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TREATING INFERTILITY  

 AND ASSISTING REPRODUCTION  
 Guidance from the Catholic Moral Tradition  
 

- Guiding Moral Principles

- Permissible Methods of Treating Infertility & Assisting Reproduction
- Methods of Assisting Reproduction which are not Permissible
- Accepting limitations
- Talking with a Parish Staff, Notes

 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.

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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)

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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)

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 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)

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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)

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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.

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