Nadya Suleman, the California woman who conceived 14 children through in vitro fertilization, including a set of octuplets born earlier this year, makes an easy target for an anxious public. Suleman seems not to have thought much about how she would support her supersized family either emotionally or financially, and the reaction to her story has ranged from derision and disgust to outright threats. I admit to being aghast myself as the details of her story unfolded, yet I felt some sympathy for Suleman too, because it appeared that she had reached her decisions about childbearing almost entirely on her own.
In this regard she is like most fertility patients, though the majority have at least a spouse with whom to share such difficult decisions. In the past few decades, assisted reproduction has made astonishing advancements, but society at large and the church’s teaching in particular have failed to keep up with the pace of technology. As a result, patients make decisions in a moral minefield—with perhaps the value-neutral counsel of a physician—or, in rare cases, after meeting with a mental-health professional, but rarely with the guidance of someone from their own faith community. It is true that the Catholic position on assisted reproduction is clear and well-documented, but in my years of struggling with infertility I found few options or resources for discussing the church’s teachings with a real human being or for sharing my pain with others in the same situation. As Catholics we can do better than this. The church has learned how to reach out to others in difficult circumstances and guide them gently toward life-giving decisions. It is time to do the same for those suffering from this heavy burden.
U.S. fertility clinics performed 138,198 cycles of assisted reproduction in 2006, the latest year for which statistics are available. There is no way to tell how many of those are Catholics.
Church Teaching on Assisted Reproduction
By the time these patients reach the office of a reproductive endocrinologist, they have likely been trying to conceive for more than a year, and sometimes much longer than that. Many are concerned about cost (fertility treatment can cost $10,000 per cycle, and many couples need multiple cycles to succeed), but their overriding concern is usually to end the ordeal as quickly as possible. If they are churchgoing Catholics, it is unlikely they have received much support at church. It is the nature of churches to reach out to families with children, and many infertile people find weekly services to be a source of pain rather than comfort. If they know anything about Catholic teaching on assisted reproduction, they probably think that all fertility treatment is forbidden, although that is not exactly the case. Many Catholics I have met do not know that the church has any teaching at all on the subject.
The church’s official teaching, first outlined in the Congregation for the Doctrine of the Faith’s instruction The Gift of Life (1987), was reiterated in the Instruction on Certain Bioethical Questions(Dignitas Personae), which was released late last year. The teachings allow for fertility medication to encourage ovulation (a source of many higher-order multiple births) and surgery to correct conditions like varicoceles and endometriosis. They forbid procedures that substitute medical techniques for human intercourse. This includes in vitro fertilization, which removes eggs and sperm from the couple to create an embryo in a petri dish; the embryo which is then transferred to the woman’s uterus. According to the instruction, the church opposes it because “it causes a complete separation between procreation and the conjugal act.”
By the time Catholics have been to a fertility specialist, it is often too late for church teaching to play a role in their decision-making. The desire for a family is often too strong at this point to be tempered by a document written by Vatican officials. To be involved in the conversation from the start, the church should broach the subject in pre-Cana training, so that couples can start to think about what they would do in case of infertility long before they reach the doctor’s office. Helping a couple to discuss the “what-if” before they marry increases the likelihood that a couple will include church teaching in their decision should they ever need fertility assistance.
Catholic parishes can also look to the Project Rachel model for help in crafting support for couples. Project Rachel is the church’s post-abortion ministry, which operates as a network of priests and counselors trained to give spiritual and psychological care to people suffering from the aftermath of an abortion. Project Rachel offers a Web site with links to local resource centers, along with support groups and retreats in some dioceses.
Like those struggling with the aftermath of an abortion, people coping with infertility often prefer to seek help privately. A ministry to them modeled on Project Rachel would allow those at the parish level to refer fertility patients to a knowledgeable diocesan contact, instead of giving priests and family-life ministers one more subject to master. It would also enable peer contacts between couples who are just beginning to confront infertility and veterans who have resolved their infertility in a variety of ways.
Discerning the Best Options
The church’s teachings on fertility are best known for what they forbid, but a robust outreach effort can emphasize the opportunities that exist for infertile couples. A growing number of physicians, trained by the Pope Paul VI Institute in Omaha, Neb., treat infertility in harmony with the church’s teachings. Referrals to such physicians should be an important part of any effort.
Adoption is not the easy solution that many imagine, but a thorough presentation of the process can dispel many of the misconceptions people have about adoption and expose them to the blessings of this path to parenthood. Other couples may find that by forgoing parenthood, they are able to devote themselves to their marriage, careers, friendships and volunteer work on a level beyond what many parents can manage. Spiritual direction can help couples discern their true call in a way that will nurture them for years to come, reframing infertility as an opportunity for growth rather than merely a problem to overcome.
Catholic leaders have been steadfast and vocal in their opposition to embryonic stem cell research, which relies largely on embryos left over from in vitro fertilization. By engaging couples before they seek fertility treatment, church leaders might convince some of them to pursue other avenues, which would then reduce the number of embryos created. And for couples who are determined to try in vitro fertilization, some options within the range of medical treatment are preferable to others. For instance, couples can choose to create fewer embryos, which reduces the chances of having unused embryos. They can also reject the option of using donated sperm or eggs, which church teaching likens to adultery because it involves someone outside the marriage in the creation of life.
Finally, the church should strive for more honesty in the documents and teachings it promulgates with respect to infertility. I have studied the issue closely for many years, and I understand and agree with many of the concerns the church has about assisted reproduction. But anyone who knows much about the subject cannot help but be bothered by errors in the official teachings. Even the instruction Dignitas Personae, which was released just a few months ago, contains factual inaccuracies. It states that “approximately a third of women who have recourse to artificial procreation succeed in having a baby,” when the eventual success rate is roughly 50 to 70 percent for all women, and up to 86 percent for women under 35. Other church documents champion techniques such as gamete or zygote inter-fallopian transfer as morally superior to in vitro fertilization, even though those techniques are rarely used now because they are medically inferior. Such lapses and distortions can make Catholics who pay close attention to this issue mistrustful of the church’s teachings as a whole.
These ideas are offered as a starting point for thinking about how the church can better support couples enduring this difficult ordeal. This is a difficult time for parishes and dioceses to be adding to their list of programs. Yet I also know that today a desperate Catholic couple is sitting in a doctor’s office receiving a list of their medical options. I want someone—someone they can trust and who has their best interests at heart—to give them their moral options too.