Anything Goes (Reproductive medicine grows ever more disturbing)

In 1978, when doctors introduced Louise Brown, the first “test tube” or in vitro fertilization (IVF) 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 Edwards—one of the brains behind Baby Louise’s birth and the acknowledged godfather of the assisted reproductive technology (ART) industry it spawned—boasted: “This is the first time we’ve solved all the problems at once. We’re at the beginning of the end—not the end of the beginning.”

Now, 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?”

Coming 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.”

Many 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.

As 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 great TV.

ART 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 infertility.

Cultural 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 rarely—if ever—described in detail.

Here’s 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 lab—that 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.

The 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.

Today, 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.

IVF 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.

· - Unemployed single mother Nadya Suleman of California gained worldwide notoriety in January 2009 as the “Octomom”—giving birth to eight IVF babies—after 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 births—birth defects and high mortality rates—that are common in IVF pregnancies, and devastating to unsuspecting parents.

These 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 embryos—labeled 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.

Same-sex parenting—egg donation and surrogacy for gay men, sperm donation and intrauterine insemination and IVF for lesbians—is 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.

These 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:

· “The 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, which—given the frequency of selective reduction—can’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, Cambridge.

· The 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 Right—What 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 Chemistry?”

· A 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 on “Future 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 by—whom else?—the ASRM’s Contraception Special Interest Group, of course.

Corporate 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.

Human sexuality, procreation, and health care through the Roman Catholic lens

There 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 control—important tenets to be sure—it is hardly the complete story.

In 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 procreation.

Driven 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.

The “hub” of NPT is a natural method of family planning—the 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.

With 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.

More 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.

Many 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.

The 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 background—if they are considered at all.

If 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).

In 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 the middle.

Catholic norms for building a family did not develop in a vacuum and are derived directly from the Church’s comprehensive vision of the human person—rooted 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 procreation.

Four norms pertaining to infertility treatment follow from this “small-c” catholic (and Roman Catholic) vision of human life and human dignity:

The 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.

Conversely, NPT treatments for infertility respect the right to life and bodily integrity of gestating babies—human beings in utero. NPT protocols not only do nothing to destroy a new human life—they do a good deal to facilitate a healthy, full-term pregnancy.

IVF 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.

NPT’s approach to infertility, by contrast, encourages couples to work cooperatively with nature and to respect their own human dignity, and that of their unborn child.

Couples 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.

Serious discussions referencing any rights of an IVF child—particularly whether that child has a right to be conceived in a natural way—are virtually nonexistent. In the world of IVF and embryo transfer, the desires of the parents trump all.

Since 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, security—and yes, intimacy—of their parents’ bodily union and marital love.

Propelled 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.

For 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.

Poland, the homeland of Blessed John Paul II—a strong supporter during his pontificate of Dr. Hilgers, NPT, and the Pope Paul VI Institute—is emerging as one battleground in the IVF struggle.

After 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.

The 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.

Although 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 exercise—at 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.

Consequences of Artificial Methods
17. Responsible men can become more deeply convinced of the truth of the doctrine laid down by the Church on this issue if they reflect on the consequences of methods and plans for artificial birth control. Let them first consider how easily this course of action could open wide the way for marital infidelity and a general lowering of moral standards. Not much experience is needed to be fully aware of human weakness and to understand that human beings—and especially the young, who are so exposed to temptation—need incentives to keep the moral law, and it is an evil thing to make it easy for them to break that law. Another effect that gives cause for alarm is that a man who grows accustomed to the use of contraceptive methods may forget the reverence due to a woman, and, disregarding her physical and emotional equilibrium, reduce her to being a mere instrument for the satisfaction of his own desires, no longer considering her as his partner whom he should surround with care and affection.
Finally, careful consideration should be given to the danger of this power passing into the hands of those public authorities who care little for the precepts of the moral law. Who will blame a government which in its attempt to resolve the problems affecting an entire country resorts to the same measures as are regarded as lawful by married people in the solution of a particular family difficulty? Who will prevent public authorities from favoring those contraceptive methods which they consider more effective? Should they regard this as necessary, they may even impose their use on everyone. It could well happen, therefore, that when people, either individually or in family or social life, experience the inherent difficulties of the divine law and are determined to avoid them, they may give into the hands of public authorities the power to intervene in the most personal and intimate responsibility of husband and wife.

HUMANAE VITAE - ON THE REGULATION OF BIRTH

Definition of MEDICINE:

1.The science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery).
2.A drug or other preparation used for the treatment or prevention of disease.

___________________________________________________________

This should be described as REPRODUCTIVE EXPERIMENTATION AND MANIPULATION. It is NOT medicine.

I have a female friend, a devout Christian—very much like a sister to me, who after waiting until her late 30s to get married, discovered her husband (several years younger than her) apparently had very low viability in his sperm.

This woman is very pro-life—firmly accepting the fact that human life is sacred and that life begins at conception.

However, so desperate was she to conceive a child (I believe having a baby was a major motivator for her to marry...) she followed the IVF route, with this caveat: All the fertilized ovum would be, one at a time, implanted inside her womb. None would be aborted.

I believe she told me she allowed three eggs to be fertilized, and she has had the first implanted, and successfully completed the pregnancy, and had the baby. He’s healthy and fine now.

She has pledged to also carry the 2 remaining (frozen) ovum to term, in time.

She’s in a happy marriage—and I’m sure they engage in normal marital relations.

Still, however, when I consider that she was using IVF methods....with the same doctors and professionals who would’ve (routinely) aborted the “least viable” embryi, had they followed standard IVF methods...to me it just seems creepy.

While strong Christians, neither my friend, her husband or I am Roman Catholic, but....I must admit being very (very) leery as to the ethics even of this very circumscribed use of IVF.

Of course I had no influence on her and her husband’s decision to go this way (I’m not their pastor—and I only found out about it after the fact)....still, I feel bad about this. To me, it just doesn’t seem right....even if I can’t quite say why.

I honestly can’t say I have a problem with selecting the healthiest embryo for implantation. Fewer than half of naturally conceived embryos ever survive until implantation, and a third of all implanted embryos end up dying. So choosing the healthiest one is an attempt to shift the odds a little.

I do, however, have a problem with IVF. When people can’t conceive naturally, there is a reason for it. Is it really wise to try to circumvent whatever problems are causing the infertility in the first place? Doesn’t that thereby preserve those problems which natural selection would normally weed out? Also, what rationale is there for trying to create babies who may have serious genetic defects (such as an inability to conceive naturally), when a million perfectly healthy babies are being killed every year?

The problem is that we are not God and need to be careful to not do what only He, as God, has the right to do.

The first time some primitive human noticed that one plant produced better fruit than another plant of the same species, and cultivated the superior plant's seeds, he was "playing God." It's something human beings have done for millenia.

There is a huge gulf between humans and plants. It's about the soul, someone made in God's image. Thou shalt not kill means that it is The LORD who has the rightful decision as to what innocent human life is to live or die. If someone dies because of an accident, sickness or old age that is not immoral. If someones life is snuffed out by another person that is the sin of murder because although life and death does happen to humans it is God's territory and when we trespass upon it we are guilty before Him. We are not God and have not the right over the life and death of other innocent human beings.

It seems to meet the intent, albeit that the suspended existence of the frozen embryos is a little unnerving. What happens to the embryos if she dies or suffers a disease rendering her permanently unable to carry, before she can carry them all? Maybe she’d want to do the other two together to hasten the process, even if it results in twins. Ultimately this is a matter of local church discipline and if her local church has something otherwise to say about it, she’ll have to get that straight with them or move on elsewhere.

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