Making babies: In vitro fertilization’s Pandora’s Box

March 10, 2013

By Maria Wiering

mwiering@CatholicReview.org

Twitter: @ReviewWiering

This is the first in a series.

Rita Buettner was in her late 20s and trying to get pregnant when her gynecologist – who knew she was a devout Catholic – told her to try in vitro fertilization, or IVF. Buettner wouldn’t consider it, and found a new doctor. She and her husband John adopted instead.

Not all Catholics are making the same decision.

Despite the church’s teaching against assisted reproductive technology, Catholics are among those turning to IVF as an answer to infertility. Online IVF discussions are peppered with self-identifying Catholics sharing their stories, some oblivious to the church’s teaching, others conflicted, still others unconcerned.

According to the Centers for Disease Control, the practice has doubled in the United States in the past decade, diminishing stigmas and obscuring the moral quandary IVF creates.

More than 1 percent of U.S.-born babies are the result of assisted reproductive technology, or ART, defined by the Centers for Disease Control as fertility treatments where both eggs and sperm are handled outside of the body. The CDC estimates that 12 percent of women of childbearing age in the United States have used an infertility service ranging from counseling to ART. Fertility services comprise a multi-billion dollar industry in the U.S.

Maryland is home to the nation’s largest fertility clinic, Rockville-based Shady Grove Fertility Center. With satellite clinics throughout Maryland, Pennsylvania, Virginia and the District of Columbia, Shady Grove boasts more than 10,000 patients and 27,000 babies born from their treatments, which include IVF.

The technology’s unprecedented promise to bring children to the childless is hailed by some as a medical miracle, but others ask if bioscience has opened a portal to Aldous Huxley’s dystopian “Brave New World.”

What’s the big deal?

At first glance, assisted reproductive technology may appear to offer something the pro-family Catholic Church would applaud: more babies. However, the church – rooted in its teachings on marriage, sex and human dignity – clearly teaches against assisted reproductive technology and similar procedures such as artificial insemination.

The Catechism of the Catholic Church urges compassion for the suffering of the infertile couple, and supports research to reduce human sterility. However, it also states that assisted reproductive techniques, whether or not they involve a married couple, are “morally unacceptable.”

“They disassociate the sexual act from the procreative act,” it continues, going on to quote “Donum Vitae,” a 1987 document from the Congregation of the Doctrine of the Faith. “The act which brings the child into existence is no longer an act by which two persons give themselves to each other, but one that ‘entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children.’ “

In its simplest form, IVF involves surgically extracting an egg from a woman and injecting it with sperm in a laboratory, creating a human embryo. The embryo is inserted in the woman’s uterus, where it gestates normally.

IVF, however, is not simple. Most IVF cases involve the creation of multiple embryos, and doctors determine which ones to implant. Those left over are discarded, frozen for later use or donated for research. The church recognizes embryos as human persons fully deserving of dignity, and considers these practices contrary to that dignity.

In addition to IVF, assisted reproductive technology includes gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT). In the church’s view, they share IVF’s moral problems, but they account for less than 1 percent of ART procedures, according to the Alabama-based Society for Assisted Reproductive Technology.

‘Right to a child’

As online message boards and blog posts attest, Catholics who know the church’s teaching against IVF but choose to pursue the procedure describe their desire for a child overriding religious scruples.

Sean Savage is among them. His wife’s third pregnancy, conceived via IVF, attracted national attention when it became known that another couple’s embryo had been implanted in her by mistake. She carried the pregnancy and surrendered the baby to its genetic parents before pursuing treatment again with her own embryos.

In an essay published by CNN in 2011, Savage argued that the Catholic Church should reverse its opposition to IVF, citing passages from “Donum Vitae” (1987) and “Dignitas Personae” (2008), Vatican documents that make the church’s case against assisted reproductive technology.

“Babies born of IVF are here because their parents loved, respected and longed for these children long before conception,” wrote Savage, who lives in Ohio and has authored a book about his family’s experience. “There is no doubt in my mind that God is working through loving parents and ethical doctors to allow these children to come into the world.”

Underlying this argument is the idea that couples have a “right” to a child, which the church believes is false, said Germain Grisez, professor emeritus of philosophy and moral theology at Mount St. Mary’s University in Emmitsburg.

Rather, he said, a baby should be understood as a gift from God.

“God never promised that if you get married and do what married couples do, you will inevitably increase and multiply and fill the earth,” he added. “It may be that in an unfallen world that everybody would be fertile, but this is a fallen world.”

The problem with IVF is that it uses technology to “make” a baby, Grisez said.

“It’s a kind of manufacturing process,” he said. “If you’re on the baby end of that relationship, you’re not so much being ‘begotten,’ you’re being ‘produced.’”

It is unlikely that parents who used artificial reproductive technologies think of their child as a product, or would love their child differently than a naturally conceived one, Grisez emphasized, but that does not justify the action.

Some IVF-using Catholics have argued that because the procedure is possible, God must permit it.

Grisez disagrees.

“There are all sorts of evils in the world that God makes possible,” he said. “That doesn’t mean that God intends them to be possible. He allows them.”

Pandora’s box

Assisted reproductive technology presents ethical quagmires recognized well beyond the Catholic Church. IVF has opened the door to unprecedented circumstances of conception and gestation, where a baby can be conceived in the lab through one set of parents, carried by a genetically unrelated woman, and raised by a separate set of genetically unrelated parents.

New technology makes it possible for children to have three biological parents, due to an in-lab process where the contents of one egg are injected into another before fertilization.

Meanwhile, researchers are separating gametes from their male and female origins, creating sperm and egg cells from stem cells. These feats have been championed as means for gay and lesbian couples to achieve biologically-related children.

Jennifer Lahl, founder and president of the Center for Bioethics and Culture, isn’t applauding.

“This is the largest social experiment of our time,” she said, pointing to the deliberate creation of children who will not know their biological parents, the unknown long-term health risks of hyper-ovulation drugs and ART’s eugenic nature.

“A lot of assisted reproductive technology is experimentation on children,” she said. “What does it mean to be a frozen embryo for five years, and then be allowed to thaw and be implanted and brought to life? We’ve never done this to human beings (before IVF).”

A nurse, Lahl began her California-based educational nonprofit almost 13 years ago to expose the cultural implications of medical efforts to “make life, take life and fake life,” including IVF and other assisted reproductive technologies.

In addition to unleashing uncertain genetic consequences, ART, including egg and sperm donation, carries other medical and emotional consequences for the donors and the resulting children, Lahl said.

Who’s your daddy?

Among those children is Alana Newman, 26, founder of The Anonymous Us Project, an online story collective of those affected by assisted reproductive technology. A sperm-donor-conceived child and former egg donor, Newman now views the trade of gamete and embryos as buying and selling people, and has called surrogacy “using women’s bodies as baby factories.”

Third-party reproduction, or the use of surrogates or donated gametes, creates a litany of identity issues for the child, said Newman, who lives in Brooklyn, N.Y.

The issues are different from those faced by adopted children, partly because donor-conceived children are not encouraged to express negative feelings about their situation to their parents, she said.

Newman said that while growing up, she had what she calls “a giving-tree complex,” where she felt she existed for other people’s happiness. That played a role in her decision to sell her eggs, she said.

“Third-party reproduction creates kids for commodification,” she said. “It’s wrong to pay people to abandon their child. I think it’s the adult’s responsibility to deal with their infertility, and not subvert the principle that human trafficking is wrong. This is a form of human trafficking.”

In 2010, the New York-based, pro-traditional family Institute for American Values released “My Daddy’s Name is Donor,” the first representative, comparative study of adults conceived through sperm donation. Among its findings were that donor-conceived children are more likely to struggle with delinquency, substance abuse and depression than children raised by biological parents.

The level to which the identity of donors is known varies by donation clinic.

“If we didn’t learn anything from the history of adoption that can translate here, then we haven’t been paying attention to history,” Lahl said. “Many years ago, adoption records were sealed, adoption was secret, there was shame associated with the fact that you couldn’t conceive and your kids were adopted.

“We now recognize from the children who have been adopted how important that biological connection is.”

Into the unknown

Efforts to achieve pregnancy through artificial means are more than 150 years old. The first recorded case of successful artificial insemination by donor occurred in 1884.

In 1949, five years after Massachusetts doctor John Rock became the first to successfully fertilize human eggs in a laboratory, Pope Pius XII condemned the creation of embryos outside the body. In 1968, Pope Paul VI promulgated “Humane Vitae,” which affirms the link between intercourse and procreation.

A decade later, the first IVF-created baby was born in England. In 1981, the first U.S. “test-tube” baby was born in Norfolk, Va., with the help of Howard and Georgeanna Jones, doctors retired from teaching at The Johns Hopkins University School of Medicine.

Between 1960 and 1980, public opinion shifted from believing IVF was “against the will of God” to favoring it.

According to the Centers for Disease Control, more than 147,000 ART cycles were performed at 443 reporting clinics in 2010, the most recent year for which data is available. These cycles produced more than 47,000 deliveries – some multiple births, making for 61,500 infants.

Twins, triplets and other multiples are more common with IVF pregnancies. They present more health risks than pregnancies with singletons – a term commonly used to describe the birth of a single baby – one reason the CDC monitors assisted reproductive technology.

“ART can alleviate the burden of infertility on individuals and families, but it can also present challenges to public health, as evidenced by the high rates of multiple delivery, preterm delivery and low-birth-weight delivery experienced with ART,” the CDC states on its website.

Sometimes, more embryos implant in the uterus than the doctor or patient hoped, and the choice is made to pursue “selective reduction,” an abortion of the unwanted fetus or fetuses, while the wanted ones remain. In deciding which to abort, the babies’ size, strength and sex are often considered.

A 2011 New York Times Magazine feature titled “The Two-Minus-One Pregnancy” quoted a woman who had “reduced” her pregnancy from twins to a singleton.

“Making a decision about how many to carry seemed to be just another choice,” she was quoted as saying. “The pregnancy was all so consumerish to begin with, and this became yet another thing we could control.”

Church-approved alternatives

Effective fertility treatments have been developed in accord with church teaching, including Natural Procreative, or NaPro, Technology.

Dr. Thomas W. Hilgers, founder of the Pope Paul VI Institute for the Study of Human Reproduction in Omaha, Neb., developed his method to diagnose and address reproductive health abnormalities. Its procedures, such as laparoscopic surgery to excise endometriosis, uphold Catholic teaching and, according to its website, claim a 50 to 75 percent pregnancy success rate with common infertility problems – compared to ART’s 30 percent average success rate.

Hilgers discussed his method last year at a Vatican workshop on the latest infertility research sponsored by the Pontifical Academy for Life.

He said that “infertility is a symptom of an underlying condition,” and too many physicians do not attempt to find the cause and treat it; they simply recommend in vitro fertilization, according to a Catholic News Service report.

Father Erik Arnold, pastor of Our Lady of Perpetual Help in Ellicott City, said he knows local Catholics who have received fertility help at Fairfax, Va.-based Tepeyac Family Center, a pro-life ob-gyn health care practice.

Over the years, he has counseled infertile couples, as well as couples who have used IVF and were trying to reconcile their decisions with the Catholic faith. He said many couples do not know the church’s teachings on IVF.

Pastorally, he said, any initial conversation should center on an infertile couple’s grief and open the doors to later discussions on moral routes to pursue.

“If we too quickly stated what the church teaches without listening to them, they might feel that we’re simply closing the door, and there’s nothing else the church can do,” he said. “There are a lot of good, morally acceptable techniques and things that are out there that a couple can try, and we want to encourage them in that.”

Marriage preparation classes might be a good place for parishes to discuss the possibility of infertility and the church’s teaching, Father Arnold said.

For some couples, like the Buettners, infertility opens the door to adoption. For others, the church’s teaching may mean childlessness.

“It’s very scary for a couple to realize that isn’t going to happen the way they had it mapped out, especially for a couple where everything else has fallen into place exactly as they thought it would,” Rita Buettner said. “It really requires looking at your faith and trusting in God that he had a plan that was not ours.”

Also see: 

Consumerist conception

Copyright (c) March 10, 2013 CatholicReview.org