Morality of Infertility Treatments

Dear Darren,

Your family is fortunate that there is an openness to discuss these important issues, and give weighty consideration to the moral and ethical considerations of the infertility treatments available. Just because one CAN do something, does not mean one should—-even, or especially, in medicine.

Your family is quite correct that IVF poses very serious ethical concerns, including the destruction of life, in the quest to conceive. And every child deserves to be conceived from a loving act of the parents—-this is not IVF. In addition, it is just poor medicine, doing nothing to correct the health problem that is causing the infertility, and with a dismal success rate. The exorbitant cost is burdensome to infertile couples, but many overlook not only the cost, but the ethical concerns, the low success rate, and the higher rate of complications associated with it, in their desperation to have a child. Even if they succeed in bearing a child through IVF, their cause of infertility is left undiagnosed and untreated, with no progress made that will enhance their ability to conceive a sibling for the child in the future.

Having said that, many families do have family members who have, out of desperation, and often convinced this is their only option, used a form of IVF to conceive, and of course children are always a gift from God, regardless of the circumstances of their conception, to be embraced by the family with unreserved love and acceptance. I am sure if your family members choose to use these techniques, despite your best efforts to dissuade them, you would never project your legitimate concerns about the means, upon the child that might result.

In treating infertility, the goal should be to evaluate the health of the couple, to determine the cause of the infertility, diagnose and treat it, so that the couple can conceive from a normal, loving marital act. Medications can certainly play a key role in this. Surgical treatments may be indicated as well. The key is that these treatments be used to correct an abnormality, and restore the health of the couple. For instance medication may be indicated if the woman has low progesterone, to supplement her levels and prevent miscarriage, or pre-term birth. Thyroid medication may be indicated if her thyroid is not properly regulated, as this can negatively impact fertility. And in some cases, medications to stimulate egg production (perhaps these are the “fertility drugs” to which you refer) may support normal ovarian function, and enable the couple to conceive. The use of such medications is not immoral, as they correct an abnormality, and restore normal reproductive health—but the couple still conceives from a loving marital act. These medications do not separate or replace the love giving and life giving nature of a normal act of intercourse, they simply restore normal reproductive function—-conception is still the result of the marital act.

Drugs which induce ovulation can increase the likelihood of multiple eggs. Some medications have a very low risk of multiples, and when they do occur are still usually only twins. Other medications carry a higher risk of multiples. Of course the couple would want to discuss these and other side effects of medications and treatment with their doctor, and make an informed decision regarding the specific medication chosen, and the appropriate dosage. And of course, the couple would want to be clear with the physician that in no case would they consider a procedure referred to as “fetal reduction” which is often suggested in situations such as IVF when more babies are conceived then is “desired” or wise.

One does not need a medical or theological degree to grasp the very basic premise I stated in the outset—-every child deserves to be conceived by the loving act of the parents. Procedures and treatments can be evaluated in this context: procedures that replace this act, do not meet the moral criteria. Medications or therapies that improve the health and restore the fertility of the couple, and permit them to conceive a child through their loving act, are licit.

In evaluating infertility treatments, it is also important to evaluate them in terms of good medicine. For instance, I constantly encounter couples who have had evaluations done at the entirely wrong time in their cycle, because they were not tailored or timed to their individual cycle, with resulting misdiagnosis, and ineffective treatment, that may do more to further disrupt their fertility than improve it!

You are wise to refer your family to Pope Paul VI Institute, or a physician trained by the Institute. Those physicians will want the couple to chart their fertility, as a vital tool in diagnosing, and timing tests and treatments. They offer ethical solutions AND good medicine, and a success rate that far surpasses that of the artificial reproductive technologies. It just makes sense!

A good resource on the Catholic teaching on this issue was provided by Joseph Cardinal Ratzinger (now Pope Benedict) and the Congregation for the Doctrine of the Faith, and approved by Pope John Paul II: “Donum Vitae: Instruction on Respect for Human Life and its Origin and on the Dignity of Procreation” .

Sheila St. John