Carolyn Allen

InvitroFertilization

Carolyn Allen

The birth of a child is arguably one of the most amazing things one can experience. As human beings, we have a biological desire to have children and thus preserve our genes and family names. However, some people cannot have children. What are they to do? In the field of medicine, scientists and doctors have made some astounding scientific discoveries that have changed the world forever. Some of these discoveries have been positive, others negative. IVF, or in vitro fertilization, is one of these discoveries. Nonetheless, there is some debate on whether IVF is ethical, with several arguments supporting each side. As expressed in the following sections, this paper will argue that IVF is unethical because it contradicts the innate sanctity of life and the natural conjugal act of procreation.

Description of the Practice

In vitro fertilization (IVF) is “a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child. ”1 It is the most common and effective form of assistive reproductive technology (ART). The term “in vitro” is a Latin derivative that means “in glass.”2 This means that the term “in vitro fertilization” translates to “fertilization in glass,” or in-glass fertilization. The concept of IVF dates back to 1878, but the first successful human attempt of IVF wasn’t until 1978 with the birth of Louise Brown. 3

IVF can be a very intricate and intensive process. The chances of success of IVF depend on several factors, including the reason for infertility, age, weight, and other health factors. IVF can also be time-

1 Mayo Clinic Staff, “In Vitro Fertilization (IVF),” Mayo Clinic (2019). https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716. 2 Tian Zhu, “In Vitro Fertilization,” The Embryo Project Encyclopedia (2009). https://embryo.asu.edu/pages/vitro-fertilization. 3 Ibid.

consuming, expensive, and invasive. 4 According to a study done by the CDC in 2015, a total of 182,111 ART procedures were performed across the United States. These procedures resulted in 59,334 livebirth deliveries and 71,152 infants born. 5 These numbers indicate that ART is 39% effective based on the most up-to-date CDC data.

The process of in vitro fertilization begins with various screenings and tests to determine eligibility and likelihood that IVF will work. This is unique to each couple or situation, so these results vary. Some screenings or tests include ovarian reserve testing, semen analysis, infection disease screening, practice (mock) embryo transfer, and uterine exam. These tests are not required in all cases but are commonly used for couples trying to conceive through IVF.6

The second step of the IVF process is ovulation induction. Ovulation induction mimics the natural process of ovulation, but with more intense stimulation. During natural ovulation, the woman’s ovary will produce a single healthy egg over the course of each menstrual cycle. For IVF, the woman will produce several eggs through the help of medication. This is done to increase the chances of a successful fertilization.

There are several medications that could potentially be used during this step of the process. The doctor will determine which medications are necessary and/or will be helpful in making the induction successful. Some common medications include a series of gonadotropins and doxycycline. Gonadotropins “are injectable hormones used to increase development of a woman’s eggs, follicles (the sac-like structures where eggs mature), and estrogen levels prior to ovulation. 7 There are three common gonadotropins used, including human chorionic gonadotropin (hCG), follicle-stimulating hormone (FSH), and gonadotropin releasing hormone (GnRH) analogs. HCG is used during IVF to trigger release of the mature egg(s) after a woman’s follicles have developed. HCG is a naturally occurring chemical produced during pregnancy. Common hCG drugs include Pregnyl, Profasi, A.P.L., Novarel and Ovidrel. Side effects may include bloating, fatigue, mood swings or breast tenderness. FSH initiates the

4 Mayo Clinic, “In Vitro Fertilization.” 5 Saswati Sunderam, Dmitry M Kissin, et al.,

“Assisted Reproductive Technology Surveillance—United States, 2015” in Mortality and Morbidity Weekly Report Surveillance Summary 67, no. 3 (2018): 1–28. 6 Mayo Clinic “In Vitro Fertilization.” 7 Women and Infants Fertility Center, “In Vitro Fertilization: Fertility Drugs” (2020), https://fertility.womenandinfants.org/treatment/ivf. VOLUME XV (2022) 37

development and growth of eggs in a woman’s ovaries. Common FSH drugs include Bravelle, Gonal-F and Follistim. GnRH analogs help prevent premature ovulation. By delaying ovulation, GnRH analogs increase the chance of a woman producing fertile eggs and prevent the release of eggs before an egg retrieval occurs. These drugs include Ganirelix Acetate, Antagon (ganirelix), Lupron Depot (leuprolide acetate) and Lupron. Side effects may include hot flashes, headaches, trouble sleeping, mood swings and vaginal dryness. Women will typically take gonadotropins for seven to twelve days, but some drugs may be taken longer. A physician will closely monitor follicle size and estrogen levels to decide if the dosing is adequate or if a woman needs to continue injections.8

Doxycycline is an oral antibiotic that decreases the chance of a bacterial infection to both partners involved in IVF treatment. Patients take one doxycycline pill twice a day after they begin hCG injections until their prescription is complete. Doxycycline increases sensitivity to sunlight, and anyone taking it should avoid long exposure to the sun for up to two weeks after taking it. Other side effects include diarrhea, sore mouth, and genital itching. 9

Although each drug has risks and side effects of its own, ovarian hyperstimulation syndrome (OHSS) is the most serious risk associated with IVF medication. This condition causes over stimulation of the ovaries, which then causes overproduction of hormones. Though most cases are mild when they occur, some people may experience a severe reaction and suffer side effects that may include severe pelvic pain, swelling of the hands or legs, stomach pain and swelling, shortness of breath, weight gain, diarrhea, nausea or vomiting, and urinating less than normal. 10

If all goes well with the medication, the ovulation induction process lasts for one to two weeks, or until the doctor determines it is time to retrieve the eggs. Some problems that could interfere or even cancel the process are an inadequate number of or too many follicles developing, premature ovulation, and other medical issues. If the IVF cycle is cancelled, the doctor may recommend changing medications or dosage, or advise the patient to use an egg donor. 11

8 Ibid. 9 Ibid. 10 Ibid. 11 Mayo Clinic, “In Vitro Fertilization. ” 38

The third step of the IVF process is egg retrieval. The doctor will determine if the eggs are ready for retrieval through either a vaginal ultrasound or a series of blood tests. Egg retrievals are typically done in the doctor’s office 34–36 hours after the final dose of medication and before ovulation. The egg retrieval process begins with the doctor sedating the patient and administering pain medication. Then, a transvaginal ultrasound aspiration is used along with an ultrasound probe to identify follicles. Once the follicles have been identified, a thin needle is inserted through an ultrasound guide to go through the follicles and retrieve the eggs. Several eggs can be removed in approximately 20 minutes. Mature eggs are then placed in a nutritive liquid and incubated. The patient may experience cramping and feelings of fullness or pressure after the procedure. 12

The fourth step of the IVF process is sperm retrieval. The male will provide a semen sample the morning of egg retrieval, usually through masturbation. If a semen sample is unable to be provided, the doctor can also retrieve sperm directly from the testicle through testicular aspiration. The procedure involves the doctor using a needle to extract sperm directly from the testicle. Donor sperm can also be used. Sperm are separated from the semen fluid in the lab. 13

The fifth step of the IVF process is fertilization. There are two popular methods of fertilization: conventional insemination or intracytoplasmic sperm injection (ICSI). Conventional insemination involves mixing the retrieved mature eggs and sperm and allowing them to incubate overnight. ICSI is performed by injecting a single healthy sperm into each mature egg. This is often used if the sperm is faulty or if previous IVF attempts have failed. After fertilization, the doctor may recommend other procedures before embryo transfer, such as assisted hatching or preimplantation genetic testing. 14

The final step of the IVF process is embryo transfer. This is usually done at the doctor’s office two to five days after egg retrieval. To begin, the doctor may give the patient a mild sedative to reduce potential cramping. Next, the doctor inserts a catheter into the vagina and through the cervix to reach the uterus. Finally, the doctor attaches a syringe containing one or more embryos to the end of the catheter and places the embryos into the uterus. If the procedure is successful, an embryo will implant in the lining of the uterus six to ten days after

12 Ibid. 13 Ibid. 14 Ibid. VOLUME XV (2022) 39

egg retrieval. After the procedure, the patient may resume normal activities. Some side effects may include passing a small amount of clear or bloody fluid shortly after the procedure, breast tenderness, mild cramping or bloating, and constipation. 15

Two weeks after egg retrieval, the doctor will test the patient’s blood to determine if the woman is pregnant. If she is pregnant, the doctor will refer her to an obstetrician. If she is not, she will stop all medication and will likely get her period within a week. If she would like to try IVF again, the doctor may suggest measures to take to improve chances of a successful IVF cycle the next time. 16

Rationale for the Practice

In our modern society, with all the advances in technology and medicine, it is unsurprising that IVF is becoming a common alternative to traditional reproductive means. More and more people are turning to IVF to have their families. On average, 1–2% of American babies are born through IVF each year.17 As described previously, IVF is a medical procedure that helps women who suffer with fertility issues. It can also help prevent genetic problems in offspring before birth. These rationales are very generalized, as there is a plethora of reasons why one might consider IVF.

Although infertility is the most common reason why people use IVF, there are several other reasons why people choose IVF to build their families. These include fallopian tube damage or blockage, ovulation disorders, endometriosis, uterine fibroids, previous fallopian tubal sterilization or removal, impaired sperm production or function, unexplained infertility, a genetic disorder, fertility preservation for cancer or other health conditions, older age, and same-sex family planning. 18 Although each person’s reasoning for using IVF is unique, many of these reasons often contribute to or are the sole cause of infertility.

The main purpose of IVF is to assist in the production of a child. Since some people are unable to do this naturally on their own, they turn to external means such as IVF. It is in our nature to desire to procreate and pass our genes to the next generation. If there is a reason

15 Ibid. 16 Ibid. 17 “IVF by the Numbers,” Penn Medicine: Fertility Blog. Published March 14, 2018. Accessed March 13, 2022, https://www.pennmedicine.org/updates/blogs/fertilityblog/2018/march/ivf-by-the-numbers. 18 Mayo Clinic, “In Vitro Fertilization.” 40

why one is unable to do this, our inclination is to figure out why this is and how we can fix it. This is where medicine and technology come into play. Medicine is how we as human beings deal with natural evils. If something is not functioning properly, medicine tries to fix it. In the case of infertility and most of the other issues mentioned previously, something is not functioning properly or is not present at all. Medicine in this case attempts to fix problems with a woman’s (or sometimes man’s) physical ailment or inability to create a child naturally. To put it plainly, IVF is a means to fulfill that desire to procreate if one is unable to do so autonomously.

As mentioned in the previous paragraph, IVF is an intervention for an inability to reproduce naturally. By that logic, IVF is an unnatural phenomenon. This says something about the relationship between medicine and humanity. With medicine, we have the ability and technology to create and destroy naturally occurring things artificially. In the case of IVF, natural human materials are used (eggs, sperm) but medicine artificially brings them together because the body cannot do so on its own. In other words, medicine does not “fix” infertility. Medicine acts as a mediator between the body and science to bypass the body’s incapability. In doing things such as this, we have found a way to manipulate the human body to do what we want it to do. We have taken its incapability or deficiency and made it capable and efficient through medicine.

IVF is becoming more and more widely accepted in our society. According to a PMC research study on beliefs, attitudes, and funding for ART, more than half of the respondents surveyed (54%), had considered or would consider having IVF treatments. Additionally, 93% of respondents answered that at least one IVF cycle should be publicly funded. 19 This data suggests that ART procedures are common, and because of this, more people are willing to get them and fund them. Although IVF is expensive and invasive, many people still rely on it to have a family. Culturally, IVF has become very common, with many viewing it as a helping hand in the path to pregnancy and building a biological family. IVF has made the impossible possible for thousands of people, and that number only seems to be increasing.

19 Bart Fauser, et al., “Beliefs, Attitudes and Funding of Assisted Reproductive Technology: Public Perception of over 6,000 Respondents from 6 European Countries,” Public Library of Science, PloS One 14, no. 1 (January 25, 2019). VOLUME XV (2022) 41

Moral Assessment

A. Ethical Claim about the Practice

In vitro fertilization is an unethical practice and should not be performed by anyone under any circumstance because it contradicts the innate sanctity of life and the natural conjugal act of procreation. B. Arguments

IVF aims to replace the act of sexual intercourse to produce a child. As defined by Merriam-Webster, sexual intercourse is “heterosexual intercourse involving penetration of the vagina by the penis. ” Further, to produce children, the male partner must orgasm and ejaculate semen into the woman’s vagina. Catholic tradition teaches that this act must be done within the context of marriage. Additionally, sex is unitive and must be open to children for it to be morally correct. By having sexual intercourse with someone, one is bonded to the other physically, emotionally, and spiritually. This is true no matter the context it is performed in. However, if sex is performed outside of marriage and is not open to children, it is morally incorrect and unethical.

Argument 1: Babies and the process of creating them are not items to be bought and sold.

Babies are living human beings. Generally, our society considers the buying and selling of human beings to be morally wrong. For example, slavery was the buying and selling of human beings for the purpose of utilizing them for unpaid labor. Slavery was abolished because society deemed it unethical. Similarly, IVF is a transactional process of buying and selling. It is the buying and selling of a procedure for the purpose of artificially creating a child. People go to a doctor so the doctor can sell a service that they can buy. The service is the medical procedure of IVF. IVF costs thousands of dollars per cycle and can be purchased by anyone who has the means to do so. Since the result of the purchase of the procedure is the possible creation of the child, IVF is essentially the buying and selling of human beings. By using the logic of the buying and selling aspect of the slave trade, IVF is morally wrong and violates the sanctity of human life.

Some may argue that if someone has the financial resources to do IVF, there is no law that says they can’t do so. However, babies are not merely products of their parents and cannot ethically be purchased as they are through IVF. Genetically, they are a matching of their parent’s chromosomes—one set from their mother and one from 42

their father. This means that the child is of their parents, not from them. Therefore, the child cannot be ethically purchased as they are through IVF because they are their own being in their own right. In other words, they are not the property of their parents, and therefore their parents do not have the right to buy them. Argument 2: Childbearing is not a right.

By design, our bodies are biologically capable of bearing children. However, just because something has the capability to do something, that doesn’t mean it should or will do it. For example, everyone has talents unique to them. Some people are gifted in the performing arts and others are not. Although both parties have the capacity to perform, some people are born with a capacity to perform well and act on their talent. Similarly, although our bodies were made with the possibility to bear children, not everyone will be able to. Additionally, believing that it is a right to bear children violates the sanctity of human life because we cannot create life ourselves. We can mediate the production of life by bringing together the natural material of sperm and egg, but we cannot create the sperm and egg necessary to form a human life. Human life is determined by the creator of the sperm and egg, which is God. Therefore, it is not a right to bear children.

Some may argue that if a couple really wants a child but can’t have one, it is within their right to do everything they can to fulfill their desire. On the contrary, there is no law that says someone deserves to have a child, no matter how badly they may want one. Additionally, even if there was a law that said someone deserves a child, that would not make it right because there are unjust laws (e.g., slavery was legal, but that doesn’t make it right). Although many people may want a child and have good intentions, it is not an innate right that their desire to have a child be fulfilled. Additionally, many want children because they believe it will bring them happiness and fulfillment. However, childbearing is designed to be a selfless act and should not be done with selfish intentions. According to the U.S. Conference of Catholic Bishops: Love is “total,” a “very special form of personal friendship in which husband and wife generously share everything . . . not thinking solely of their own convenience. ” This marital friendship means that spouses love each other not because they will get something from each other, but just because of

who they are. This kind of generous, selfless love “leads the spouses to a free and mutual gift of themselves” to each other.20 Similarly, children are not a means to an end. Many people want children because they have an innate desire to have them and believe it will bring them happiness and a sense of fulfillment. However, having a child is a serious commitment and is not something one should do to fulfill selfish desires.

Argument 3: IVF denies the nature and necessity of sexual difference in relation to unity in marriage and procreation.

Human beings were created as man and woman, sexually differentiated, by God: “So God created man in his own image, in the image of God he created him; male and female he created them” (Genesis 1:27). This was not an accident, and it had, and has, a purpose. For a child to be made, a sperm from a man and an egg from a woman must join. A child cannot be created from one or two sperm or one or two eggs. Although there are many other reasons for sexual difference, this is the only pertinent information in relation to this argument. Although IVF requires sperm and an egg, it doesn’t require that they originate from a heterosexual married couple. A single mother could use a sperm donor and IVF to have a child. Similarly, a homosexual couple could use IVF and a surrogate to produce a child. Both scenarios are a direct violation of the unity of the sexually differentiated man and woman and deny the sanctity of the sexual act. In the case of the single mother, she is completely foregoing both marriage and the conjugal act and is surpassing the need for that union. In the case of the homosexual couple, there are several violations. For one, they are not sexually differentiated and therefore cannot create a child naturally in any case, so IVF is necessary regardless. Secondly, like the case of the single mother, there is no need for the bonding act of sexual intercourse. In both cases, the use of surrogate donors or carriers also ignores the need for the conjugal act. Therefore, IVF is morally incorrect.

Some may argue that it is not morally correct that only heterosexual married couples be allowed to have children. Single mothers and homosexual couples should be able to have children because it doesn’t matter if the child has one parent or two same-sex

20 USCCB, “Responsible Parenthood,” https://www.usccb.org/issues-and-action/marriageand-family/natural-family-planning/what-is-nfp/responsible-parenthood. 44

parents. On the contrary, research has shown that children who grow up with married heterosexual parents fare better than those without a mother or father. A study conducted in 2015 indicates that children who grow up in non-traditional family structures do worse in school and struggle socially and emotionally in contrast to their peers.21 This is just one example of research. This research addresses the outcome of IVF (a child) and that the family structure as well as the relationship between the parents makes a difference in the child’s development. Argument 4: IVF denies the natural intimate bonding act of sexual intercourse.

As stated earlier, IVF aims to mimic and replace the natural act and process of sex. However, the bonding element of intercourse is completely denied. For one, sexual intercourse is meant to take place between a married man and woman. As Christ affirms in Mark 10: 6–

8, “But at the beginning of creation God ‘made them male and female.’ ‘For this reason a man will leave his father and mother and be united to his wife, and the two will become one flesh.’ So they are no longer two, but one flesh.” This also raises the issue of the role of a third party, the doctor, in the picture. Because sexual intercourse is an intimate act that bonds a married man and woman together, the presence of a third human being violates the sacred nature of sex and the chaste love of spouses.

Some may argue that it’s not important or relevant that conception be done naturally because we have the medical technology to do it without the need for sex and the barriers that may come with it (such as infertility and medical problems). On the contrary, the pure and ethical sexual act creates a bond between two people. This is done through the chemical release of oxytocin, which promotes trust in the other person and psychological stability. 22 This is just one benefit of the natural and conjugal sexual act. These results of the release of oxytocin connect to the bonds of marriage and the traditional family structure. Although it is possible that children be born naturally outside of marriage, the parents will not have the bond and commitment of marriage, which may result in separation of the parents. In other words, the oxytocin bond manifests and is meant to affirm the metaphysical bond of marriage. Additionally, it is well

21 Richard P. Fitzgibbons, “Growing Up with Gay Parents: What Is the Big Deal?” The Linacre Quarterly 83, no. 2 (May 2016): 332–36. 22 Markus MacGill, “Oxytocin: The Love Hormone?” Medical News Today, ed. Michael Weber, (Sept 4, 2017), https://www.medicalnewstoday.com/articles/275795. VOLUME XV (2022) 45

known that children who are born into loving households with a married mother and father have numerous advantages over those who don’t. For these reasons, it is important that children be conceived naturally and born into traditional nuclear family environments. Argument 5: Human lives are inevitably lost through the IVF process.

The fifth and final steps of the IVF process involve fertilization and embryo transfer. To reiterate, an embryo is the name that a person is called at fertilization, or conception. During the fertilization stage, depending on which method is used, the sperm and retrieved eggs join to create several embryos. Then, the doctor manually inserts the embryos into the woman’s uterus. At this stage, the woman waits to see if the embryo has attached to the uterine wall and she becomes pregnant. However, procedures such as IVF have an efficacy rate of only 39%, so many, if not all, the embryos die in utero. In other words, many of the embryos fail to attach to the uterine wall, so they essentially die because they haven’t attached to initiate the next steps of pregnancy. This equates to the loss of several human lives. Additionally, many women elect to undergo multiple IVF cycles until a viable pregnancy occurs, thus resulting in the loss of even more lives. Therefore, IVF is unethical due to the inevitable loss of human life during the fertilization and embryo transfer stages of the process.

Some may argue that embryos aren’t human beings, and therefore it is morally acceptable if they don’t make it. On the contrary, research shows that the joining of a sperm and egg creates a new genetically distinct being. The only things that separate the embryo from the human being living outside the womb are environment and allowance for development. It has nothing to do with the form of the being.

23 Additionally, the Catholic Church teaches that life begins at conception. Therefore, the fifth and final steps of IVF violate the sanctity of human life, and therefore IVF does. People choose to do IVF fully aware that the chances of success are slim. As a result, they consciously risk the nearly inevitable loss of human life. Because human life begins at conception, the loss of embryos in the final step of IVF results in the loss of human life and therefore makes IVF unethical.

23 Fred De Miranda and Patricia Lee June, “When Human Life Begins,” American College of Pediatricians (March 2017): acpeds.org/position-statements/when-human-life-begins. 46

Conclusion

In conclusion, although millions of people have used IVF and millions of babies have been born as a result, IVF is unethical at its core. In summation, IVF dehumanizes the procreative process and molds it into a cold and unintimate transaction that can be bought by anyone. Procreation is supposed to be a natural act and was designed for a married man and woman who have solidified their bond of love and who have been blessed by God to share in that love. Not everyone is meant to have children, and no one deserves to have them. It is not our duty as human beings to manipulate the gifts God has or has not given us to fit our idea of happiness. On the contrary, it is our duty to be gracious for what has been given to us and to seek our God-given purpose.