The Real Costs of the Infertility Industry

Despite Church sanctions against such practices, it is likely that IVF and other forms of assisted reproduction technology will continue to grow.

While Wall Street is celebrating the latest global deal between fertility group Genea and pharmaceutical giant Merck—a deal that promises to “take its fertility treatment to the world and double its revenue over the next five years”—faithful Catholics are increasingly vilified for failing to embrace fully the burgeoning business of assisted reproduction. Criticized for the Church’s unwillingness to endorse in vitro fertilization and the use of gestational surrogates, Catholic leaders like San Francisco’s Archbishop Salvatore Cordileone have been denounced, in Cordileone’s case for requiring that Catholic school teachers in his archdiocese support Catholic teachings on life issues—including assisted reproduction. A teacher at San Francisco’s Sacred Heart Cathedral Preparatory recently spoke at a protest against the archbishop, telling fellow protestors about a student who had been conceived through IVF. Suggesting that the archbishop would view such a student as a “product of evil,” the teacher asked the crowd: “Is she the product of evil? Absolutely not! She is a product of God!”

Dismissing the fact that neither the Church nor the archbishop ever suggested that a child conceived through IVF was a “product of evil,” the San Francisco teacher’s hyperbole reminds us of the real teachings of the Church on assisted reproduction. Since children conceived by these means are intrinsically good by their nature, it is important to make a distinction between the goodness of the child and the goodness of the act by which the child was conceived. Unlike the fertility industry, which monetizes what it calls the “products of conception,” the Catholic Church does not view any child as a “product.” Rather, the Church teaches that all children—from the moment of conception—are children of God, regardless of the circumstances of their conception and birth.

In “Begotten Not Made: A Catholic View of Reproductive Technology,” John Haas of the National Catholic Bioethics Center writes that “since children are a wonderful gift of marriage, it is a good thing to try to overcome the obstacles which prevent children from being conceived and born.” Haas reminds us that Scripture is filled with accounts of women who suffered from infertility, and recalls the power of God to help women become mothers. But Haas also cautions that some of the technologies now used to overcome infertility also have “profound moral implications.” In 1987, the Vatican’s Congregation for the Doctrine of the Faith issued Donum Vitae (“Gift of Life”), which teaches that “if a given medical intervention helps or assists the marriage act to achieve pregnancy, it may be considered moral; if the intervention replaces the marriage act in order to engender life, it is not moral.” There are several moral options for infertile couples to choose to achieve pregnancy that are in line with Catholic teachings. 

While IVF is contrary to Catholic teaching, because conception occurs outside the woman’s body, there is an alternative reproductive technique with similar levels of success that remains under discussion by the Congregation for the Doctrine of the Faith—and is neither approved nor disapproved by the Church. This technique is called gamete intra-fallopian transfer (GIFT) and involves obtaining ova from the woman and taking one ovum, separated with an air bubble from a prepared seminal fluid sample, and reinserting that into the woman’s fallopian tube so that conception will occur within the woman’s body.  Pregnancy rates and live birth rates for GIFT are similar to those for IVF—but the difference is that conception occurs within the woman’s body and not in a laboratory. In contrast, IVF requires several ova be removed from the woman’s body and then fertilized in a glass in a laboratory. The “best” embryos, those considered “genetically fit,” are then implanted in the mother—or the gestational surrogate hired to carry the child to term—and the rest destroyed or used for research, all of which runs counter to Church teachings. 

Despite Church sanctions against such practices, it is likely that IVF and other segments of the assisted reproduction industry will continue to grow.  In an article in the Wall Street Journal lauded a new smartphone app that would allow doctors and would-be parents receiving IVF treatment to monitor the growth of embryos in a lab thousands of miles away. This, according to the article is the “latest example of how innovation in the global IVF industry—tipped by some analysts to be worth US$14 billion in 2020—is gathering pace.” There are now more than 4,000 clinics world-wide, according to International Federation of Fertility Societies, performing about 1.5 million treatments annually. According to the European Society of Human Reproduction and Embryology, an estimated 350,000 such babies are born each year. “With the new smartphone technology, parents can watch their embryos divide and multiply on their screens, several times a day,” WSJ reports. “The smartphone add-on could also be a selling point for clinics looking to attract patients.”

These innovations are crucial for the increasingly competitive fertility industry, as clinics rely on their ability to attract patients who are able to pay for services that are not usually covered by medical insurance. In January 2014, a report released by the National Center for Health Statistics revealed that despite the fact that infertility rates are equally distributed across all demographic categories, wealthy couples are much more likely to be able to use assisted reproductive technologies. In a recent Washington Post article, Janell Ross suggested that the high cost and relative rarity of insurance coverage for assisted reproductive treatments has resulted in socioeconomic disparities in access. Ross points out that a single round of IVF costs, on average, $8,158—but that is a conservative estimate, as costs go up dramatically when the couple uses frozen genetic material, and several rounds of medications. Ross cites a federal report released in 2014 that estimates the average cost to be more than $12,000 for each cycle of infertility treatment. Many couples need several cycles in order to produce a child—and some never do. 

The celebrity treatment for infertility

One of those who can afford these kinds of treatments is reality TV star Kim Kardashian, who is just the most recent celebrity to announce her use of IVF in her quest to have a second child with her husband, Kanye West. Ross described the Kardashian-West collaboration as an opportunity to “teach us about yet another political health issue: infertility.” Calling infertility a “political health issue,” Ross is clearly demonstrating her support for expanding access to IVF through changes in the delivery system—and third-party payment by the government or private health insurance. The Church will once again be embroiled in disputes over whether Catholic institutions will have to provide payment for employees to engage in assisted reproductive services. 

The unfortunate story of yet another celebrity couple—sitcom star Sofia Vergara and her former fiancé, businessman Nick Loeb—reminds us of the “real costs” of IVF and the use of gestational surrogates. Their dilemma points to the real reason that the Catholic Church is reluctant to sanction forms of assisted reproduction that replace the marital act and involve surrogates. In July, after a break-up of their four-year relationship, Loeb filed a lawsuit to prevent Vergara from destroying the frozen embryos they created together in 2013. Many in the pro-life community have rallied behind him, viewing the embryos that were created by Loeb and Vergara as persons deserving protection by the state.

Pleading that he is committed to the well-being of his two pre-born daughters, Loeb filed an amended motion on May 14 in Superior Court of the State of California in Santa Monica, seeking full custody of the frozen female embryos—including the ability to bring them into the world. In this new motion, Loeb has also added claims against Vergara for breach of contract for reneging on verbal and written agreements to allow the birth of the embryonic children they conceived. In his filing, Loeb also alleges that Vergara had coerced her 44-year-old personal assistant to act as gestational surrogate for the couple.

Loeb claims that counter to his wishes, Vergara hired her assistant for surrogacy services, paying her $200,000 in gifts and mortgage payments for her home. Embryos were implanted in Vergara’s assistant on two occasions in 2013, but neither survived.

As in the Vergara case, surrogacy often depends on the exploitation of poorer women. These unequal transactions often result in consent that is under-informed if not completely uninformed, or involve coercion. Jennifer Lahl, director of the Center for Bioethics and Culture, and producer of Breeders, a documentary film exposing the surrogacy industry, has initiated a campaign called “Stop Surrogacy Now,” which maintains that “the practice of commercial surrogacy is indistinguishable from the buying and selling of children.”

Several countries, including France, Italy, Germany, Spain, Portugal, and Bulgaria, already ban all forms of surrogacy. In the UK, Ireland, Denmark, and Belgium, surrogacy is allowed where the surrogate mother is not paid, or is only paid for specific expenses. Paying the mother (known as commercial surrogacy) is prohibited in those countries. Commercial surrogacy is legal in some states here—including California—and in countries including India, Russia, and Ukraine. Russia seems to have tightened up restrictions on commercial surrogacy following a highly controversial surrogacy case a few years ago involving a same-sex couple who used a child born to their Russian surrogate in a pedophile ring. 

The BBC reports that most states allow people to go elsewhere if their home country does not allow surrogacy, but some Australian states have criminalized going to another country for commercial surrogacy. Countries that have been the most popular with parents for surrogacy arrangements are the United States, India, Ukraine, and Russia. Mexico, Nepal, Poland, and Georgia are also popular sites for surrogacy arrangements. According to the BBC, costs for surrogacy vary from $45,000 for a surrogate in Mexico to $100,000 for a surrogate in the United States.  

Some states within the United States—including Arizona—prohibit both traditional surrogacy agreements, in which the surrogate mother is the biological contributor of the egg, and gestational surrogacy agreements, in which the surrogate mother is provided with an embryo that has no genetic connection with the surrogate. Arizona law has always maintained in the past that if a surrogacy occurs, the surrogate will be the true mother of the baby. Yet, an appellate court ruled in the case of a divorcing couple that automatic conferral of legal-mother status (to the surrogate) was not constitutional. The Arizona case, like the Loeb-Vergara case, involved a couple in which both members contributed to the biological make-up of the embryo, but split up. It is an important case, because it suggests that the true parents are those who genetically contribute to the creation of the child, and not the surrogate mother who is biologically unrelated to the child. This Arizona case would seem to add support to Loeb’s pleadings for custody as the father of the embryonic children in his lawsuit against Vergara even though the Loeb-Vergara embryos have not yet been implanted. 

In Washington, DC, all surrogacy agreements, regardless of the sexual orientation of the individuals involved, are prohibited by law. Florida law allows both gestational surrogacy agreements and traditional surrogacy, but neither has been available to same-sex couples. Indiana law declares that all surrogacy contracts, regardless of the sexual orientation of the individuals involved are against public policy and unenforceable. Surrogacy laws are changing constantly in the direction of becoming more permissive.

Surrogacy carries many problems beyond the moral and ethical problem of “hiring” or coercing a woman to carry a child that is not her own. For example, a baby with Down’s syndrome was born to a Thai surrogate mother, but was abandoned by the intended Australian parents.  Because of this case, Thailand recently implemented a ban on all commercial surrogacy arrangements.

In some ways, the Thailand case reveals yet again the real costs that these kinds of assisted reproduction technologies carry, because it provides a clear example of looking at the created child as a commodity that is bought and sold—a product that can be “returned” if it is not what was “ordered.” From a Catholic perspective, these practices destroy the two meanings of the conjugal act, the unitive meaning and the procreative meaning. Between the two is an “inseparable connection willed by God and unable to be broken by man on his own initiative” (Donum Vitae II.B). Introducing a third party to the conjugal act, whether it is a laboratory technician or a surrogate mother, the unitive meaning is completely removed. As a result, children become “products” that are deserved, no longer gifts from God. When the unitive aspect is preserved and husband and wife truly embrace each other in the conjugal act, it is a free gift of self from one to the other. Their uniting embrace is an expression of love, one that resembles the love and unity within the three persons of the Holy Trinity. When the procreative aspect is also preserved and a child comes forth from that union, it is a fruit of that love, and the child can be clearly seen and accepted as a gift and not as a product that was purchased. When the child is viewed as a product, that child can be simply discarded—as Ms. Vergara wishes to do with her inconvenient embryos.

While a confused world aims to establish the ability to have sex without babies and babies without sex, the Church stands firm in her teaching to preserve the natural connection between these two meanings of the conjugal act. This is ultimately an act of love, whether it is for the ones being united or the potential child being created. Thus, the further and more detrimental consequence of separating the unitive and procreative aspects is the destruction of love itself. 

About Joseph Cavello 0 Articles
Joseph Cavello is a student associate at the Veritas Center for Ethics in Public Life at Franciscan University of Steubenville, Ohio.