The National Catholic Review
What the church can do for couples struggling with infertility
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Nadya Suleman, the California woman who conceived 14 children through in vitro fertilization, including a set of octuplets born earlier this year, makes an easy target for an anxious public. Suleman seems not to have thought much about how she would support her supersized family either emotionally or financially, and the reaction to her story has ranged from derision and disgust to outright threats. I admit to being aghast myself as the details of her story unfolded, yet I felt some sympathy for Suleman too, because it appeared that she had reached her decisions about childbearing almost entirely on her own.

In this regard she is like most fertility patients, though the majority have at least a spouse with whom to share such difficult decisions. In the past few decades, assisted reproduction has made astonishing advancements, but society at large and the church’s teaching in particular have failed to keep up with the pace of technology. As a result, patients make decisions in a moral minefield—with perhaps the value-neutral counsel of a physician—or, in rare cases, after meeting with a mental-health professional, but rarely with the guidance of someone from their own faith community. It is true that the Catholic position on assisted reproduction is clear and well-documented, but in my years of struggling with infertility I found few options or resources for discussing the church’s teachings with a real human being or for sharing my pain with others in the same situation. As Catholics we can do better than this. The church has learned how to reach out to others in difficult circumstances and guide them gently toward life-giving decisions. It is time to do the same for those suffering from this heavy burden.

U.S. fertility clinics performed 138,198 cycles of assisted reproduction in 2006, the latest year for which statistics are available. There is no way to tell how many of those are Catholics.

Church Teaching on Assisted Reproduction

By the time these patients reach the office of a reproductive endocrinologist, they have likely been trying to conceive for more than a year, and sometimes much longer than that. Many are concerned about cost (fertility treatment can cost $10,000 per cycle, and many couples need multiple cycles to succeed), but their overriding concern is usually to end the ordeal as quickly as possible. If they are churchgoing Catholics, it is unlikely they have received much support at church. It is the nature of churches to reach out to families with children, and many infertile people find weekly services to be a source of pain rather than comfort. If they know anything about Catholic teaching on assisted reproduction, they probably think that all fertility treatment is forbidden, although that is not exactly the case. Many Catholics I have met do not know that the church has any teaching at all on the subject.

The church’s official teaching, first outlined in the Congregation for the Doctrine of the Faith’s instruction The Gift of Life (1987), was reiterated in the Instruction on Certain Bioethical Questions (Dignitas Personae), which was released late last year. The teachings allow for fertility medication to encourage ovulation (a source of many higher-order multiple births) and surgery to correct conditions like varicoceles and endometriosis. They forbid procedures that substitute medical techniques for human intercourse. This includes in vitro fertilization, which removes eggs and sperm from the couple to create an embryo in a petri dish; the embryo which is then transferred to the woman’s uterus. According to the instruction, the church opposes it because “it causes a complete separation between procreation and the conjugal act.”

By the time Catholics have been to a fertility specialist, it is often too late for church teaching to play a role in their decision-making. The desire for a family is often too strong at this point to be tempered by a document written by Vatican officials. To be involved in the conversation from the start, the church should broach the subject in pre-Cana training, so that couples can start to think about what they would do in case of infertility long before they reach the doctor’s office. Helping a couple to discuss the “what-if” before they marry increases the likelihood that a couple will include church teaching in their decision should they ever need fertility assistance.

Catholic parishes can also look to the Project Rachel model for help in crafting support for couples. Project Rachel is the church’s post-abortion ministry, which operates as a network of priests and counselors trained to give spiritual and psychological care to people suffering from the aftermath of an abortion. Project Rachel offers a Web site with links to local resource centers, along with support groups and retreats in some dioceses.

Like those struggling with the aftermath of an abortion, people coping with infertility often prefer to seek help privately. A ministry to them modeled on Project Rachel would allow those at the parish level to refer fertility patients to a knowledgeable diocesan contact, instead of giving priests and family-life ministers one more subject to master. It would also enable peer contacts between couples who are just beginning to confront infertility and veterans who have resolved their infertility in a variety of ways.

Discerning the Best Options

The church’s teachings on fertility are best known for what they forbid, but a robust outreach effort can emphasize the opportunities that exist for infertile couples. A growing number of physicians, trained by the Pope Paul VI Institute in Omaha, Neb., treat infertility in harmony with the church’s teachings. Referrals to such physicians should be an important part of any effort.

Adoption is not the easy solution that many imagine, but a thorough presentation of the process can dispel many of the misconceptions people have about adoption and expose them to the blessings of this path to parenthood. Other couples may find that by forgoing parenthood, they are able to devote themselves to their marriage, careers, friendships and volunteer work on a level beyond what many parents can manage. Spiritual direction can help couples discern their true call in a way that will nurture them for years to come, reframing infertility as an opportunity for growth rather than merely a problem to overcome.

Catholic leaders have been steadfast and vocal in their opposition to embryonic stem cell research, which relies largely on embryos left over from in vitro fertilization. By engaging couples before they seek fertility treatment, church leaders might convince some of them to pursue other avenues, which would then reduce the number of embryos created. And for couples who are determined to try in vitro fertilization, some options within the range of medical treatment are preferable to others. For instance, couples can choose to create fewer embryos, which reduces the chances of having unused embryos. They can also reject the option of using donated sperm or eggs, which church teaching likens to adultery because it involves someone outside the marriage in the creation of life.

Finally, the church should strive for more honesty in the documents and teachings it promulgates with respect to infertility. I have studied the issue closely for many years, and I understand and agree with many of the concerns the church has about assisted reproduction. But anyone who knows much about the subject cannot help but be bothered by errors in the official teachings. Even the instruction Dignitas Personae, which was released just a few months ago, contains factual inaccuracies. It states that “approximately a third of women who have recourse to artificial procreation succeed in having a baby,” when the eventual success rate is roughly 50 to 70 percent for all women, and up to 86 percent for women under 35. Other church documents champion techniques such as gamete or zygote inter-fallopian transfer as morally superior to in vitro fertilization, even though those techniques are rarely used now because they are medically inferior. Such lapses and distortions can make Catholics who pay close attention to this issue mistrustful of the church’s teachings as a whole.

These ideas are offered as a starting point for thinking about how the church can better support couples enduring this difficult ordeal. This is a difficult time for parishes and dioceses to be adding to their list of programs. Yet I also know that today a desperate Catholic couple is sitting in a doctor’s office receiving a list of their medical options. I want someone—someone they can trust and who has their best interests at heart—to give them their moral options too.

Julie Irwin Zimmerman, a former reporter at The Chicago Tribune and The Cincinnati Enquirer, is the author of

Comments

Charles Speicher | 7/9/2009 - 9:58am
This is a timely article,  It is a daunting pastoral task to advise couples facing infertility problems.  How can we fault those who want desperately to start a family?  What is not mentioned in the article however, is the possibility of embryo adoption which is mentioned in Dignitas Personae but not specifically forbidden.  See the website  [url=http://www.embryicinnection.org]www.embryicinnection.org[/url] for information about embryo donation/adoption.
Charles Speicher | 7/9/2009 - 9:48am
> The article by Julie Irwin Zimmerman is indeed timely. It is a daunting pas=
> toral challenge to advise couples faced with infertility problems.  How can=
>  we fault young couples who desperately want to begin a family?  Not mentio=
> ned in the article, though, is the possibility of embryo adoption, mentione=
> d in Dignitas Personae but not explicitly condemned.  Information about emb=
> ryo adoption is available at [url=http://www.embryoconnection.org%3Chttp//www.embryoconn]www.embryoconnection.org> ection.org/>.
>
Enrique I. Alonso | 7/7/2009 - 12:14am

Except for the second, it's interesting to see the responses this essay has thus far so subtly provoked (e.g. the fifth).

Consider for example how the author pitched this remedy or invitation: "And for couples who are determined to try in vitro fertilization, some options within the range of medical treatment are preferable to others. For instance, couples can choose to create fewer embryos, which reduces the chances of having unused embryos."

So, if one is going to accept that killing human embryos is justifiable by its end, that is, creating one any way technically possible, well, hmm, kill as few as you can.

Why is there not even a disclaimer from the Jesuit editors?

L | 7/5/2009 - 12:08am

Following the logic of the Roman Catholic Church’s argument...

Why is there no coordinated effort within the Roman Catholic Church to have women donate womb space to bring frozen embryos to life? Why isn’t the Roman Catholic Church at the forefront of advocacy for research into fallopian tube, vas deferens and uterus transplants? Catholics on sites such as Life News have shown vast ignorance in relation to assisted reproduction and a lack of compassion that cannot be considered Christ-like. They assume all IVF cycles involve destruction of embryos and they mock married couples that would like to become biological parents through IVF as selfish and ignoring God’s will for them in their lives. They assume these couples are too narcissistic to adopt, and that those who have conceived naturally (no matter the circumstances) have been “blessed” by God. I’d love to read a poll about what percent of Catholics who have had children naturally have in addition adopted children into their families? It seems so convenient to match up the unwanted babies in the world with couples struggling with infertility (and it certainly lifts the burden on taxpayers that otherwise would be supporting the unadopted children’s needs). If no babies were available for adoption (the supply is shrinking as we give greater support to single mothers), would the Life News writers and posters still feel so self-righteous in demanding infertile couples forgo fertility treatments?   For me, this issue is tremendously personal. My son’s father and I are each one of more than 10 children with strong ties to the Pro-Life movement. Due to several of my brothers’ being carriers of cystic fibrosis, they have together with their wives brought 6 children into the world with IVF. I know the parents are committed to giving all embryos they have created a chance at life, as they believe each one is unique and deserving of life. I also know the parents are committed to raising their children Catholic, and that our local priest supported their decisions to procreate through IVF (as my brothers, lacking vas deferens, could not conceive “naturally” with their wives).   I asked Fr. Tad Pacholczyk, Director of Education at the National Catholic Bioethics Center, in person about the moral status of my brothers and their wives. He said that IVF is never morally acceptable and that it is a grave offense. When asked what my siblings should now do, he said that they need to make a good confession. I wonder, though, what have they done that is sinful? I interpret Fr. Tad’s perspective to be that, if my brothers and their wives were “good” Catholics, their children would not exist. I know firsthand the tremendous sadness that infertility can bring to a marriage, as another close family member’s spouse divorced them over disagreements about how to become biological parents while being faithful to Catholic Church teaching. How many Catholics turn to IVF when they have no other biological options, and how many other infertile Catholics chose adoption instead?   I also asked Fr. Tad about snowflake babies and the Catholic Church’s perspective on this procedure. He essentially said it is morally wrong to create new embryos and that while the Church had no official position on adopting frozen embryos, there are good arguments on both sides. He left me with the impression that, instead of pursuing a path that would produce a biological sibling for our child, my son’s father and I would find more favor with the Catholic Church if we adopted a snowflake baby instead. I would welcome Fr. Tad or other Catholic bioethicists to expand upon this reasoning. The way I see it is, then, if the Catholic Church recruited enough generous women to donate their womb space to bring all the frozen embryos to life, then those of us who have not abused the IVF process and will not abuse it by creating more embryos than we will give life to will then have a moral chance at procreating with our own embryos.   It is beyond my understanding, even as a theology minor at a Jesuit college who has worked for several dioceses, how the Roman Catholic Church can sympathize with and forgive women who have chosen to have abortions, even welcoming them back into the Church if they are now married with other children (who will never know about their murdered sibling), but the Roman Catholic Church completely condemns a Catholic couple who has never so much as used birth control to prevent pregnancies, who choose to procreate via IVF using their own eggs and sperm, and transfer all embryos to the uterus.   My son still attends Catholic school. At some point, will he be taught that, if his uncles and aunts were good Catholics, his 6 cousins would not exist? If so, please tell me now, so I can investigate other educational options before he is exposed to this hateful line of reasoning.
Michael Bindner | 7/4/2009 - 5:00pm

If stem cells are removed at the blastocyst stage, there is no damage to the potential human life.  It is entirely undifferentiated, all cells are equivalent and no cell is essential.  This is not a condition one finds in a living organism, where all parts are essential.  Stem cells prior to gastrulation are ontologically and spiritually alike to adult stem cells.  They are tissue, not life.  That is not the case after gastrulation.  Frankly, it is not correct to call a blastocyst an embryo at all.  This is not scientism, but scientific fact.

john vercellone | 7/2/2009 - 9:36pm

for inferitle catholic couples i suggest to try other medical sources when one doesnt work actuallly try half dozen..DOCTORS ARE NOT INFALALIBLE EVEN THE EXPERT ONES,SO TRY A FEW OTHERS.THEN CONSIDER ADOPTION OF AN AMERICAN BORN ORPHAN.IF THAT IS NOT HELPFUL THEN GO ON TO THE ARTIFICIAL MEANS.BUT I WOULD EXHAUST ALL THE OPTIONS OF THE FIRST TWO SUGGESTIONS..

Rosemary Keenan | 7/1/2009 - 10:43pm

What a good article.  Hopefully it will be circulated widely  around the world.  Not enough teaching anywhere occurs in relation to infertility and its sequelae. The response of the Church to Reproductive Technology is often clouded and as the article states we Catholics know what is forbidden and little about what is allowed or possible.

Are children and young people given enough correct information even know when we have so much more knowledge than ever??

Thanks again for a great article.  Rosemary Keenan (68 married 40 years; no children; member of local parish).

Gerald McGrane | 6/30/2009 - 10:26pm

This was an excellent article with a poor title.  Catholic publications should be very careful not to cast any positive light on an organization so terribly corrupt and misguided as Planned Parenthood.  I realize a play on words was intended, but it was an ill conceived one.

 

Michael Bindner | 6/30/2009 - 12:35pm

Marie, when a chorion is removed prior to gastrulation the cells which survive the process (all of the ones that would have been a child) are pluripotential stem cells and are ontologically the same as stem cells harvested from an adult.  Until gastrulation, they are not "beings."  A blastocyst is not really an embryo.  To be an embryo, one must be developing.  Embryo is a title which should be reserved for after gastrulation.  It is a misuse of language to call a blastocyst an embryo - however it is the standard nomenclature.  The act of harvesting stem cells from a blastocyst is morally neutral.  Indeed, creating a blastocyst for this purpose through cloning would also be morally neutral.  Using cloning to create an identical twin of oneself would be an act of vanity, while creating a clone from the cells of a dead child would be an act of bad faith in the resurrection - since such a clone would be its own person, not a reincarnation of the child.  The means of doing both, however, are morally neutral.

Marie Rehbein | 6/30/2009 - 11:25am

Michael,

 I would like to address your point of how removing the chorion from a blastocyst does not prevent the stem cells from developing according to their nature.  This is exactly the same as if a surgeon were to remove someone's esophagus.  It would not immediately cause the death of the person.  However, without an esophagus, a person would not be able to continue living without medical intervention to obtain nourishment.  Without a chorion, the blastocyst will not be able to develop a placenta.  So even if the cells continue to function, as would all the cells present in the person whose esophagus we removed, the ultimate fate of that blastocyst is determined by the removal of the chorion.  In other words, the fact that the remaining cells continue to function does not mean that a child will result if what remains is implanted into a womb.  Actually, the opposite would result.  The child would not die, only because it would never have developed due to being unable to form a placenta.

 

 There are errors in Dignitas Personae, however, there are also errors in the logic of your justification for embryonic stem cell research.  If this is the logic of "those scientists who are authorities in these matters", then the Church is wise in not incorporating their perspective into its teaching on infertility treatments and ESCR. 

 

 While the specifics of Church guidance on reproductive matters may be inadequate and inaccurate, it is still the case that the principle of being in communion with God and nature should dominate both private decision making and public policies.  There is absolutely no reason that the government should assist people with fertility treatments or investigations into producing cures and treatments that depend upon the creation and destruction of human embryos.

Michael Bindner | 6/30/2009 - 9:47am

Julie Irwin Zimmerman is correct that there are quite a few errors, both scientific and ethical, in Dignitas Personae.  There is a very basic error regarding human embryology, which is consistent with prior misunderstandings by the Curia and the Popes.  Embryonic Stem Cell Research has taught us that if you remove the Chorion from an blastocyst, the underlying stem cells continue on.  If ESCR killed a child, those cells would die (as they would if you removed the Chorion from a bona fide embryo after gastrulation).  Among the ethical errors are it citation of the danger of haves and have nots in the ability to pay for these treatments.  This is not a fault of the treatment modality, however, but in the funding of them.  If equality is a concern, the answer is to make sure that the poor can afford them as well.

To underline the main point that Mrs. Zimmerman makes, in this day and age the only power the Church has is the power to persuade through the truthfullness of its arguments.  Until the Church is willing to actually listen to those scientists who are authorities in these matters, as well as those faithful who have undergone these procedures, it cannot cling to the notion that anyone will listen to it's teachings.