenthood?� Hastings
Center Report 20/2 (March/April 1990): 38- 46 at 43.
 
  21.
Bernardin, �Science and the Creation of Human Life,� p. 24.
 
  22.
May, �Donum Vitae,� p. 77.
 
  23.
Ibid., p. 76.
See also Congregation for the Doctrine of the Faith, Instruction,
II.4.c.
 
  24.
Congregation for the Doctrine of the Faith, Instruction,
I.1; National Conference of Catholic Bishops, Ethical
and Religious Directives for Catholic Health Care Services, no. 39.
 
  25.
Congregation for the Doctrine of the Faith, Instruction,
I.1.
 
  26.
Ibid.
 
  27.
Ibid., II.5.
 
  28.
Ibid., II.6.
 
  29.
Ibid., II.6.
 
  30.
Infertility, Gynecology, & Obstetrics Medical Group of San Diego, http://www.igomed.com/fertilityserv.htm;
Marrs, Bloch, and Silverman, Fertility
Book, p. 216, 269, 273.
 
  31.
Infertility, Gynecology, & Obstetrics Medical Group of San Diego, http://www.igomed.com/fertilityserv.htm.
 
  32.
John W. Carlson, �Interventions Upon Gametes in Assisting the Conjugal Act
Toward  Fertilization� in Kevin
William Wildes, S.J. (ed.), Infertility: A Crossroad of Faith, Medicine, and
Technology (Boston: Kluwer, 1997), p. 109.
 
  33.
Marrs, Block, and Silverman, Fertility Book, p. 128.
 
  34.
Ibid., pp. 178-9.
 
  35.
Ibid., pp. 146-7.
 
  36.
Ibid., p. 242.
 
  37.
Mayo Clinic, Health Oasis, Fertility Drugs, http://www.mayohealth.org/
mayo/9902/htm/fertilty.htm.
 
  38.
American Society for Reproductive Medicine, Fact
Sheet: Multiple Gestation and Multifetal Pregnancy Reduction, http://www.asrm.org/Patients/FactSheets/multiple.html
.
 
  39.
Ibid.
 
  40.
Ibid.
 
  41.
About.com, Infertility, http://infertility.about.com/…/aa111399.htm?iam=dp&terms
=infertility+%22multiple=births%2 .
 
  42.
Mayo Clinic, Health Oasis, Fertility Drugs, http://www.mayohealth.org/mayo/
9902/htm/fertility.htm .
 
  43.
Ibid.
 
  44.
Poets Pharmacy, http://www.iop.com/~poetsrx/art/ art.html.
See also Fertilitext, http://www.fertilitext.org /gift.htm; Infertility,
Gynecology & Obstetrics Medical Group of San Diego, http://www.igomed.com/fertilityserv.htm;
Reproductive Medicine Group, Tampa, Florida, http://www.vbtivf.com/GIFT.htm .
 
  45.
Poets Pharmacy, http://www.iop.com/~poetsrx/art/ art.html.
See also Infertility, Gynecology & Obstetrics Medical Group of San
Diego, http://www.igomed.com/fertilityserv.htm; IVF.com, http:// www.ivf.com/gift.html;
 
  46.
For a summary of the theological discussion about GIFT, see Medical-Moral
Commission, Health Care Ethics: A Handbook
of Policies for the Archdiocese of Dubuque (Dubuque, IA: Archdiocese of
Dubuque, 1990 –  ),
entry on Gamete Fallopian Transfer.
 
  47.
Ronald Munson (ed.), Intervention and Reflection Basic Issues in Medical Ethics, 5th ed.
(Belmont, CA: Wadsworth, 1996), pp. 499-500; Advanced Fertility Center of
Chicago, http://www.advancedfertility.com/ivftreatment.htm; Institute for
Reproductive Health, Cincinnati, http://www.cincinnatifertility.com/ivf.htm;
University of Iowa Hospitals and Clinics, Advanced Reproductive Care, http://www.uihc.uiowa.edu/pubinfo/arc.htm.
 
  48.
Orville N. Griese, Catholic Identity in Health Care: Principles and Practices
(Braintree, MA: Pope John Center, 1987), pp. 56-7; Advanced Fertility Center of
Chicago, http://www.advancedfertility.com/ivftreatment.htm; University of Iowa
Hospitals and Clinics, Advanced Reproductive Care, http://www.uihc.uiowa.edu/pubinfo/arc.htm;
International Consensus on Assisted
Procreation, http://www.mnct.fr/iffs/a_artbis.htm.
 
  49.University
of Iowa Hospitals and Clinics, Advanced Reproductive Care, http://www.uihc.uiowa.edu/pubinfo/arc.htm.
 
  50.
For example, the Advanced Fertility Center of Chicago reports pregnancy rates
between 35.7% and 59% per embryo transfer and corresponding delivery rates
between 21.4% and 52.5% for the period 1997-98; the success rates vary with the
age range of the woman undergoing the procedure.
http://www.advancedfertility.com
 
  51.
See, for example, the embryo donation program available at the University of
Iowa Hospitals and Clinics, Advanced Reproductive Care, http://www.uihc.uiowa.edu/pubinfo/arc.htm.
It should be noted that the Catholic Church does not regard it as morally
permissible to freeze embryos in the first place; see Congregation for the
Doctrine of the Faith, Instruction, I.6.  However,
an official statement on the moral permissibility or impermissibility of
adopting embryos which have already been frozen and are �spare� has not yet
been made by the Catholic Church.
 
  52.
For example, on August 1, 1996 the destruction of more than 3,000 frozen embryos
took place in Britain because of a five-year legal deadline for the disposal of
unwanted human embryos.  The
Tablet 10 August 1996.
 
  53.
See, for example, the Draft National Institute of Health Guidelines for Research Involving
Human Pluripotent Stem Cells II.A.2.a.vii (1999).
 
  54.
For a description of  these assisted
reproductive technologies, see, for example, University of Iowa Hospitals
and Clinics, Advanced Reproductive Care, http://www.uihc.uiowa.edu/pubinfo/arc.htm;
Genetics and IVF Institute, Fairfax, Virginia and Gaithersburg, Maryland,
http://www.givf.com; Advanced Fertility Center of Chicago, http://www.advancedfertility.com;
Infertility, Gynecology, & Obstetrics, Medical Group of San Diego, http://www.igomed.com/fertilityserv.htm
.
 
  55.
D. Gareth Jones, Brave New People
(Grand Rapids, MI: Eerdmans, 1985), p. 127.
 
  56.
Congregation for the Doctrine of the Faith, Instruction
on Respect for Human Life in its Origin and On the Dignity of Procreation,
II.B.8; p. 34.
 
  57.
Paul T. Jersild, �On Having Children: A Theological and Moral Analysis of In
Vitro Fertilization� in Edward D. Schneider (ed.), Questions
about the Beginning of Life (Minneapolis: Augsburg, 1985), p. 46.
 
  58.
Sharon Begley, �The Baby,� Newsweek (Sept. 4, 1995): 38-41, 43-7 at 38-40.
 
  59.
Making Babies CBS 48 Hours (Sept.
1989).
 
  60.
Begley, �The Baby,� p. 40.
 
  61.
Ibid., pp. 39-40.
 
  62.
Congregation for the Doctrine of the Faith, Instruction
on Respect for Human Life in its Origin and On the Dignity of Procreation II.B.8;
p. 34.
 

63. Rev. John Doerfler (Diocese of Green Bay, Wisconsin), �In
Vitro Fertilization and the Person,� Ethics
and Medics 25/5 (May 2000): 3-4 at 4.