An embryologist removes frozen embryos from a storage tank at the Smotrich IVF Clinic in La Jolla, Calif., in this 2007 photo. (CNS photo/Sandy Huffaker)
1978, when doctors introduced Louise Brown, the first “test tube” or in vitro
baby, to the world, the international media hailed the event as
something just short of the definitive answer to infertility. In Time
magazine, Dr. Robert Edwardsone of
the brains behind Baby Louise’s birth and the acknowledged godfather of the
assisted reproductive technology (ART) industry it spawnedboasted: “This is
the first time we’ve solved all the problems at once. We’re at the beginning of
the endnot the end of the beginning.”
more than three decades later, a critical look at the direction of the ART
industry’s agenda and actions leaves Catholic observers with several troubling ethical
and medical questions that might be summed up as: “Where will it all end?”
precisely one decade after the publication of Pope Paul VI’s prophetic encyclical,
Humanae Vitae, the initial Catholic
response to Baby Louise was ambiguous. Just days before being named Pope John Paul
I, Albino Luciani expressed his “best wishes to the baby,” suggesting that the
parents may “have great merit before
God for what they have decided on and asked the doctors to carry out.”
Catholic scholars, scientists, and laypersons adopted sentiments similar to
those of the pope, only without the helper verb, “may.” Unencumbered by meaningful opposition, the ART industry, a
consortium of researchers, medical school professionals, pharmaceutical
companies, and others, formed an unofficial alliance with the secular media and
quickly evolved into a formidable and profitable presence worldwide.
IVF births mounted, media outlets recognized and satiated the public’s appetite
for heartstring-tugging stories about infertile couples who were finally able to achieve pregnancy and
live birth via the “miracle of IVF.” Multi-birth pregnancies and grateful moms
and dads holding their smiling IVF triplets, quads, quints, or more made for
publicists were only too happy to supply IVF doctors and other medical
professionals who delivered appropriate soundbites. To the casual viewer on the
outside looking in, the medical world had, indeed, solved the problem of
the cutting room floor: The IVF procedure
attitudes and perceptions of IVF, formed in large part by the media, are long
on images of darling IVF children and short on information about the impersonal
IVF procedure itself, which is rarelyif everdescribed in detail.
the basic process: oocytes, or human eggs (obtained surgically from the wife’s
ovarian follicles in drug-induced, super-ovulated cycles) and prepared sperm
(previously collected from the husband, usually through masturbation) are
brought together in a petri dish in the laboratory. Fertilization, if it is
successful, takes place in that dish in a labthat is, outside the woman’s body
and any act of sexual union between the couple hoping to conceive. Next, three
or more blastocyst-stage (five-day old) embryos are placed in the uterus
through a process called embryo transfer. Less robust-looking embryos are
either destroyed or cryofrozen at -320 degrees Fahrenheit in liquid nitrogen
for possible future implantation or use in embryo-destructive research.
average cost for a single, basic cycle of IVF in the US is about $12,000.
Success rates, a hotly debated topic even within the ART industry, vary widely
according to a number of factors, most notably the age of the woman. The latest
available data (2008) from the Centers for Disease Control (CDC) place IVF success
rates (measured by numbers of live births) for women between the ages of 35 and
37 at 37.4 percent; women 38-40, 28.2 percent; women 41-42, 16.5 percent; women
43-44, 7.8 percent; and women 44 years or older, 2.8 percent. About six out of
every 10 IVF procedures are performed on women age 35 or older.
after the birth of more than four million IVF children worldwide, the procedure
is looked upon as commonplace, even routine. The most recent data available
from the CDC shows IVF procedures in the US have doubled over the past decade,
with 475 IVF clinics performing nearly 150,000 “cycles” of IVF annually.
stories in the media, including TV reality shows, continue to generate good
audience ratings. But in recent years a number of new, unscripted storylines
have begun to emerge, revealing the darker, unsettling underbelly of the ART
industry and its practices.
sampling of these revelations includes:
- Unemployed single mother Nadya Suleman of
California gained worldwide notoriety in January 2009 as the “Octomom”giving
birth to eight IVF babiesafter a Beverly Hills doctor transferred 12 human
embryos to her uterus. It appears that Suleman’s children are the world’s
longest-surviving set of octuplets. They joined the six children Suleman had already
given birth to through previous IVF procedures. All 14 births were from the
same physician, whose medical license was eventually revoked. Although a spokesman
for the American Society of Reproductive Medicine (ASRM), the chief advocacy
group of the ART industry, condemned the event as a violation of ASRM
guidelines for embryo transfer, an Associated Press story revealed that less
than 20 percent of IVF clinics in the US follow the guidelines, which do not
carry the force of law.
- The largely unknown practice known as “selective
reduction” gained prominence through Washington
Post journalist Liza Mundy’s book Everything
Conceivable: How Assisted Reproduction is Changing Men, Women, and the World (2007). The book offered detailed descriptions
of the reductions of multiples-pregnancies (twins, triplets, or more), in which
the least viable-looking fetus (or fetuses) is aborted by sodium chloride
injection. More recently, a New York
Times Magazine cover story (August
11, 2011) highlighted selective reduction under the headline “The Two-Minus One
Pregnancy,” recounting chilling explanations from IVF mothers of how they decided
which of their fetuses to destroy.
- The connection between sperm banks and IVF
clinics drew scrutiny after an article titled “One Sperm Donor, 150 Offspring” appeared
in the New York Times (September 5,
2011). In the article, writer Jacqueline Mroz chronicled the myriad potential health and ethical concerns surrounding sperm
donation, including the case of one sperm donor who “fathered” 150 children
(with more on the way), all of whom are half-siblings. The possibility that
genes for rare diseases could be spread throughout the population and the increased
odds of incest between half-sisters and half-brothers who live in close proximity
to each other but are unaware of their blood relation are just some of the
potential problems arising from a largely unregulated sperm-donation industry.
- Two recent documentaries highlight other
little-known health consequences of IVF. Eggsploitation
(2010), produced by the Center for
Bioethics and Culture, earned high praise from across the political and
cultural spectrum for exposing what the film calls the IVF industry’s “dirty
little secret”the hidden dangers and risks to the health of young women who
“donate” eggs for use in IVF clinics, thus fueling the human-egg trade. The
film was named Best Documentary at the 2011 California Independent Film
Festival. Echoes of Our Choice (2010,
Ignatius Productions) is a film by Michigan neonatologist Robin Pierucci
documenting the largely ignored dangers of premature multiple birthsbirth
defects and high mortality ratesthat are common in IVF pregnancies, and devastating
to unsuspecting parents.
and other revelations represent merely the tip of the IVF iceberg. With
regulation of the IVF industry virtually nonexistent in the US, it is estimated
that a stockpile of some 500,000 human embryoslabeled as “spares”are now in a
cryopreserved (frozen) state. Moving toward “designer babies,” IVF specialists are
marketing and promoting the use of prenatal genetic diagnosis to scan and test
chromosomes of IVF embryos, allowing for the elimination of those nascent human
beings with less-than-desirable genetic traits.
parentingegg donation and surrogacy for gay men, sperm donation and
intrauterine insemination and IVF for lesbiansis on the uptick. Assisted Human
Reproduction Canada, a federal regulatory agency, reports that three out of
every five demands for assisted reproduction in that country come from same-sex
couples. As same-sex marriage and surgery for transgendered persons gain
political and popular traction in the US, the number of same-sex or
transgendered persons wishing to have children is also sure to rise.
the radical agenda: Mainstream medicine’s role
and other reproductive techniques, services, and consequences are well within
the mainstream of the medical field. In fact, major ART conferences in the US
and around the world tell the story of an obstetrics/gynecology/endocrinology profession
that is not only not aghast at the
anti-life, anti-marriage, and anti-family protocols that are givens in the
field of human reproduction and nascent life, but is in fact leading the charge
for such practices and procedures:
Embryo’s Out-of-Body Experience” is one session title at the 2011 conference of
the Progress Educational Trust, which is being held in London this November and
which is sponsored by international biopharmaceutical giants Merck Serono
(Germany) and Ferring Pharmaceuticals (New Jersey). The “out-of-body” language
challenges attendees to consider the question of which environment is best for
the newly created embryo: the mother’s uterus, or a petri dish. A session
called “Making the Grade,” offers guidance on selecting embryos for transfer
based on established guidelines, whichgiven the frequency of selective
reductioncan’t be good news for those embryonic human beings determined to be
less desirable than their siblings. Conference speakers include a sympathetic columnist
from the Guardian and Simon Fishel,
Ph.D., a former colleague of Dr. Robert Edwards whose achievements include appointment
as deputy scientific director of the world’s first IVF clinic at Bourne Hall,
title of an Australian science symposium associated with the World Congress on
Human Reproduction speaks volumes: “When Starting a Family Takes More Than
Two.” Other symposium topics include “Are
the Kids Really All RightWhat Happens When the Donor Families Link Up?”,
“Family Structures are Changing More Than You Know,” and “Does Sperm Donation
in Australia and New Zealand Have a Future?” The World Congress on Human
Reproduction’s provocative theme for 2011 is “Making Babies: Is It Just
veritable Who’s Who of prestigious US research universities and reproductive institutions
will be represented at the October 2011 meeting of ASRM in Orlando, titled “Realizing
Scientific Dreams.” Among the post-graduate sessions: “Fertility and Family
Building in the Transgender Population,” a one-day course exploring “gender
identity dysphoria/disorder, its diagnosis and management, and special needs of
transgendered individuals seeking ART.” Two Yale Medical School professionals will
lead a symposium titled “Two Moms, Two Dads: Same-Sex Couples and Assisted
Reproduction.” Alan E. Guttmacher, MD of
the Guttmacher Institute (the research arm of Planned Parenthood) will offer thoughts
Directions in Reproductive Research.” Other sessions will cover
embryo selection, mandated insurance coverage for ART, and tips for acquiring
embryonic stem cells. Mental health professionals will look at “Assessing Books
for Donor-Conceived Young Adult Readers.” Attendees will investigate the ethics
of posthumous reproduction. A major conference highlight will be “Contraception
Day,” featuring a keynote address titled “Let’s Get Serious: Evidence Clearly
Suggests What Could Be Done to Diminish Unintended Pregnancies,” and an
interactive debate on “Adolescent Contraception: DepoProvera vs. IUDs”
presented bywhom else?the ASRM’s Contraception Special Interest Group, of
sponsors play a key role at the ASRM gathering, with pharmaceutical companies
like Merck and Pfizer among the “Ruby Level Supporters,” donating at least
$100,000 in exchange for high visibility among attendees. The ASRM is
recognized by the Internal Revenue Service as a 501 (c)(3) non-profit
corporation, with total revenue in 2010 of more than $9 million, and total
assets exceeding $30 million.
sexuality, procreation, and health care through the Roman Catholic lens
is a profound contrast between current mainstream approaches and solutions to
infertility and reproductive health and that of a relatively small but growing group
of medical surgeons and other professionals trained within a Catholic ethos.
While much of the popular perception of Roman Catholic thinking on sexuality tends
to focus on the Church’s opposition to abortion and artificial birth
controlimportant tenets to be sureit is hardly the complete story.
1985, Dr. Thomas W. Hilgers and his wife Sue, inspired by the message and call
of the papal encyclical Humanae Vitae,
decided to establish the Pope Paul VI Institute for the Study of Human
Reproduction. Since that time, the Omaha, Nebraska-based institute has become
the epicenter for medical and surgical approaches to infertility that conform
to the Catholic Church’s vision of the value of human life and human
by the Church’s age-old vision of the human person, human sexuality, and
marriage, the institute has developed the women’s health science known as NaProTechnology
(natural procreative technology, or NPT) as the “small-c catholic” (universal)
and “capital-c Catholic” answer to infertility, touting success rates that are
one-and-a-half to three-and-a-half times higher than various methods of IVF.
“hub” of NPT is a natural method of family planningthe Creighton Model
FertilityCare System (CrMS)that provides couples with fertility information to
help them pursue their goal of conceiving babies of their own. The system teaches
the woman to observe and chart cervical discharge, known as a “bio-marker,”
throughout her cycle.
this information, the woman and her husband know their window of fertile days,
allowing them to direct their acts of intercourse to the days that optimize chances
of achieving a pregnancy.
than just a roadmap to days of fertility, medical data from the couple’s charts
also serve as a diagnostic tool for NPT-trained physicians, helping them
identify many underlying diseases and conditions. These are not just related to
infertility, but include a range of women’s health issues such as recurrent
miscarriage, premature birth, post-partum depression, and much more.
NPT-trained doctors can also provide medical and/or surgical solutions to infertility
and other health problems. These procedures are all done in the context of
protecting human life and the dignity of the conjugal act that leads to human
procreation. In all of these respects, NPT is not only effective in its medical
and surgical approach to infertility, it is also superior to other reproductive
treatments in its ethical perspective.
desperation experienced by couples seeking solutions to infertility, combined
with the seductive marketing of ART alternatives and a lack of solid catechesis,
very often pushes Catholic moral and ethical concerns regarding fertility
treatments to the backgroundif they are considered at all.
society’s moral infrastructure rests squarely on the foundation of the family,
then appraising the moral character of the means by which couples build those
families takes on critical individual and social importance. NPT protocols
assist couples struggling with fertility “to procreate in full respect for
their own personal dignity and that of the child to be born” (in the words of
the Vatican’s 1987 instruction on human life, Donum Vitae).
nearly every aspect, ART’s goals and protocols do not pass this test, nor do
they even try to do so. The Catholic vision of sexuality and procreation is, in
almost every way, a polar opposite of the secular, IVF-based vision. The result
is a clash of competing cultures with emotionally vulnerable couples trapped in
norms for building a family did not develop in a vacuum and are derived
directly from the Church’s comprehensive vision of the human personrooted in
reason, confirmed and enriched by faith. The good news, then, is that couples seeking
to realize the laudable goal of conceiving babies of their own can use these
norms as guideposts directing them to a good means of achieving that goal: an
infertility treatment that promotes the values of human life and human
norms pertaining to infertility treatment follow from this “small-c” catholic
(and Roman Catholic) vision of human life and human dignity:
- Infertility interventions must respect the
inviolable integrity of a newly developing human life in vitro or in utero;
- spouses do not have a right to a child. Children
are, and must be viewed as, a personal gift, the supreme gift of marriage;
- human dignity demands conception, not production
of new human beings; and
- a child has the right to be conceived within
- There is an inherent absurdity about reproductive
technologies such as IVF that bring
life through death. Couples are informed by IVF specialists as to
which embryos should be transferred, which should be cryofrozen (possibly
to be donated for embryonic stem cell research, which destroys the embryo),
and which should be discarded.
higher number of multiple births that occurs with IVF invites the practice of selective
reduction as the pregnancy enters the second trimester. For those babies that
do survive, there is a commensurate higher risk of premature birth, often a
precursor to abnormal motor and mental development.
NPT treatments for infertility respect the right to life and bodily integrity
of gestating babieshuman beings in utero.
NPT protocols not only do nothing to destroy a new human lifethey do a good
deal to facilitate a healthy, full-term pregnancy.
providers and users demonstrate an overtly utilitarian outlook. Infertile
couples, in their minds, have the right to reproduce in any way they please and
to conceive their own babies in the easiest, most expedient way they can. IVF
specialists reduce parents to suppliers of fertilization material and reduce
the baby to an end-product, manufactured and controlled by technology.
approach to infertility, by contrast, encourages couples to work cooperatively
with nature and to respect their own human dignity, and that of their unborn
who have been treated successfully for infertility through NPT, and conceive as
a result, do so within their own acts of intercourse, that is, within the only
context worthy of the conception of a new human being.
discussions referencing any rights of
an IVF childparticularly whether that child has a right to be conceived in a
natural wayare virtually nonexistent. In the world of IVF and embryo transfer,
the desires of the parents trump all.
NPT assists the couple in conceiving a child within their own acts of sexual
love, this approach to infertility also encourages parents to appreciate and
respect the rights of their children, which follow directly from their dignity:
to be conceived within, and therefore to be connected to, the protection,
securityand yes, intimacyof their parents’ bodily union and marital love.
global struggle: The IVF industry vs. NaProTechnology
by favorable media coverage, deep-pocketed multinational pharmaceutical allies,
and burgeoning demand driven by the instinctively holy, natural desire of
couples to bring children into the world, the IVF industry shows little sign of
subsiding. The issue for Catholics is how best to respond to this increasingly
aggressive assault by the mainstream medical community on the dignity of human
life, marriage, and the natural procreation of children.
perhaps the first time since Baby Louise, a viable, medically superior
alternative is available for not only Catholics, but anyone willing to consider
an effective approach to reproductive medicine that differs from the
mainstream. And Catholic medical professionals are using this knowledge to
engage mainstream medicine on an intellectual and scientific level in the
United States and around the world.
the homeland of Blessed John Paul IIa strong supporter during his pontificate of
Dr. Hilgers, NPT, and the Pope Paul VI Instituteis emerging as one
battleground in the IVF struggle.
making presentations in late September 2011 to the Polish Society of Perinatal
Medicine, Dr. Hilgers engaged that country’s leading IVF doctor, obstetrician/gynecologist
Marian Szamatowicz, in a debate before dozens of physicians about the merits
and safety of IVF. Hilgers’ trip to Poland was made partly in response to more
than a dozen Polish medical professionals who journeyed to Omaha for an intense
week of NPT education and training, part of the largest training class in the
Pope Paul VI Institute’s history.
Pope Paul VI Institute has become an international destination for physicians
and other medical professionals seeking NPT training. In July 2011, the fourth
class of fellows graduated from the Pope John Paul II Post-Graduate Fellowship
in Medical and Surgical NaProTechnology. These and eight other graduates are
practicing NPT surgical techniques throughout the United States. Two fellows
have been accepted into the 2011-2012 class.
the medical and surgical practice of NPT continues to grow in popularity, Dr.
Hilgers and those connected to the Pope Paul VI Institute are under no
delusions about what they are up against.
However, “Building a culture of life in women’s
health care,” the mission of the Pope Paul VI Institute, is not a quixotic
exerciseat least not for those physicians, practitioners, and most importantly
the couples who have been touched by this emerging reproductive health science.
How deeply NPT impacts the secular culture, and an IVF industry spiraling out
of control with an “anything goes” mentality, remains to be seen.
Editor's note: This article originally appeared in the November 2011 issue of Catholic World Report.