THE TENSION BETWEEN INFERTILITY AND IN-VITRO FERTILIZATION TODAY:  A MORAL INVESTIGATION

THE TENSION BETWEEN INFERTILITY AND IN-VITRO FERTILIZATION TODAY:  A MORAL INVESTIGATION

DANIEL EVBOTOKHAI (Fr.)

ABSTRACT

“There is a way that seems right unto a man but the ends in it are the ways of death” (Prov. 14:12). The amazing inventions, achievements and developments in medical science in this twenty-first century and the last forty years precisely is like a new dawn or age in medical science. This dawn is followed by the dusk of controversial atmosphere. Science claims to have answers to all questions irrespective of the cost. It inaugurates In-Vitro Fertilization as a veritable tool to conquer infertility. However clinically feasible this may appear it directly contravenes and contradicts the basic fact that life is a gift. It is a threat to love, and to the procreative and unitive purposes of the marital union. Thus, this progress in medical science calls for obvious redress through ethical evaluation.

INTRODUCTION

The expression “man’s conquest of nature” is often used to describe the progress of science and technology. Man in his state of existence has reached a new crossroad in biological history where he is now responsible for his own evolution, or ’self-evolvers’. Agonizingly, this advancement undercuts the dignity of human life which Bernard Haring calls ‘disacralization’.[1] These advancements in biotechnologies have become issues of far-reaching effects and consequences in contemporary life. This paper focuses on in-vitro fertilization which replaces in part or totally, the natural process of conception an in-utero gestation. There is no gainsaying that in-vitro fertilization is actually aimed at solving the problem of infertility; but it poses a threat to human dignity, family life, and marriage in general. This is the case not only because infertile couples have found it as a way out but also because single women and lesbian couples have found it favorable as a means to have children without marital ties to a man. It behooves us therefore, through the powers of ethical study to call for a ‘re-sacralization’ whereby the sacredness of life becomes the indispensable worth of the sciences.  

INFERTILITY: Is the inability in a woman to conceive or in man to induce conception after regular unprotected sexual intercourse for two years. Female infertility may be due to failure to ovulate, to obstruction of the Fallopian tubes, to disease of the lining of the uterus (endometrium).[2] Generally, it is the inability to bear children. For example, a healthy woman who has a hysterectomy[3] is infertile but not impotent. In contrast, a woman who has a vagina that cannot accommodate the male member is impotent but she may still be able to become pregnant through Artificial Insemination or In-Vitro fertilization (IVF).

For many couples, the feat of conceiving a child is achieved effortlessly. At the same time, there exists a substantial minority who long to savor the experience of parenthood, but who find these longings frustrated. Indeed, one infertility expert has estimated that more women yearly fail to have desired babies than other women have induced abortions. It is variously calculated that from one-in-ten to seven in marriage or cohabiting couples have an infertility problem.[4] The problem is noticed if attempts to conceive over a period of 18 months to 2 years have proved unsuccessful.

THE CAUSES OF INFERTILITY

There are many causes of infertility. First of all, there may be psychological problems: anxiety, guilt or depression can eat their way ‘into a couple’s lives and impair their performance of the sexual act. Anxiety on the man’s part can lead to a failure to ejaculate or premature ejaculation. Depression on the woman’s part can affect her ability to ovulate and have periods. Concern that one may be infertile is of course likely to exacerbate feelings of stress.[5] Again, infertility in women; might be due to failure to ovulate or menstrual cycle irregularities, endometriosis (abnormal tissue in the pelvic cavity, preventing conception); hormonal imbalances; scar tissue in the oviducts; physical abnormalities (an unusually shaped uterus); or an allergic response that kills the partner’s sperm. Infertility in men is caused mainly by a low sperm count or by sperm with poor motility.[6] These problems can often be traced to an injury of the testicles, infection (mumps during adulthood is a common one), exposure to radiation, glandular disorders, birth defects, or exposure of the testicles to high temperatures (such as those produced by hot baths).

Similarly, tubal problems whereby fallopian tubes can get seriously scarred or even completely blocked. This is usually the result of an infection known as Pelvic Inflammatory Disease (PID). It may be contacted in variety of ways: use of the intra-uterine contraceptive device, the effects of a miscarriage or abortion, an ectopic pregnancy and promiscuous sexual behavior are some of them. Often, tubal disease affects not just one but both of the tubes. It can be diagnosed and its extent assessed through either special type of x-ray or a laparoscopy. A laparoscope is a telescope which can be inserted into a woman’s abdomen – under anesthesia and which provides an accurate view of both tubes and ovaries. It is lit by very thin glass rods. Sometimes, it shifts tissue which may be blocking the tube, thereby performing a surgical function.[7]  Mr. Patrick Steptoe, the infertility expert at Bourn Hall near Cambridge, was the person mainly responsible for pioneering its use in Britain.

IN-VITRO FERTILIZATION (IVF)

It is the fusion of the human reproductive cells in an extra-corporeal way.[8] It is also the fertilization of an ovum by a sperm outside of the uterus[9] or the fertilization of an ovum outside the body, the resultant zygote being incubated to the blastocyst stage and then implanted in the uterus. The technique, pioneered in Britain, 1978 resulted in the birth of the first child born as a result of this process has been called a “test tube baby”. IVF may be undertaken when a woman has blocked Fallopian tubes, unexplained infertility, endometriosis, or ovulation disorders; it is also carried out for purpose of surrogacy and egg donation. The mother-to-be is given hormone therapy causing number of ova to mature at the same time. Several of them are then removed from the ovary through a laparoscope. The ova are mixed with spermatozoa and incubated in a culture medium until the blastocyst is formed. The blastocyst is then implanted in the mother’s uterus and the pregnancy proceeds normally.[10]  Since this is most typically accomplished in a test tube, such a method allows individuals who are either infertile or have problems connected with fertilization of the ovum to conceive and bear children.

In the case of male infertility it is called Artificial Insemination, a process in which the man’s sperm are collected, concentrated and mechanically introduced into the woman’s vagina or uterus – it can sometimes aid conception.[11] While female infertility is treated through in vitro fertilization. This process is very different from the normal process that is called in utero fertilization. Fertilization in utero is the natural process of the production of the embryo through genital copulation. This normal process is as follows: at copulation, two reproductive cells (the sperm and ovum), unite and form an embryo, the beginning of new human life. The embryo at this early stage called zygote travels to the womb of the woman called uterus. The zygote dwells in the uterus, so as to mature for nine months.

Conversely, IVF is done by medical scientist in the laboratory. There they make a combination of the life-forming parts of the man and woman to produce the embryo, a fertilized egg which is transferred from a dish to the uterus of the mother or another woman who will carry the baby and give birth to it after the normal gestation period of nine months.

By way of method, theoretically IVF could be carried out by collecting the contents from a woman’s fallopian tubes or uterus after natural ovulation, mixing it with sperm, and reinserting the fertilized ova into the uterus. However, the chances of pregnancy would be extremely small without additional procedures. The commonly used procedures are ovarian hyper-stimulation to generate multiple eggs or ultrasound-guided transvaginal Oocyte retrieved directly from the ovaries; after which the ova and sperm are prepared, cultured and selection of resultant embryos before embryo transfer into a uterus.[12]

Historically, IVF was the brainchild of Patrick Steptoe and Robert Edwards. They started their investigation into the possibility of producing a child by this method in 1968 and the first “test tube baby”, Locise Brown, was born in Oldham in 1978.[13] According to Bernard Haring, “this method was first done simply for research, to gain greater knowledge about the beginning of life, evidently in the hope that this would yield valuable help for fetal therapy and for the whole plan of genetic engineering”[14]

EVALUATION: ETHICAL IMPLICATION OF IVF

As the practice of IVF spread many theologians began to quarry this process, many frowned at it and accused those esteemed Christians who supported the movement of inadequate theology. In the face of this Pope Pius X11 repeatedly analyzed the various forms of the procedures and noted the grave moral disorders involved. As a matter of fact he rejected all forms of artificial insemination (in vivo or in vitro) whether within or outside marriage. He noted the adulterous act involved in it and the devaluation of the human person. In his address to the Second World Congress on fertility and sterility in 1956 that Pius X11 stated explicitly “on the subject of the experiments in artificial human fecundation in vitro, let it suffice for us to observe that they must be rejected as immoral and absolutely illicit.[15]

The Catholic Church opposes all forms of assisted reproductive technology and   artificial contraception, asserting that they separate the procreative goal of marital sex from the goal of uniting married couples. The Church permits the use of natural family planning, which involves charting ovulation times. Pope Benedict XVI had publicly re-emphasized the Catholic Church’s opposition to In vitro fertilization, claiming it replaces love between a husband and wife.[16] Let us further view these implications under the following subheadings:

Dehumanization of IVF: IVF removes from a person the special human qualities of independent origin, thought and feeling.  Intrinsic to this is the preimplantation diagnostic (PID).[17] The technological nature of IVF arouses uneasiness in some people for a number of reasons. Richard Higginson gives some of the reasons as follows: Doctors in the interests of efficiency and their wish to maximize the chances of success exercise an unhealthy measure of control over the whole process. For example, doctors seek to determine the precise timing of the wife’s ovulation; they carefully wash the husband’s sperm; they select an embryo, which looks normal from those that do not.[18] The emphasis therefore is on quality control. We may ask: does the embryo conceived by the process have too much the character of a product, of something that has been fabricated by human skill and ingenuity? Also, when human fertilization comes to be considered a human achievement, one not primarily of the couple concerned but of the medical staff that have assisted them, is it not rather a troubling trend at work? We know that not all human achievements are morally permissible. Again, the rigours the couple passes through, when considered, are points of concern. Some people have argued that children conceived by IVF have the character not of an offshoot of love, but of creatures, some theologians corroborate this when they argued that the result of IVF should not be called procreation but reproduction and in the larger sense such children are made not begotten.[19] Thus, the children are fashioned into existence and this has serious implications for their parents’ attitudes towards them.

No Respect for Embryonic life: In Catholicism, an embryo is viewed as an individual with a soul that must be treated as a person.[20] According to Richard Higginson, IVF is also controversial because the technique can be said to display a cavalier or arrogant attitude to the value of embryonic life. Some embryos are left in the position of being “spares” Then, the question that comes to mind is “what is the fate of these spare embryos?” In response to this question Richard Higginson says, First of all, they may simply be discarded. Secondly, their development can be observed or they can be subjected to different kinds of scientific procedure. Thirdly, spare embryos can be put into a “deep freezer”, left there for months or even year and then thawed out and transferred to the mother if and when she wants to start another pregnancy. Fourthly, spare embryo could be donated to another infertile woman, perhaps one who is unable to produce eggs of her own [21] and in the words of Thomas O’Donnell the “spare” are left to an absurd fate.[22]

Parental Confusion: The donation of a spare embryo to another infertile couple is only one of the many different ways in which IVF could cross family boundaries and leave children with social parents different from their genetic ones. Richard Higginson says that, third-party involvement in IVF raises series of questions. Question about the relationship of the couples, for instance is in some sense disloyal to one’s partner to enlist a donor in his or her place? There are also questions about the part played by the donor, e.g. is it right to donate or sell sperm and eggs for the creation of a child in whom one takes no further interest? Again, the child might have confused sense of identity.

Dignity of the couple: The standard of the couple  own importance and value is relegated in IVF for instance; Heterologous artificial fertilization[23] is contrary to the unity of marriage, to the dignity of the spouses, to the vocation proper to parents and to the child’s right to be conceived and brought into the world in marriage and from marriage. On the other hand respect for marital union and conjugal fidelity demands that the child be conceived in marriage and allows the parents to exclusively express their right to become father and mother solely through each other.[24] In the same vein, surrogate motherhood is morally illicit, for it represents an objective failure to meet the obligation of maternal love, of conjugal fidelity and responsible motherhood. As a matter of fact it insults the dignity and the right of the child to be conceived.[25] 

Medical Scientists can assist in the begetting of children. This is acceptable. But it should be within limits. It can remove obstacles in the way of childbearing, but then no one for instance is morally justified to command either science or God to produce children to satisfy one’s ego. We need not bring confusion to families and to the human race in the craving for issues.[26] We should be careful about the means we employ to achieve certain goals. In this light, Immanuel Kant in his categorical imperative argued successfully that each human person must be treated autonomously as an end in himself and never as a means. For him, categorical imperative which is an unconditional imperative commands action not as means to ends but as good in themselves.[27] Therefore, the purposefulness of each human person must be respected. As such, since we are fully persons on the same ethical grounds, allow others to be fully autonomous and not manipulated or mere instrumental persons.

CONCLUSION

Impressive progress has been made in the identification, examination, and intervention on the medical answer of IVF and time-honored arguments theologically and morally have denounced it. Certainly, it is a good thing to have children; but not at all cost. It is ethically problematic to desire and act towards having children at all cost. To desire to have children is of course natural and legitimate. But to desire to have them no matter the cost and circumstances, is an expression of godlessness and inadequate moral cum theological understanding of the gift and sacredness of life. Our desires are to be satisfied within the limits of human possibilities. The Church maintains that it is not objectively evil to be infertile; spouses who still suffer from infertility after exhausting legitimate medical procedures should unite themselves with the Lord’s Cross, the source of all spiritual fecundity. However, the Church advocates adoption as an option for such couples who still wish to have children.[28]  Therefore, having children is a gift and not a right.[29] In this light, Michael Monge writes: IVF promotes erroneous thinking: People are taught to think that they have a ‘right to a child’ as if it were a necessity to own a child at all cost. Yet no one properly has the right to possess another person.[30]  

Without misgiving, to say that the issues raised by IVF are thorny is to state the obvious with sincerity. As humans we have the natural inclination to respect human life in its origin and dignity but IVF practitioners fail in this regard. Again, higher good should be sought, respect for human life in its origin and dignity is the first in the hierarchy of rights. Therefore, in the progress Medical scientists are making they should consider what is morally permissible as they are not above the natural law. Medical scientists are encouraged in their task of research and discoveries but should have as their basic principle respect for human life or methods that are morally favored.

END NOTES

[1] Bernard Haring, Medical Ethics, England; St. Paul Publication 1974,  p. xii.

[2] Possible treatments depending on the cause include administration of drugs such as Clomifene or Gonadorelin analogues. “Infertility” in Oxford Concise Medical dictionary, (Eight Edition) New York: Oxford University Press, 2010

[3] A surgical operation to remove a womb

[4] Richard Higginson, Whose Baby? The Ethics of in Vitro fertilization; U.K. Marshall Pickering, 1988, p.1

[5] Ibis p2

[6] David H. Olson and John Defrainhs., Marriage And The Family Diversity And Strength United States: Mayfield Publishing, 1994, p382.

[7]  Richard Higginson, op. cit p.5

[8] Karl H. Pescheke, Christian Ethics: Moral Theology in the Light of Vatican II, Vol.2 Bangalore: Theological Publications, 2013, p.298     

[9] Shannon T. and James Digiacomo, An Introduction to Bioethics, New York: Pauline Press, 1979, p.138.

[10] “In Vitro Fertilization(IVF)” in Oxford Concise Medical dictionary, (Eight Edition) New York: Oxford University Press, 2010

[11] David H Olson and John Defrain; Marriage and the Family Diversity and Strengths op cit. p.382.

[12] Method of IVF  https://en.wikipedia.org/wiki/In_vitro_fertilisationcite_note-LaMarca2013-50 retrieved 2/11/2017

[13] ibid.

[14] Bernard Haring, Manipulation, England: Pauline Publication, 1975. P.207

[15] Thomas J. O’Donnell, Medicine and Christian Morality, New York: Society of St. Paul, 2002, p. 261

[16]  Benedict XVI ” Declares Embryos Developed For In Vitro Fertilization Have Right To Life”, http:/www./medicalnewstoday.com/articles/38686.php   retrieved 29/11/2017

[17] Karl H. Pescheke, Christian Ethics: Moral Theology in the Light of Vatican II, Vol.2 p. 300

[18] Richard Higginson, Whose Baby, p.9

[19] Jerome Okwuosa, Human Life and The Family, Lagos: Criterion Publishers, 2015, p.145

[20] Catechism of the Catholic Church, Kenya: Pauline Publication, 2008 no. 2274

[21] Richard Higginson op. cit p.12

[22] Thomas J. O’Donnell, op cit.  p. 299

[23] Heterologous artificial fertilization, human conception is achieved through the   fusion

    of gametes of at  least one donor other than the spouses who are united in marriage.

[24] Thomas J. O’Donnell, op cit. p. 302

[25] Ibid. p.303

[26] P. Iroegbu, ‘In vitro fertilization, Embryology, making Babies’ in P. Iroegbu & A. Echekwube

    (Eds) kpim of Morality p. 608.

[27] Joseph Omoregbe Ethics: A Systematic and Historical Study, Lagos: Joja educational Research and Publishers, 2006 p .224

[28] CCC no. 2379

[29] CCC no. 2378

[30] Michael A. Monge, Ethical Practices in Health & Diseases. Pp. 150 – 151

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Fr. Daniel Evbotokhai is a priest of the Catholic Diocese of Auchi, Edo State, Nigeria. He was ordained October 20th, 2018. He offers his daily homilies, talks and articles that bother on, faith, theology, morals and many other burning issues in religion and politics. Fr. Daniel writes poems, inspirational quotes and clips.

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