Monday, 30 January 2017 12:21

In Vitro Fertilization – What Many Christians Fail To Consider - Part 1

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Framing the IVF Issue, Gamete Donation & Pre-Implantation Screening.
This report is presented in two parts.  Part 1 will introduce a broad perspective on IVF issues as well as review the topic of gamete donation and pre-implantation screening and the related moral assessment.  Part 2 will follow as a separate report to review matters dealing with embryo donation, surrogate motherhood, and genetic engineering with the associated moral assessment.

FRAMING THE IVF ISSUE

The most commonly used form of fertility treatment is in vitro fertilization (IVF).  It is used to bypass infertility issues  so that with technical intervention a couple can have a child.  It is also used to help a fertile couple have children who want to avoid passing along a known genetic problem to their children.  During the IVF procedure, mature eggs are retrieved from a woman and fertilized with sperm in a laboratory.  The resulting embryo is then implanted into a woman’s uterus.  The procedure can be done using a married couple’s eggs and sperm (homologous fertilization) or can be completed using donor eggs and/or donor sperm (heterologous fertilization).  The woman initiating the IVF treatment may have the embryo implanted into her womb or the purchaser may contract with an unrelated woman to carry the pregnancy to term.  The chances of having a healthy baby vary based on many factors including the age of the woman who is using IVF, the cause of infertility, the age of the donor who provides the egg if a donor is used, and medical issues of the woman carrying the embryo to term. 

The first ‘test tube’ baby, Louise Brown, was born in England in 1978.  The first IVF baby born in the USA was Elizabeth Carr, born in 1981.  Since then the infertility industry has grown enormously.  This is due to many factors.  For one, infertility rates in the USA and other western countries are growing.  Women are delaying pregnancy beyond the normal age of child bearing, contraception and abortion have diminished a woman’s capacity to conceive, and venereal diseases have proliferated impacting reproduction.  It is also true that the fertility industry is very lucrative and has attracted many highly skilled medical and scientific personnel as well as institutional investments.  Financial incentives play a role in the promotion of IVF.  Widespread marketing programs target those who cannot conceive naturally, explaining that science now has a possible solution.  For others, at the recommendation of physicians, IVF is preferred over natural child bearing because of the opportunity to reduce the likelihood of having a child with disabilities through the use of embryo screening.  It is estimated that in the USA 50,000 IVF babies were born in 2006.  The number of births using this technology intervention grows annually.  As a business model it can be said that medical and scientific personnel find this a very lucrative market… but for those who choose IVF to have a child, the return on investment is low.  For women who are 38-40 years old, the likelihood of having a live birth with a normal birth weight using frozen embryos is 24.4%.   

In the United States alone, there are an estimated 1 million frozen embryos stored in cryopreservation tanks around the country.  These embryos are human beings (children) in a suspended state whose fate is unclear.  Managing storage tanks of frozen embryos has become a business, as has the sale of frozen embryos.  Parents, many of whom never considered the implications of having frozen embryos, must decide whether to continue to pay the storage costs (estimated to run between $300 and $1,200 per year) indefinitely, provide them for sale to other couples who desire a child, have them thawed for natural death, have them destroyed, or give them to research.  This is a gut-wrenching decision for many who never considered the implications when they began the process of IVF.  Some find the decision of what to do with their ‘unused’ frozen embryos so agonizing that they defer the decision indefinitely.  Some have left the decision to their children as part of their inheritance with the result that children can beget their own siblings if they choose to give birth to these embryos.  And so the moral issues snowball.  But before going into IVF morality, let’s look at a few of the components of IVF in a little more detail.

GAMETE DONATION

Human gametes, sperm and egg, are needed to create an embryo.  Men masturbate to obtain sperm for donation.  Women have to go through a painful and risky procedure that involves lengthy medical interventions and use of hormones to stimulate ovulation of eggs that are then extracted by medical staff.  Typical egg donors are in their 20’s.  Donation of eggs may cause donor women to become prematurely infertile.  This is because the number of healthy follicles available for egg donation is limited and that number decreases over time as a woman ages.  Although rare, women have died from hyper-stimulation which is done to obtain eggs.  Some women have contracted cancers, which are believed to be caused by high dosages of hormones used to obtain eggs.  Others suffer thrombosis, renal and liver dysfunction, acute respiratory distress, pelvic infection, and organ puncture during egg retrieval.  While most complete the donation cycle without immediate problems, other than the stress that is caused by the program itself, the medical implications of this procedure for women are non-trivial.

There is no shortage of available donated sperm.  The typical sperm donor receives $75 to $100 for his contribution.  The demand for egg donation is increasing as IVF becomes more widespread and as people choose to have children who would not otherwise do so, such as single persons, non-married heterosexual couples, and homosexual persons.  The price for eggs ranges from $2,000 to over six figures.  Those seeking to purchase eggs for IVF will often specify the physical characteristics of the donor they are looking for such as height, weight, hair color, color of eyes, IQ, SAT scores, specific talents, grade point average, attendance at a prestigious university, race, ethnicity, etc. The same egg donor may register on multiple web sites to find the best price they can get for their donation.  It was estimated that the egg market is valued in the US at about $80 million.  Advertising campaigns are developed to promote the purchase and sale of gametes.  One advertisement promotes the notion of altruism for selling gametes by marketing the idea that one is offering a ‘priceless gift’ to an infertile couple.  No matter how your spin it, though, the reality exists that people are treating as a commodity the very capacity God has given them to participate in the creation of a child.  Money has overshadowed the dignity of fruitfulness.

PRE-IMPLANTATION SCREENING

Pre-implantation screening is done on embryos created via IVF.  That screening is done in the laboratory after creation of the embryo and prior to implantation in order to select those embryos most likely to survive the transfer process.  Screening is also done to eliminate the possibility of known inherited diseases by eliminating potential carriers from the transfer process.  There are screenings done on embryos to select the desired sex of the child and desired traits of the child.  Once screening and selection is complete, the embryos are either transferred into a woman’s uterus, discarded as waste, frozen for possible future use, or given to scientists for research, which will result in the destruction of the embryo.  The dignity of the embryo is completely ignored in this process.  The divine image God has inscribed on each person and the respect due to every human being is denied to those embryos who fail the screen.

MORAL ASSESSMENT

IVF Relative to Christian Marriage and the Dignity of Procreation

One must accept a valid anthropology about matters of human sexuality and marriage in order to understand fully the appropriate role of technology in support of procreation within marriage.  This is necessary to recognize the incompatibility between the dignity of the human person and actions that demonstrate contempt for life and love.  Appreciation of a valid human anthropology is also needed to recognize the incoherence between faith in the living God and the ability to decide arbitrarily the origin and fate of a human being.  In a holy marriage the spouses respect the right to become mother and father only with each other.  They also respect the child that may be born from their union.   It is God’s design that children should be conceived within a valid marriage between a man and a woman whose commitment is life-long and ordered towards the welfare of the spouses and the children of that marriage.  Moral fertility interventions are limited by the nature and dignity of human love and the acceptance of God’s design for exclusivity in the marital relationship. Licit medical interventions are those that are respectful of spousal love, such that procreation is achieved through sexual union of the spouses, and the marital embrace is never substituted in order to accomplish the conception of a child.  A couple should always respect God’s design for marriage, which is inscribed in the human body created as either male or female.

Science and technology must exercise respect for the moral law, which includes being at the service of the human person, respecting his/her inalienable rights, and maintaining the integral good of marriage according to the design and will of God.  God, who is love, has inscribed in the bodies of man and woman the vocation of love such that they share through the expression of their love in God’s Trinitarian communion and become open to the creation of new life that is a manifestation of their self-giving love.   Their sharing of love is much more than a bodily union.  It is also a spiritual union that cannot be replicated in a laboratory.  It is the respect of the bodily and spiritual totality of self-giving married love that frames the context for the moral law that is operative here.  It is also relevant that children are intended by God to be formed in personal cooperation with Him for each child is inseparably corporal and spiritual with an eternal destiny that cannot be shaped by medical science alone.  God always has a role to play in the creation of a new human being.

Morally acceptable approaches to addressing infertility fall into three general categories.  The first category concerns natural family planning (NFP).  NFP helps a couple understand the wife’s signs of fertility in order to give information to a physician to help diagnose female hormone deficiencies and other infertility problems and help the couple know how to time sexual intercourse for fertile periods.  Medications can help a couple resolve hormone production issues and sometimes solve problems with production of eggs and sperm.  Medication properly prescribed and used can correct other bodily deficiencies as well.  Surgery may also help some couples to repair reproductive organs or remove obstacles to fertility.  

It is true that many married couples do not fully appreciate the dignity of their spousal relationship and fail to consider the spiritual dimension of sexual union and procreation.  When this happens, they may choose IVF as a means to address infertility and bypass the licit forms of medical interventions that can help to solve some, if not all, infertility problems.  For those who choose to use IVF, many find the IVF focus on baby-making to be physically and emotionally traumatic to the extent that it affects one’s health and marital relationship.  A couple’s unconditional love for one another can be overshadowed by their desire for a child.  The self-giving act of love can be transformed into a clinical experience to such an extent that the unifying significance of the marital act is lost. Rather than fall into this trap, which many inadvertently experience when pursuing IVF, a couple should focus on healing the whole person, not just seeking a particular end.  In so doing, a couple will avoid treatments that violate God’s plan for generation of human life.  The time of infertility can actually become a time of grace to rediscover the essence of one’s marriage partnership and bring new life to that relationship.  It also heals the exaggerated desire for children, reconciling our wills to God’s even if that means accepting infertility and finding other ways for making a marriage fruitful in terms of a couple’s mission in society. 

IVF Relative to the Dignity of the Human Embryo

In the world of IVF there is very often confusion about the real status of the embryo.  The embryo is not just a cell mass. The embryo is a unique living human being and should be given the same respect as any other living human being. Once a human being is conceived there is no change in his/her human nature or his/her moral value based on growth or any other measure. The very young human being, the embryo, should be shown the dignity proper to a person from the first moment of his/her existence.  It is necessary to show respect for the love of the spouses, the dignity of procreation, and the respect due to children who have a right to be conceived, carried in the womb, brought into the world and brought up by his/her own parents. 

Often in the biological sciences there is a lack of recognition of the special character and nature of the human being that distinguishes the human being from animals.  Human beings are the only creatures on earth that God has ‘willed for Himself.’  Each human person has infused into his being an immortal soul that involves the creative action of God at the very beginning of life.   For this reason God has designed human procreation with a special dignity that is intended to be a collaboration with the fruitful love of God.  Every child is a gift of human life that should be actualized in marriage through specific and exclusive acts of husband and wife in accordance with the laws of nature inscribed in their persons and in their marital union. 

In IVF, this relationship between marriage and family life is lost.  A child is considered an entitlement and becomes an object or property that one can negotiate for in the context of contract law.  God’s intended expression of spousal love betting children is often completely lost.  Further, IVF uses assembly line production protocols for quality control and screening in such a way that life becomes commoditized and eugenics principles employed to decide which lives are worthy of life.  This is a grave injustice.

  Having said all that, the important truth remains that all children, no matter how they were conceived and gestated, and no matter what disabilities they may have, are worthy of love and are of great value to the Creator, independent of what acts were done to cause their creation.  Every child should be loved as a cherished gift and treated with the same dignity owed to every other member of the human race.  Respect for human life is central in both Jewish and Christian faiths as represented in the 5th Commandment “You shall not kill”.  This theme is woven throughout Sacred Scriptures, especially in the New Testament.   Christ’s words have a particular resonance here:  “What you do to one of the least of my brethren, you do unto me.” (Mt 25:40). 

IVF Relative to Pre-Implantation Screening

It is standard IVF protocol to complete a pre-implantation diagnosis before an embryo is transferred into a woman’s womb.  The intention of this evaluation is to insure that only embryos free of defect or having the desired sex or particular qualities are transferred.  IVF pre-implantation diagnosis involves the qualitative selection and destruction of embryos.  This selection and destruction process constitutes an act of abortion and is always morally wrong.  It is a form of eugenics and is shameful and reprehensible.  By its nature it defines the value of human life in terms of ‘normalcy’ and physical well-being or based on the presence of specific desired characteristics.  Acceptance of this diagnostic process opens the door to infanticide and euthanasia. 

Morally speaking, technological interventions must respect the sacred vulnerability of embryonic life.  Science must be at the service of this life and not used to decide which human beings are going to be allowed to continue living.  The Divine Law calls us to show compassion for weakness and infirmity not eliminate such conditions by killing the one who has them.  Science can be useful in finding solutions for correcting disabilities and in so doing becomes an instrument at the service of life.  All attempts to eliminate life when the life fails to meet some arbitrary standard must be rejected as immoral.  For this reason pre-implantation screening procedures and prenatal diagnostic procedures that are used for the purpose of eliminating life that fails to meet desired characteristics should not be employed.  

IVF Relative to Confusion of Ends and Means

Most people are familiar with the expression ‘the ends do not justify the means.’  In the case of parents looking to IVF to have offspring, their desire to have a child does not justify doing whatever is possible to obtain a child.  It is not sufficient to consider ‘good intentions’ and ‘desirable outcomes’.  The reality of what is involved in the IVF industry must be considered and the intended role of the Creator in the generation of new offspring should never be excluded.  In summary, all infertility treatments must respect:  1. the right to physical integrity of every human being from conception to natural death; 2. the right within marriage to become a father or mother only together with one’s spouse; and 3. procreation as the fruit of a specific conjugal act that expresses the love of the spouses. 

SEEKING MERCY

Christians are called to keep the faith alive even in the darkest moments of history, to trust God, and to persevere.  For couples seeking help to have a child, it is possible, even with the pressures of professionals dedicated to using technology in novel ways, to say no to immorality and to reaffirm that we will follow the Lord and His Commandments, to honor life from conception to natural death, to avoid perversions to the marriage bond, to honor the rights of children, and to give witness to truth no matter what comes.  Professionals who are trying to care for the needs and wants of their patients need to set boundaries on how far they will go to serve the desires of their patients in order to maintain professional integrity remembering that one’s professional gifts and talents ultimately come from God and should remain accountable in service to Him.  

We are all sinners in need of conversion.  Whether one is struggling with infertility or a practitioner caught up in trying to service professional demands, God is loving and merciful and He waits for us to return to Him and put our lives in order, while there is still time.  We must always remember and witness to the fact that all human beings share the same value and dignity and all reflect the truth of God’s design and the call to be people who love at all times and in all seasons of history.  Let us stand together in solidarity with our smallest and weakest brothers and sisters and work to build a civilization of love.

Dr. Knouse is a professional Catholic bioethicist who focuses on developing education materials and delivering instruction to clergy, teachers, students, and adult audiences on various topics related to beginning-of-life and end-of-life ethics.  She is able to draw from her extensive health care experience to bring a broad perspective to current issues while giving guidance that is actionable for her audiences.  Dr. Knouse also works with families in crisis during critical medical events to aid them in understanding the ethical implications of proposed medical interventions for loved ones who are dealing with an unanticipated health crisis.  

Dr. Knouse is passionate about helping those interested in practicing their Christian faith in those areas that pertain to the Gospel of Life.  She has a doctorate and a license in bioethics from Regina Apostolorum Pontifical University in Rome as well as a Master’s of Science in Health.  Through Esther Associates LLC, Dr Knouse provides consulting services as well as educational services in the fields of bioethics and health care.