When a couple is unable to conceive due to unexplained infertility, is it acceptable to proceed with alternative methods of IUI if not IVF?

Being married for five years and as a couple struggling with infertility we do understand the pain felt by those who dream of having children of their own. I know that it is a hard place to be and at times couples do tend to feel that the Church does not understand the pain they are going through. How can the Catholic Church not see our pain? How can the Church say that we cannot use artificial reproductive technologies? These are questions that prevail among couples who are desperate to have children and at the same time want to remain faithful to the teachings of the Catholic Church.

Let me start by saying this – the Church has great compassion to those who suffer from infertility and that is out of love for all human life and respect for the integrity of marital relations, that the Church teaches that some means of trying to achieve pregnancy are not morally acceptable. To understand the viewpoint of the Church, it is imperative that we understand what happens during these procedures. 

IVF

In vitro fertilisation is a process of fertilisation where an egg is combined with sperm outside the body. The sperm required for the IVF process is usually collected prior to the egg retrieval which is usually achieved through masturbation or through more advanced sperm retrieval procedures such as micro-epididymal sperm aspiration (MESA), or testicular sperm extraction (TESE). On an average 20 embryos are made to increase the chances of success. As embryo quality is a critical factor affecting the success of IVF they are selected based on grade and cell number. It could also be that two to five embryos would be transferred to the uterus which then leads to selective reduction (which is done during the first trimester). Here too the fetuses are evaluated to determine whether any of them are unhealthy and which are accessible for the procedure. After this either potassium chloride is injected to stop the heart of the fetus or a needle is used to apply electric currents which cuts off the blood flow from the umbilical cord to one or more fetuses. The embryos that were not used for the procedure will be either frozen for future attempts or donated for research. There also have been cases where embryos were deliberately discarded.  

Let us now look into some of the data available regarding IVF. A 2009 study [1] in the US journal Fertility and Sterility by researchers at Yale University School of Medicine found that out of every 100 eggs fertilised in an IVF laboratory, only 5 resulted in live births. In other words, 95% of all IVF embryos are discarded, perish in the Petri dish or die in the womb. The Human Fertilization and Embryology Authority (HFEA), the fertility industry regulator in the UK, puts forth a similar number. According to them only 7% of the embryos created led to pregnancy and more than 1.7 million embryos created through IVF had been essentially thrown away and killed in a span of 21 years starting from 1991 till 2012 in the UK [2]. In their report published in June 2020, it has been reported that on average, only about one in every four embryos transferred resulted in a live birth in 2018 [3].

IUI

Intrauterine insemination (IUI), the most popular form of artificial insemination in which the sperm that have been washed and concentrated are placed directly into the uterus around the time the ovary releases the egg to be fertilized (medications might be used to make the woman ovulate one more eggs at the right time). Here too the semen is obtained generally through masturbation. If multiple embryos are formed, selective reduction is used to limit the number of children. 

Where does the Catholic Church stand regarding IVF and IUI?

The Church is opposed to any method that violates the fundamental values connected with the techniques of artificial human procreation. Them being:

1. The life of the human being called into existence and 
2. The special nature of the transmission of human life in marriage

Every human being has an inherent value and dignity from the moment of conception and therefore he/she is not to be used, manipulated, or destroyed. This is exactly what happens during IVF where children are engendered through a technical process, subjected to “quality control,” and eliminated if found “defective”. Moreover when they are frozen and stored for future attempts or are donated for research we are acting against their innate dignity.

As for the second fundamental value, it is the Church’s understanding that the two meanings of the conjugal act – the unitive meaning and the procreative meaning – are inseparable from each other. Separating them from each other leads to problems that have both individual and societal implications. In the individual level one can see how by nature the conjugal act is ordered towards bringing the couple together in a way that the other is the end in herself/himself. By separating the unitive aspect from the procreative leads to the spouse being seen as a means to the end rather than the end itself. When we look for the impact this separation would have on society, we are already reaping the consequences in the form of rise in single parent families (globally more than 84% are headed by women), irresponsible parenthood, infidelity and the general lowering of morality.

As we know by now in both IVF and IUI, the unitive aspect of the marital act is absent. It is because of this the Church remains opposed, from a moral point of view, to both IVF and IUI. For more information refer to the Church document titled Instruction On Respect For Human Life In Its Origin And On The Dignity Of Procreation Replies To Certain Questions Of The Day [4]. 

Know the Alternatives

The Catholic Church is not against technology. She only opposes the ones which act against the dignity and well being of human beings. Since explaining each of the methods that assist in attaining pregnancy is beyond the scope of this article, I will be restricting each to a few sentences. 

• NaProTechnology

Natural Procreative Technology, developed by Dr. Thomas Hilgers uses natural methods and restorative surgery to treat diseases. It has been successfully used for treating infertility, endometriosis, ovarian cysts, polycystic ovarian syndrome etc.

• Lower Tubal Ovum Transfer (LTOT)

This involves transferring the wife’s egg beyond a blockage in the fallopian tube so that marital relations can result in pregnancy. 

• Microsurgical tubal recanalization

It is a surgical procedure to repair the fallopian tubes that have been damaged as a consequence of pelvic inflammatory disease, endometriosis, postoperative pelvic adhesions and tubal ligation. The procedure looks to reconnect the fallopian tube and therefore make fertilization possible. 

• Gamete Inter-Fallopian Transfer (GIFT)

It involves obtaining a husband’s sperm following marital relations and aspirating an egg from the wife’s ovary. The Egg and sperm are then placed in a tiny tube separated by an air bubble, and the contents of the tube are then injected into the wife’s fallopian tube with the hope that fertilization will occur. There are some theologians who consider this to be a replacement of the marital act and others see it as assisting the marital act. The Church has not made a judgment about GIFT and therefore catholic couples are free to choose it or reject it based on their conscience. However, once the Church makes a decision regarding GIFT, we are to obey her teachings.

To those infertile couples who are reading this, I would like to say that even if nothing works out, remember that you both are precious in the eyes of God and that our God is someone who can bring light out of darkness and life out of death. Just let Him lead you both through the Holy Spirit. If you let Him, you will see how fruitful your life becomes. Always keep this in mind: God is enough. 

Reference:

1. Patrizio, P. and Sakkas, D., 2009. From oocyte to baby: a clinical evaluation of the biological efficiency of in vitro fertilization. Fertility and sterility, 91(4), pp.1061-1066.
2. https://timesofindia.indiatimes.com/home/science/1-7-million-IVF-embryos-wasted-in-21-years/articleshow/17837256.cms 
3. https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2018-trends-and-figures/
4. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html