Having struggled with infertility for nearly six years, we know the pain of not being able to have a baby. We're also familiar with the awkward silences — and tears — that often accompany conversations with those who have never experienced infertility. On the one hand, people tend to believe fertility is something we have perfect control over. "Just relax," we've been told. "When you settle down, I'm sure it will happen." Or, "Maybe you're just not ready yet," as if "buying a house" or "getting a better job" would make us pregnant. On the other hand, it's a mystery why so many couples like us aren't blessed with biological children. If, as Scripture tells us, "children are a gift from the Lord" (Ps. 127:3), how should couples understand their infertility? What hope is there for couples who desperately desire children, but also want to remain faithful to the Church's guidance regarding artificial reproductive technologies?
According to the Centers for Disease Control, infertility is a condition that affects 2.1 million married couples (1 in 8 of childbearing age) and 6.1 million women, aged 15 to 44. Male factor infertility accounts for 30 percent to 40 percent of all cases. These rates are increasing as more couples delay marriage and childbirth to pursue careers and educational opportunities.
But did you know that according to Harvard researcher Alice Domar, "Infertile women report equivalent levels of anxiety and depression as women with cancer, HIV status or heart disease"? Adds Domar: "The majority of infertile women report that infertility is the most upsetting experience of their lives." Such heartbreak might help explain why so many hurting couples are tempted to pursue morally questionable remedies for infertility.
Fortunately, though, most couples can conceive using natural techniques that accord with the Church's wisdom on marital sexuality. Counsels Dr. Domar: "Very few people have physical conditions that make it impossible to have a child, and in many cases simple lifestyle changes and low-tech strategies can make a decisive difference. … Many couples can be helped by our greater knowledge of how lifestyle factors like stress, exercise, and nutrition affect conception, of better ways to regulate and target ovulation cycles, and of common medicines to avoid that can inhibit sperm and egg production." Dr. Paul Dmowski, a leading infertility specialist, estimates that "only 8-10 percent of couples in treatment need high-tech … procedures," such as in vitro fertilization (IVF). Concludes Domar: "So much attention in the media is focused on the latest high-tech intervention that many people forget to give nature enough of a chance."
Domar's observations allude to a popular prejudice in our culture that nature and science are at odds with one another. Natural, scientifically based alternatives are thus thought to be inferior to their high-tech counterparts. In reality, scientific technologies that work in accord with nature have proven very effective in treating infertility. The Creighton System's NaProTechnology program, for instance, boasts an overall pregnancy rate of up to 50 percent for patients of all ages and diagnoses — with rates as high as 80 percent for many couples. These figures are nearly two to three times higher than results from the leading artificial technologies.
Techniques like those taught by the Pope Paul VI Institute, Couple to Couple League, and the Billings Ovulation Method Association differ from artificial technologies in that they cooperate with nature by equipping couples to listen to what their bodies are saying. For a woman, these messages can usually be discerned by charting monthly cycles and mucus patterns. According to the Pope Paul VI Institute, couples who have learned to chart effectively have a 76 percent chance of conceiving during their first cycle of use and a 98 percent pregnancy rate by their sixth cycle. Yet, because many couples assume they'll get pregnant right away, they rarely take time to explore how their fertility works. "Even sophisticated couples," relates Dr. Domar, "may not be clear about when ovulation occurs or how long sperm live."
Diet and nutrition are also crucial to achieving pregnancy. According to John Kippley, cofounder of The Couple to Couple League, "In many cases, cycle irregularities can be either eliminated or alleviated simply by better nutrition or body balance." Many other seemingly insignificant modifications — wearing boxers instead of briefs, eliminating nightlights, taking 500 mg of extended release B6, using iodized salt — can likewise aid in conception.
Despite high success rates, some couples (like us) might not be able to have a baby using natural family planning. Lured by promises frequently backed up by a "100 percent money back guarantee," more and more couples, including many Catholic couples, are resorting to artificial insemination (AI) and assisted reproductive technologies (ART) to conceive a baby. The majority of people who employ high-tech treatments turn first to intrauterine insemination (IUI), the most popular form of artificial insemination (a technique by which processed sperm are injected into the uterus with a catheter). If that fails, many couples move on to in vitro fertilization (IVF), by far the most widely used form of ART. In recent years, however, IVF has become so popular that some physicians no longer consider IUI a first-line approach.
Given that very few Christian ethicists approve of donor insemination, or heterologous artificial insemination (AID), we will limit our remarks to the homologous forms of IUI and IVF. By and large, Protestant theologians agree that infertility procedures that are homologous or exclusive, in that they use only the husband's sperm and/or his wife's eggs, are Biblically defensible. Out of her deep respect for the human person, however, the Catholic Church holds that no form of artificial insemination or ART is permissible.
The primary reason the Church opposes IUI and IVF is that these techniques frustrate the unitive aspect of the marital act. As discussed below, the unitive end of marriage encompasses the personal and spiritual good of the spouses themselves. One indication of this breach in unity is that artificial interventions (excepting a tubal ovum transfer with sperm) always require masturbation.
Until quite recently nearly all Protestant theologians disapproved of masturbation. Genesis 38:8-10, in which Onan is struck dead by God for repeatedly practicing coitus interruptus, is the locus classicus for the traditional teaching on masturbation. Commenting on this passage, Luther argued that God punished Onan because he "preferred polluting himself with a most disgraceful sin to raising up offspring for his brother." Continues Luther: "It is far more atrocious than incest or adultery. We call it unchastity, yes a Sodomitic sin." Calvin likewise declared: "The voluntary spilling of semen outside of intercourse between man and woman is a monstrous thing."
Yet most Protestant authorities no longer agree with the traditional elucidation of Genesis 38 and so do not consider masturbation a sin. James Dobson, for one, posits that Onan was killed for failing to do his "duty" to produce offspring for his brother, rather than for spilling his seed. In a similar vein, When Empty Arms Become a Heavy Burden, a "Christian guide to the practical, moral, marital, and spiritual challenges of infertility," acknowledges that while masturbation "can prove disruptive to a relationship with God as well as others, particularly in marriage," providing a semen specimen "on demand" can be a gesture of "respect for God" and love of one's spouse.
Protestant scripture scholar Charles Provan, however, demonstrates in The Bible and Birth Control that Onan was not killed for disobeying his father, Judah, or because he did not honor his brother's memory, or for anything other than spilling his seed. Citing Genesis 2:24, Provan shows that Judah's authority over his son ended when Onan got married. Provan also recalls that the punishment prescribed for failure to "raise up seed for a dead brother" is not death, but merely to have the widow publicly remove her brother-in-law's sandal and spit in his face (Dt. 25:5-10). Additionally, Provan leads us to ask why Onan — and not Adam, Eve, Cain, Jonah and countless others — merited such harsh punishment for his disobedience? Provan's conclusion, based upon a close analysis of Leviticus 20, is that God forbids all forms of intentionally sterile intercourse.
The Narrow Way
Apologists for IUI and IVF often call the Church's view on masturbation narrow, just as they call the Church's definition of conjugal love constrictive. Empty Arms offers this partially misleading analysis of Catholic teaching: "The Vatican, which interprets Scripture for members of the Roman Catholic Church, holds that sex (the unitive) must not be separated from the opportunity to reproduce (the procreative) nor vice versa. … As a result, the Vatican prohibits birth control, D.I. [donor insemination], and even insemination using the husband's sperm. … While we agree on the importance of Scripture, we question the specific interpretation that leads to the Vatican's viewpoint. If carried to its extreme conclusion, this view would suggest that no sterile man or woman may have sexual intercourse. It would also prohibit postmenopausal women from sexual relations. For this reason, some have suggested that the Vatican redefine conjugal love in such a way that it encompasses all forms of physical expression in marital love, rather than limiting it to sexual intercourse" (167-168).
Similarly, John and Sylvia Van Regenmorter, authors of a popular text on infertility published by Focus on the Family, contend that "numerous Roman Catholic theologians" disagree with the Church regarding infertility treatments. "Following this reasoning many Roman Catholic couples are convinced they may pursue AIH [homologous artificial insemination] without violating their consciences or their faith."
Granted, some Protestants don't approve of any form of artificial insemination or ART. But lacking doctrinal authority, most discussions about these matters are vague and unsystematic; equivocation is also common. Frequently, couples looking for specific advice are told there is no simple right or wrong answer. That's why it's so great to be Catholic. Regardless of what dissident Catholic theologians claim, the Church offers concrete guidance for couples struggling with infertility. This guidance is grounded in the Church's longstanding teaching on human sexuality. As reaffirmed in Humanae Vitae (Of Human Life): "There is an unbreakable connection between the unitive meaning and the procreative meaning [of the conjugal act], and both are inherent in the conjugal act. This connection was established by God, and man is not permitted to break it through his own volition (12)." These last four words — "through his own volition" — are essential to understanding the Church's position. Contrary to what the authors of Empty Arms say, the Church does not prohibit sterile (impotency is another matter, cf. Can. 1084) or postmenopausal couples from having intercourse. These couples are not choosing to disconnect the procreative and unitive aspects of their lovemaking; rather, they are letting nature take its course while continuing to come together as man and wife in the way nature ordains.
But the main point here is that the unitive aspect of the marital act does not consist merely of sex, as asserted above. Rather, as the Catechism teaches, its end is the "good of the spouses themselves" (CCC 2363). This good is such that it can only come about through the mutual surrender of one spouse to another: a self-donation that must be both personal and exclusive.
Contrary to what many couples may believe, IUI and IVF are neither exclusive nor personal acts. As we shall see in part two of this series, IUI and IVF thus violate both the baby's right to be created through a specific personal act and the mother and father's right to become parents only through each other (CCC 2376).