(This article courtesy of Canticle Magazine, the Voice of Today's Catholic Woman.)
A widely known technique used in the U.S. today is called in vitro fertilization or IVF, which translates literally to “fertilization in glass”—the glass being a test tube, or petri dish, in a laboratory setting. Very basically, for IVF to occur, a physician removes an egg cell from a woman’s ovary, and combines it with a sperm cell from her husband or a donor. The resulting zygote is allowed to multiply two or three times before the newly formed embryo is placed into the woman’s uterus (her own uterus or a surrogate’s) through the cervix using a small tube or catheter.
Given the difficulty of such a procedure using just one egg cell, more than one embryo is usually generated for implantation into the uterus in order to increase success rates of this type of fertilization. Many times no fertilization occurs at all, and at other times all the embryos implant into the woman’s uterus. This leads to the next concern: how many embryos can a uterus grow into healthy babies? Should “selective reduction” (i.e. abortion) then be employed to reduce the number of embryos and, hopefully, insure a healthy birth or births of fewer infants? IVF is fraught with physical, emotional, psychological, and moral concerns for a woman and her family.
The processes that normally occur in a woman’s fallopian tube take place in the laboratory during IVF. The four basic steps in IVF are controlled ovarian hyper-stimulation, egg retrieval, fertilization and embryo culture, and embryo transfer. During a woman’s normal menstrual cycle, the ovaries “take turns” producing a mature egg—one month the right ovary, the next month the left ovary. Several egg follicles (fluid-filled sacs inside the ovaries) begin to mature during each menstrual cycle, but once a single egg comes to maturity, the other follicles stop growing and begin to disintegrate and the unusable follicles are passed out with the menstrual flow.
The goal of controlled ovarian hyper-stimulation is to collect more mature eggs from a woman’s ovaries than the usual one per menstrual cycle. This process is accomplished by giving the woman injections of fertility drugs containing follicle stimulating hormone, which is a natural hormone normally produced by the pituitary gland. This treatment allows the collection of a number of mature eggs from the woman’s body during a single procedure, rather than just the one that would be the norm. Fertility drug schedules can be a demanding balancing act, since blood tests must determine how much medication is needed at a particular time in the menstrual cycle for a successful harvest of mature eggs to occur.
Egg retrieval is the next step in IVF. After the woman has been given anesthesia to sleep, a needle is guided through the vaginal wall into the follicle of the ovary. The eggs and fluid around the eggs are gently suctioned out of the ovaries and into a collection tube. This fluid is given to the embryologist for examination, and to determine the location of the eggs. This procedure takes about twenty minutes to perform, and is usually done on an outpatient basis.
The third step to IVF is egg fertilization and embryo culture. The father or male partner is asked to produce a sperm specimen, usually through self-stimulation, or the specimen can be obtained by needle aspiration (suction) from the testicles. Fertilization may take place by putting several thousand sperm cells together with the harvested eggs in a test tube or petri dish, which is then set in an incubator for some time (about eight hours), and then examined to determine which eggs have been fertilized.
Another method of fertilization that can be used is injecting a single sperm cell into a single egg cell, called intracytoplasmic sperm injection or ICSI. ICSI is chosen in cases when sperm counts are very low or there are other problems with sperm. This method is more dependent on the skill of the embryologist performing the procedure, which requires a very sharp, micro-thin needle and a special microscope to place the sperm into the nucleus of the egg cell.
Embryo transfer is the last basic step of IVF. Two to five days after egg collection, the embryologist loads the embryos into a tiny soft tube and deposits these, through the cervix, into the appropriate place in the woman’s uterus, using abdominal ultrasound for guidance. The number of embryos placed in the uterus depends on how healthy the embryos appear and on the wishes of the parents or mother.
Hormonal therapy is maintained to stimulate optimal growth of the uterine lining to encourage embryo implantation. Blood levels of hormones are checked for a two- to three-week period after embryo transfer, noting whether the body is producing enough hormones to sustain pregnancy. After four weeks an ultrasound may be done to document fetal number and viability. Following this point of achieving pregnancy or pregnancies, the woman is supported medically, as necessary, with hormonal therapies and other concerns of a natural pregnancy.
The beauty of the marital union contrasts sharply with IVF in many ways. Probably the most obvious way is that a human child is generated in the laboratory, “in vitro”—in glass, cold and sterile, rather than conceived in his mother’s womb. The conjugal love of a man and woman is more than a means to the end of the creation of a child, it is also a “sign and a pledge of spiritual communion,” (#2360 CCC) where the “two become one flesh.” The dignity of husband, wife and child are of the utmost consideration in Catholic teaching and morality.
Church teaching surrounding IVF can be confusing, frustrating, and even liberating. The Church holds that “fecundity [fertility] is a gift, and end of marriage” (#2366 CCC). Many couples who experience infertility long for the gift of a child, and medical technology has assisted in marvelous ways to help couples receive the gift of a child.
Why would the Church, which is pro-life and Life giving, oppose IVF? The 1994 “Ethical and Religious Directives for Catholic Health Care Services” issued by the US Bishops Conference sums up Catholic moral teaching on this matter.
Those techniques of assisted conception that respect the unitive and procreative meanings of sexual intercourse and do not involve the destruction of human embryos or their deliberate generation in such numbers that it is clearly envisioned that all cannot implant and some are simply being used to maximize the chances of others implanting, may be used as therapies for fertility.
IVF involves the dissociation of the husband and wife, and the addition of a third party (physician, donor sperm, donor eggs, surrogate uterus). Many times in the course of IVF therapy, embryos are produced in numbers that cannot survive in utero (more than two or three) or are considered “extras” to be destroyed after pregnancy is achieved.
The marital act, holy within marriage, contains the unitive and procreative reciprocal self-giving of each spouse—”that the two may become on flesh.” The dignity of the husband and wife are important, as is the dignity of the child to be created.
The human person must be accepted in his parents’ act of union and love; the generation of a child must therefore be the fruit of that mutual giving which is realized in the conjugal act wherein the spouses cooperate as servants and not as masters in the work of the Creator who is Love (Donum Vitae, #45, 46).
Our Mother, the Church, responds to IVF by saying “we cannot use each other.” “A child is not something owed to one, but a gift. . . A child may not be considered a piece of property” (#2378 CCC).
Sterility is a difficult trial, and it certainly is the most common reason to seek the treatment of IVF. Couples who find themselves in this sad situation are called on to unite their suffering to Our Lord’s cross, and seek other avenues of living out our Catholic faith in the service to other human persons. Perhaps the adoption of children, assistance to other families, educational work with children, and care for the poor and handicapped children or adults can help live out the longing for children in one’s life. In our life-giving and life-loving Church, the end does not justify the means. Children who are conceived through IVF are still to be loved and cherished, baptized and raised in the Church.
