IVF - Why Not

[A simpler audio presentation of the topic can be heard HERE.]

When we were preparing for marriage, we discussed the number of children might want.  We both agreed that we wanted a big family, maybe six to eight kids.  More than seven years into marriage, we are still childless, and for six of those years we have knowingly suffered with infertility.  We’ve tried herbal supplements, medications, shots, even surgery.  We’ve prayed and made pilgrimages.  Barring a true miracle, we will never have biological children of our own.  On more than one occasion we have been told that we could have biological children of our own only if we go the route of in vitro fertilization.

Infertility is like getting in a car accident, or getting cancer – you never think it will happen to you.  But we’ve met dozens of couples like us.  We know the heartache, the pain, and the despair of infertility.  We see pregnant mothers and families with newborns everywhere we look.  We pass each Christmas, birthday, and anniversary being reminded that this is yet another year without a child to hold.  Our dreams for our future together, the meaning of our marriage, and the purpose of our lives have been shaken.  And IVF is held out to us as a solution, a healing for all the pain.

We are also Catholic.  Our Church teaches that IVF is morally unacceptable.  In the midst of our pain, and despite the “hope” that IVF holds out to us, we have embraced the Catholic Church’s teaching.  Not only that, but by God’s grace we have come to see it not as an imposition on us from an arbitrary authority from without.  No, we have come to see the reasons behind the Church’s teaching, and the wisdom and beauty in the Church’s vision of the human person and human sexuality.  In that way, the Church’s teaching on IVF is not an imposition, but the condition for us to joyfully exercise true freedom in doing the good in regard to our infertility. 

As we’ve walked this path, and met others who have experienced infertility, we’ve discovered that most people, even Catholics, do not know the reasons for the Church’s teaching regarding IVF.  This is complicated by a number of factors.  It’s important to address some of the issues that complicate an understanding of this teaching, especially by first addressing two common misunderstandings.

The first misunderstanding is that if the Catholic Church condemns the IVF procedure as morally unacceptable, it must also be condemning the children born of IVF.  Nothing could be further from the truth.  It does not follow that criticizing the objective means by which a child comes into existence implies a criticism of the subjective worth of the child.  A blunt, but illustrative parallel example can show this.  We all agree that rape is a reprehensible act.  And yet, we would say that any child that is born as a result of that act is no less human, no less valuable, no less precious, than any other baby.  The evil nature of the objective act does not translate into lessening the subjective worth of the child born.  So let us be very clear from the start.  While we argue here that IVF is a morally unacceptable act, we are not claiming that there is anything wrong with a child born of IVF.  A child born of IVF is a precious child of God, no less valued, worthy, or loved than any other child.

The second common misunderstanding is that the Catholic Church is against IVF simply because the Church is anti-science, or anti-technology.  We’ve actually heard it argued that, if we wear glasses, we must also be in favor of in vitro fertilization.  If you approve of one kind of technology improving your health, you can’t logically be opposed to another.  This is another non-sequitur.  It only follows if you universally accept that all technology is good.  The Catechism of the Catholic Church states that “research aimed at reducing human sterility is to be encouraged, on condition that it is placed at the service of the human person, of his inalienable rights, and his true and integral good according to the design and will of God” (2375).  So it’s not technology the church opposes.  But technology must always serve the true good of the human person.  The question becomes, not is IVF simply a form of technology, but does it serve the integral good and inalienable rights of the person.  As we will argue, it does the exact opposite.

Besides these two common misunderstandings, there are also several other obstacles to understanding the Catholic Church’s teaching when it comes to IVF.  First, when is it taught?  We have children in Catholic schools and parish religious education programs until eighth grade or perhaps through high school.  Do we teach 13 or 17 year olds about the Church’s moral teachings regarding IVF?  Well, hopefully we do, but even so, at that point in their lives, this is a rather inconsequential point, a commercial at best.  Even the best religious education will give that student only an adolescent understanding of the moral argument being made.  As the maxim goes, “that which is received is received according to the mode of the receiver.”  If one comes to marriage and infertility with only an adolescent understanding of the moral reasoning behind the issue, they are in a gravely deficient position by which to make a decision.  And this is assuming a best case scenario.  In most cases, the issue is never taught, or merely glossed over, so an adult Catholic has basically no understanding of the Church’s teaching, and even less the “why” involved behind the “what.”  Moreover, the teaching does assume some background many people don’t have in general moral theology, theological anthropology, even Trinitarian theology!  

This situation is then exacerbated by the fact that many people first learn of the Church’s teaching when they are already experiencing the pain of infertility.  It’s only when one has been suffering with this for some time, and now has the hope that IVF will give them a child, that they may approach their priest asking about what the Church says about it.  We all know that emotions cloud our ability to reason.  The pain of infertility and the desire for a child to love are no exception.  When, in the midst of this heartache, a couple hears for the first time that using IVF is a sin, they are less likely to receive this truth and the reasons for it. At such a time, couples are more likely to see the Church arbitrarily imposing this upon them.  This is why, at our parish, the topic is covered in our marriage preparation program, when those extreme emotions are not active.

This is also a difficult teaching because, prima facie, it seems the Church is being self-contradictory.  After all, the Church sees in large families a sign of God’s blessing and the parents’ generosity (CCC 2373).  The Church even condemns contraception!  How can the Church at the same time condemn a couple who wants to have children!?  The teaching seems invasive into our private lives.  How can the Church tell us how to regulate our family or make decisions about something as personal as our fertility?  Finally, the church seems heartless.  In the midst of the incredible pain that comes from infertility, how can the Church abandon couples who finally have the hope of a family?  Given all these misunderstandings and obstacles, it is no wonder so few people, including Catholics, know the Church’s teaching and the wisdom and beauty it embodies. 

Perhaps a good place to start in explaining the morally problematic nature of IVF is to discuss an aspect of basic moral decision making.  Most of us, in our instinctive moral decision making, tend to be consequentialists. A consequentialist judges the moral goodness or badness of an act based solely on its consequences: if an act has good consequences, it is morally good; if an act has bad consequences, it is morally evil. In such a system, one would say that “the ends justify the means.”  We encountered consequentialist arguments during debates surrounding the construction of an IVF clinic.  Opponents brought several different arguments against its constructions (mostly non-religious arguments).  In response, the proponents of the clinic did not address our arguments, but rather brought in several children born of IVF as evidence of the virtue of the practice.  Without IVF, it was argued over and over, my child would not be here.  While we don’t disagree that such children are wonderful and precious, this is a clear example of consequentialism.  The consequence of IVF is a wonderful, precious child, therefore IVF must be wonderful and certainly not morally problematic.  Not to mention that this was an appeal less to reason than to emotion.

But the opponents of the clinic were not arguing that the consequences of IVF could not be good.  We were saying that there is more to the ethical quality to the procedure than its consequences.  We offered arguments against the procedure itself.  Again, the blunt but parallel instant of rape is illustrative.  Imagine someone bringing forth beautiful children who resulted from rape and then arguing from that for the legalization and moral goodness of rape!  We all see the fallacy in that starker example.  We judge the morality of an act not only on its consequences, but on other factors as well.  A consequentialist has only part of the moral picture.

The Catholic Church offers a different, three-step guide for making a moral decision (Cf. CCC 1750-1756). First, there is the object, or the act itself, the “what” of the act.  Second, the “end” or the intention of the person acting.  This is the “why” behind the act.  Finally, the circumstances, the who, where, when, how, and also the consequences of the act.  For an act to be morally good, the object, intention, and circumstances must all be good simultaneously.  In a sense, this is a more holistic view of moral decision making: the who, what, where, when, why, how, and consequences all play a moral role in the act.  Further, if the “what” is evil, no good intention or different circumstances can make it good.  We all know this instinctively in certain cases.  Child abuse, as the object of a moral act, the “what,” is always wrong, no matter the intention of the abuser or the circumstances surrounding it.  In that sense, child abuse is what we call “intrinsically evil.”  So when it comes to IVF, we have to explore not just the moral quality of the consequences (some of which may be good, but others, as well will see, are evil), but also the moral quality of the act itself.  In other words, “the ends do not justify the means.”  We must have morally good means to arrive at a morally good end.

With these preliminaries covered, we can move on to the specific question, what is morally unacceptable about the process of in vitro fertilization?  Here we draw largely on two documents from the Vatican’s Congregation for the Doctrine of the Faith, the 1987 Donum Vitae, and the 2008 Dignitas Personae.

A preliminary point, but a very important one, has to do with the consequences of IVF regarding the respect due the human embryo. Remember, an embryo is a fertilized egg. An embryo is a genetically unique, unrepeatable individual member of the human species.  We might equally refer to it as an embryonic human being.  Development of the practice of in vitro fertilization has required the destruction of countless human embryos.  Even today, the usual practice of IVF presupposes that a number of ova are withdrawn, fertilized and then cultivated in vitro for some days. Some “spare” embryos are very often destroyed or frozen indefinitely.

The reason for the transfer of multiple embryos is to increase the probability that at least one embryo will implant in the uterus. In this technique, therefore, the number of embryos transferred is greater than the single child desired, in the expectation that some embryos will be lost. In this way, the practice of multiple embryo transfer implies a purely utilitarian treatment of embryos. In fact, often embryos produced in vitro which have defects are directly discarded.  If an excess number of embryos implant and begin to develop, a surgeon may "selectively reduce" the number, destroying those least healthy, or simply those easiest to reach.  From the ethical point of view, embryo reduction is an intentional selective abortion. It is in fact the deliberate and direct elimination of one or more innocent human beings in the initial phase of their existence and as such it always constitutes a grave moral disorder.

The connection between in vitro fertilization and the voluntary destruction of human life occurs too often. But even if technology were to advance to the point that the destruction of embryos were eliminated, experience has shown that techniques of in vitro fertilization proceed as if the human embryo were simply a mass of cells to be used, selected and discarded.  Techniques of in vitro fertilization are based, in principle, on the presupposition that the individual embryo is not deserving of full respect in the presence of the competing desire for offspring which must be satisfied.

The preceding objection, though grave, is somewhat circumstantial to the IVF procedure itself.  With the advance of medical sciences, the destruction of embryos may possibly be eliminated.  Nevertheless, the Catholic Church still sees the procedure of IVF as morally unacceptable by its very nature on the basis of three considerations.

First, the Church affirms an inseparable connection between the two meanings of the marital, sexual act: the unitive meaning, by which the couple is drawn into deeper intimacy, and the procreative meaning, whereby the sexual act is per se open to new life. By its very nature, or structure, the marital sexual act, both closely unites husband and wife, and at the same time opens them to the possibility of bringing forth new life, according to laws inscribed in the very being of man and of woman.  IVF, in seeking a procreation which is not the fruit of a specific act of martial sexual love, causes a separation and rift between these two goods and meanings of marriage. From the moral point of view it is wrong to dissociate the procreative meaning of the union from the integrally personal context of the marital, sexual act: human procreation is a personal act of a husband and wife, built into the very structure of what they are individually and as a couple, and which is not capable of substitution. 

Second, the link between the two meanings of the marital sexual act is based upon the unity of the human person, a unity involving both a body and a spiritual soul.  In the sexual act, spouses mutually express their personal love, a spiritual reality, in the "language of the body."  The marital sexual act by which the couple mutually express their self-gift to one another at the same time expresses openness to the gift of life. It is an act that is inseparably both bodily and spiritual. It is in their bodies and through their bodies that the spouses both consummate their marriage and are able to become father and mother. Thus, in order to be true to what is spoken by the language of their bodies, marital sexual love must remain open to procreation; and the procreation of a new life must be the fruit and the result of this expression of marital love. The origin of the human person thus follows from an act of the parents that is not merely biological but also spiritual.  Fertilization achieved outside the bodies of the couple remains by this very fact deprived of the full meaning which is expressed in the language of the body and in the union of human persons.

Finally, procreation must be in conformity with the dignity of the person to be conceived. In his unique and unrepeatable origin, the child must be respected and recognized as equal in personal dignity to those who give him life. In reality, the origin of a human person is the result of an act of self-giving. The one conceived has the right to be the fruit of his parents' love; the generation of a child must therefore be the fruit of that mutual giving which is realized in the marital sexual act. The child should not be conceived as merely the product of an intervention of medical techniques; that would be equivalent to reducing the child to an object of scientific technology, or a product of manufacturing.  Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children. 

What, we might still ask, is so unique, so special about the martial sexual act that it cannot be replaced in the conception of a new life?  To more fully answer that question, we have to bring in a little more theology. We have to inquire into the very inner life of God himself as Trinity.

The love of man and woman reveal to us something of God’s inner life as Trinity.  If we turn to the creation narrative in the first chapter of Genesis, we hear: “God created man in his image; in the divine image he created him; male and female he created them (1:27).  That humanity was created male and female was not incidental, accidental or unintentional.  God, a community of persons (Father, Son, and Holy Spirit), created humans to reflect that life of communion with one another.  The Catechism says that “God is love and in himself he lives a mystery of personal loving communion. Creating the human race in his own image.... God inscribed in the humanity of man and woman the vocation, and thus the capacity and responsibility, of love and communion” (2331).

The Trinity has been described as Lover, Beloved, and the Love between them.  The Father loves the Son, the Son returns that love, and the love between them is another Person, the Holy Spirit.  In the Holy Trinity, the Holy Spirit is the very personification of the love between the Father and the Son.  So the family is an icon of the Blessed Trinity.  A husband loves his wife (in that way particular to a husband and a wife), a wife returns that love, and the love between them is so real that (in nine months) it becomes another person.  The love of husband and wife is personified in a third person.  So, the Church sees in sexuality and in the family bringing forth children a window into the very inner life of God Himself. As the document Dignitas Personae says, “These two dimensions of life, the natural and the supernatural, allow us to understand better the sense in which the acts that permit a new human being to come into existence, in which a man and a woman give themselves to each other, are a reflection of trinitarian love. ‘God, who is love and life, has inscribed in man and woman the vocation to share in a special way in his mystery of personal communion and in his work as Creator and Father.’”

So the way we come into existence is not a matter of indifference.  We came into being through an act that is, objectively speaking, an act of self-giving love that participates in the life giving love of the Trinity.  Moreover, we have a right, and it is part of our personal dignity that we arise from such an act of self-giving love, rather than through a technological procedure in a laboratory. IVF denies the child to be born this right and denies them this dignity. 

Someone might here object and say that their decision to conceive through IVF is no less a choice borne out of love than the choice to conceive naturally.  How, it could be asked, can we say that the sexual act is an act of self-giving love, but the couple choosing IVF is somehow lacking this love?  Here want to make a distinction between the intention of the couple and the act itself.  There is no doubt that a couple seeking to conceive through IVF is doing so with the intention of love.  And it may even be the case the many new lives are conceived naturally through a sexual act that lacks true self-giving love.  But here we are not talking about the intention of the couple, but about the nature of the objective act itself.  The nature of the sexual act between husband and wife, regardless of their intentions, speaks with the language of the body “I am yours, you are mine; I give myself to you completely.” This language of self-gift is absent in the objective act of in vitro fertilization.  The latter can never be a substitute for the former, and all the meaning it carries.

With these moral considerations in mind, perhaps we can now see that the objections against the Church’s teachings are not as potent as they first appear.  The Church, in valuing large families and teaching about the immorality of contraception is not being inconsistent or contradictory when it also teaches the moral evil of IVF.  In fact, the two teachings are two sides of the same coin.  The Church upholds the inherent unity of the unitive and procreative meanings of marriage and sexuality.  Contraception seeks to have sex without babies; IVF seeks to have babies without sex.  Both divorce the inherent unity of the unitive and procreative meanings of marriage and sexuality. 

Also, whereas the Church can seem invasive and heartless, hopefully the considerations we’ve discussed show that the Church is intensely interested in the true good of the human person, including the integrity of the meaning of marital love, the human person, and the rights of the child to be born.  The Church is solicitous that the dignity of even the littlest person is not violated, and that life is respected from the moment of its creation.  The Church offers us the truth so that we have the true liberty to seek the good in accord with that truth, and in seeing this truth, we see the beauty of the vision it is based upon.

What if you’re hearing this for the first time, and IVF is part of your story?  What if you’ve had successful or unsuccessful IVF treatments in the past?  First know again unequivocally that your child is precious, wonderful, a child of God with all the dignity and worth of any child.  None of these comments about the process of IVF change that about your child in the least.  They are not “less than” in any way.

It is important, however, when we realize the faults of our past that we own them, repent of them, and bring them to Christ.  There is no condemnation for those who are in Christ Jesus, only mercy and fullness of redemption.  If you have gone through IVF, bring the matter to the sacrament of confession, lay it before the foot of the cross, receive God’s mercy, and trust in His love.  There is no sin that can keep us from the love of God and no sin greater than His mercy.  True peace can be found in the sacrament of Confession; waste no time in running to Christ for his mercy.

What if you are in the midst of infertility?  What options are you left with if IVF is off the moral table? First, it’s important to take the time to pray, reflect, and continue to learn about the Church’s teachings. Take some time to read the Catechism of the Catholic Church and the USCCB’s website.  Check out the National Catholic Bioethics Center, and the documents mentioned in this article. Pray and ask God to soften your heart to listen to his word through the Church.

A key rule of thumb particularly helpful in discerning treatment options is that any medical procedure that assists the sexual act in reaching its goal may be morally permissible. On the other hand, any medical procedure or intervention which replaces the sexual act, is morally impermissible.  For instance, fertility medications can be used, with the caution that certain drugs can cause dangerous multiple pregnancies.  Surgeries that clear blockages in either the male or female reproductive organs are acceptable.  Methods of charting the natural course of fertility (NFP) are also helpful.  NaPro Technology treats infertility by diagnosing the underlying cause of infertility (in either spouse) and treating that underlying cause, so that optimal health can be achieved and our bodies can work naturally as they were meant to. Unlike artificial reproductive technology, which often bypasses or doesn’t even diagnose the underlying issues preventing conception, NaPro is a medical and surgical approach that has achieved documented success in helping countless couples conceive.

Some couples may never conceive, even with the help of infertility treatment. Other couples may decide not to purse treatment at all. For these couples there are two other meaningful options to share their life and love with others. One option is adoption, and the other is living a childless life in service to God. Adoption is not for everyone, but for those couples who feel called, it is a beautiful way build a family. As a couple we traveled the path to adoption in different stages and rates.  Before we got married we talked about our hopes and dreams for our future family. If not able to have children physically, we both agreed that we would want to adopt.  Over time we realized that adoption is a special and beautiful way in which we can share in God’s love.  Numerous biblical passages refer to our adoption by God our Father.  We are God’s children by adoption. We can call him “Daddy, Abba, Father!"  He has accepted us, welcomed us, and loved us even in the midst of our brokenness, inadequacy, and sin. We realized that a family created through adoption images God’s love in a unique way. Parents and children not only share love with one another, but are also a sign to the world of God’s very love for us, his adopted children.

Some couples may not feel called or be able to adopt and instead be called to live a life serving one another and God without children. While the pain of not having children can be devastating, there is still value in this marital vocation. In fact it is far from a second class vocation and responsibility. The opportunities to give and receive love are countless, through volunteering, opening up your home to those who are lonely, caring for aging parents, being a meaning and positive presence in the lives of nieces, nephews, and godchildren. In addition, a couple without children may have fewer family demands and may be able to impact the professional sphere and their co-workers in a deeper way. Childless couples in a special way can take heart from the words of Pope Benedict XVI on February 25, 2012: “I would like to remind the couples who are experiencing the condition of infertility, that their vocation to marriage is no less because of this. Spouses, for their own baptismal and marriage vocation, are called to cooperate with God in the creation of a new humanity. The vocation to love, in fact, is a vocation to the gift of self and this is a possibility that no organic condition can prevent. There, where science has not yet found an answer, the answer that gives light comes from Christ.”