The Lesser Known Consequences of IVF
By Madison Chastain
Our increasingly globalized, technologically advanced world makes possible the sharing of stories with wider and wider audiences. Coupled with the steady increase in open conversations about women’s health, the last few of years have shown a rise in online sharing about experiences with infertility. It seems like we, as a society, are starting to understand how common things like infertility, miscarriage, hormonal disruption, and reproductive injury are. Alongside this greater dialogue around infertility is a steady rise in the use of assisted reproductive technologies, one of the most commonly known being in vitro fertilization or IVF.
According to the Center for Disease Control and Prevention, 12% of women in the United States between the ages of 15 and 44 seek medical reproductive assistance. In 2018, over 306,197 instances of assisted reproductive methods were reported in the United States, with only a third of those instances successfully producing a pregnancy. Still, 2% of children born in the United States are born from assisted reproductive technologies.
The Catholic Church strictly forbids the use of IVF, surrogacy, artificial insemination, and sperm or egg donation. The Catechism of the Catholic Church (CCC) says the following:
Married couples who suffer from infertility can accept any medical assistance that does not contradict the dignity of the human person, the rights of the child to be conceived, and the holiness and sacrament of matrimony...All assistance in conceiving a child through research and medicine must stop when the common bond of parenthood is loosened and destroyed by the intrusion of a third person, or when conception becomes a technological act outside of sexual union in marriage (CCC 2375-2377).
With 12% of American women pursuing these technologies, it is statistically likely that some of these women are Catholic. But, if the Church is against it, why would Catholics pursue assisted reproductive methods? The answer seems pretty clear: because they lead to the most objectively good thing! New life!
The purpose of this article is not to contest the goodness of human life, nor is it an attempt to quantify or qualify the immense difficulties that come with infertility, which is why it’s important to begin by addressing two potential readers:
If you are a reader who has chosen to pursue assisted reproductive methods, I hope you will join me with an open mind in exploring all aspects of these choices, knowing that one’s participation in decision-making always necessarily contains unintended consequences as well as intended ones. I hope you hear and believe that this is not meant to be a “call out” but a “call in.” Let’s work together to explore what the systems we participate in can bring about without us knowing.
If you are a reader whose life is the product of assisted reproductive technologies, know that absolutely nothing can delegitimize the abundant and inherent goodness of your life. From the moment you were conceived, no matter how you were conceived, you were genuinely known and loved. God works towards the goodness and abundance of all life out of every single human decision.
Some decisions are ethical and some are not. When we explore ethics and decision making, we must consider all components of a choice: circumstances, intentions, methods, the act itself, consequences (both intended and unintended, immediate and future), and precedents the choice sets. In decision-making, it is likely that one or more of these components will be objectively good! That is why ethics is so tricky!
Perhaps, in a college class (or in your favorite episode of The Good Place), you have experienced an ethical dilemma designed to make you think about how you would act in a fraught situation. These dilemmas are intended to have no easy solution. In many cases, the only way out is to weigh the good against the bad. We can come away from these circumstances feeling that there is no such thing as absolute good or absolute evil.
As Christians, we know that this is not the case. Some things are objectively good and others objectively bad. However, it may surprise us to know that the Church has a long history of moral theology that encourages us to examine the components of a choice and weigh the positive components against negative components because, in doing so, we are able to see within convoluted situations how acts themselves can be objectively bad, even if the consequences are good, and vice versa.
Without careful examination, and within the desperation of fertility struggles, it would seem obvious that the positive consequence of new life outweighs the negative precedents of assisted reproductive methods. As a Catholic ethicist and a woman with reproductive struggles, I want to explore and begin a dialogue about the important issues concerning the dignity of life, women, and the marginalized that are neglected when assisted reproductive methods are pursued.
Assisted reproductive technologies make the act of sexual intimacy clinical
This is the Church’s primary concern with issues of sexual ethics. Sex is designed to be both unitive and procreative. The togetherness of spouses and the intimacy it involves is a good, beautiful, and necessary part of procreation. When Catholics talk about the intersection of medicine and sex, contraception is often the focus because of how it removes procreativity from the sexual union. But, the reverse is just as concerning––removing union from procreativity.
Any procreation that takes place outside of a marital union can lead us to view children as separate from the marital relationship and complicate the marital relationship too. Making and raising a child is a fruit meant to be born of an established relationship, one that is committed to the teamwork required. What’s more, a special sort of intimacy between spouses arises during natural pregnancy, as new kinds of reliance and relationship form.
Surrogacy also poses challenges to the multitude of needs and maternal relationships that develop from a surrogate pregnancy. Some of these challenges include dilemmas like, who is the “real” mother? What sorts of biological connections do both surrogate and biological mothers have to the child? Who is responsible for meeting the needs of the surrogate mother? In the complicated instance in which a surrogate mother wishes to keep or maintain some sort of relationship with that child, who has more of a biological, maternal right to that child? What about existing siblings who may themselves feel a right to a relationship? Additions and removals from the couple and their family are bound to cause pain and complications, for all members involved and for the child.
Assisted reproductive technologies normalize having a child as a "right"
In the Catechism, it is made explicit: “There is no absolute right to have a child” (CCC, 2379). This may seem obvious, but I believe our culture has forgotten it. With the rise in access to the lives of other people through social media, it can seem like just about everyone is able to have kids––and that having kids is a sign of personal success––within and outside of marriage. This is one reason why struggles with fertility can be so painful! Women especially are constantly asked, “So when are you having children?” or worse, “Why haven’t you had kids yet?”
But what if we thought more imaginatively about the possibilities of marital fruitfulness? What if we viewed biological impediments to having children not as hurdles to overcome in order to reach the mandatory benchmark of biological offspring, but as signals from God that we are called to marital fruitfulness in other ways? If we pursue IVF or other assisted reproductive methods as necessary next steps to having children, we can neglect holy alternatives that we may be called to. What sorts of art are you drawn to produce? Who in your life do you feel called to show up or give care for? What devotions of prayer and service might you give to your community?
Assisted reproductive methods can place biological pregnancy "above" adoption or fostering
A fruitful marriage does not need to be one of biological parenthood. All children are worthy of love. All too often, however, biological children are viewed as the first choice for married couples, with fostering and adoption viewed as secondary or “backup” options if having biological children proves impossible. There is, of course, something incredibly special about having a child that shares your and your partner’s DNA. However, we must also consider the immense number of children in need of loving homes and the abysmal state of the American foster system. There are over 400,000 children in foster care. According to UNICEF, there are over 140 million orphaned children worldwide. As Christian adults called to be family for those in need, why do we regularly view the care of these children as a backup plan? Why are foster care and adoption not a mandatory part of the discernment of marriage and parenthood?
The existence and ready availability of assisted reproductive technologies reveal to us our values. With so many children in need of loving homes, if we were to choose these children first, the demand for assisted reproductive technologies would naturally decrease. So why don’t families pursue fostering and adoption first? Is there something better about having biological children?
Of course not! But remember, this is a call-in, an invitation to consider systems. On average, one-third of children in the foster care system are children of color. We regularly hear stories in the news about adopted children having unexpected disabilities or medical needs, and the stereotype that foster children are always plagued by violent or aggressive behavioral tendencies still haunts the system. One quick internet search of “stereotypes about foster children,” and article after article (some even written by the children themselves!) shows up and invites us into an examination of conscience. These biases are situated messily at the intersection of race, class, and ability. They reveal to us our preconceived beliefs about trauma, race, disability, and exceptionalism.
The fact of the matter is, our biological children may be born with aggressive tendencies, behavioral struggles, medical needs, or disabilities. Diversity of race and ability are parts of the world God created, and it is the God-given responsibility of all parents to be willing to love and tend to the needs of their children, no matter how they look or what they can or cannot do. Our families should look like the world we live in.
IVF and sperm or egg donation can be a slippery slope to manipulative genetic interventions, which leads to devaluing certain kinds of human life, especially those with disabilities
In a similar vein, we must consider the ways that the medical manipulation of eggs and sperm invite the examination and manipulation of genetic material. The selection of sperm or eggs for donation are especially imbued with bias: parents look for the traits they find most appealing, and family history of disease and disability is always included. We must recognize the history of beliefs about genetic weakness and call them like they are: completely phony! Genes are neither strong nor weak, and if we start shopping around for the ideal genes, we are only a few steps away from “playing God,” and modeling future human beings around a certain set of biased ideals.
As a person whose life’s work is in disability theology and advocacy, it astonishes me how many disability advocates, both religious and secular, still struggle to identify assisted medical technologies as an issue of the dignity and rights of disabled life.
A well-known disability advocate, whose YouTube videos and other social media platforms have hundreds of thousands of followers each, recently published a video in which she shares her experience searching for a sperm donor. Despite being congenitally deaf herself and having made her name advocating for the rights of disabled persons, in the video she openly discusses her selection of one sperm donor almost solely based on the absence of disability and illness in his history. When her fertilization did not garner a successful pregnancy, she was heartbroken that she would have to go back to the drawing board and hope for no disabilities. As a person doing work in disability advocacy and theology, realizing that someone I looked to for leadership in this area still has such a blind spot about the value of genetic variation deeply saddened me. At times, it can feel like prejudice against disability runs too deep to uproot.
Certainly, disabilities come with immense challenges––both for those living with them and those who care for them––but we cannot weigh the value and dignity of a life against the order of a person’s genes or the legs of their chromosomes. Imagine how it might feel to a person with a disability to know that people viewed the mere potentiality of their existence as unworthy of life. Now, imagine how less beautiful the world would be without genetic diversity.
Assisted reproductive methods put steep paywalls in front of biological pregnancy, thereby making it a privilege reflective of economic means
IVF is notoriously expensive, as is surrogacy, artificial insemination, and the acquisition of donor sperm or eggs. As a result, infertility becomes a game of privilege determined by who has the means to pursue these technologies and who doesn’t. The opportunity to have a biological child should never be a privilege reserved for the wealthy because it ultimately places a price on new life and gives a heightened value to biologically homogenous families. This, additionally, participates in the classist undertones of the choice between IVF and adoption or fostering: those who have money don’t need or have to adopt.
The risks and consequences go on and on. Assisted reproductive methods are regularly unsuccessful and it often takes multiple tries before a successful pregnancy––if one is to achieve success at all. With all the time and money these methods require, it calls into question whether or not we’re taking comparable time and money to explore the root causes of our infertility as conditions like PCOS and even stress can greatly impact fertility. Outside of our concern for others, we are indeed called to have concern for the bodies God has given us. Those root causes could very well be reversible or potentially dangerous. If we don’t give ourselves time to find answers, we may never know our body’s full story.
No matter what, consideration of all of these consequences, precedents, and implications requires immense sensitivity. Fertility struggles are extremely difficult and can carry with them feelings of failure, frustration, and grief. While using IVF is never condoned by the Catholic Church, we must not dismiss the pain of all those who wrestle with an unfulfilled longing for children, including those who identify as LGBTQ+, particularly when we talk about alternatives or ethics regarding this topic. Rather than approach our brothers and sisters who desire children armed with Church teaching, we should instead consider how we have formed our culture in exclusionary and painful ways. We should examine our sociocultural emphasis on the biological, nuclear family, and look to the life of Christ as an example of making family out of those most unconventional relationships formed along our road to Heaven. In the Gospel of Matthew, Christ says,
‘Who is my mother? Who are my brothers?’ And stretching out his hand towards his disciples, he said, ‘Here are my mother and my brothers. For whoever does the will of my heavenly Father is my brother, and sister, and mother (Matthew 12:48-50).
Christ shows us that it is imperative that we be family, even if we are not biological family. If we can begin to think expansively, ethically, and creatively about what it means to be family, what it means to be fruitful and what it means to parent, we can create a world in which all people have access to love.
*Translation of the Catechism of the Catholic Church in this article taken from the YouCat youth translation for the sake of accessible language, with provided citations cross-referencing the formal document.
