Infertility : IVF & the lot

Let’s start with the fundamentals , as boring as they may be . You’d be surprised how little so many people don’t know about reproduction . On the other hand , it’s hard for me to decide how to concise such a vast subject into something less than a book , so don’t judge me for the seemingly shallow conceptual paragraphs . For those who know or think they already know , feel free to skip the irrelevant sections as you see fit .

The reproductive period for him and her

The reproductive time of life for men as well as women begins with puberty . However , the exact pinpoint of this ‘beginning’ is uncertain ( statistics indicate a decreasing puberty age ) as well as the number of fertile years . Women remain fertile until menopause (whenever that may be – cease of menstrual bleeding at a mature age is an indicator) whereas men may remain fertile throughout life despite the decline of fertility with age . Moreover , the fertility of women is cyclical ; women are fertile only a few days each month . Throughout the reproductive years of a woman’s life , a mature ovum (egg) is released each month from her ovaries . This ovulation takes place mid-way between two menstrual periods and the ovum is picked up by the fallopian tube where fertilization normally occurs . If the ovum is not fertilized within 12-24 hours of ovulation , it perishes and a new period follows 12-14 days later . However , because the sperm survives longer than the ovum , intercourse up to four or five days before ovulation can result in fertilization , as can intercourse one day after . Hence , in actual fact , the fertile days of the woman’s cycle number about fix or six . Women , however , is most likely to conceive around the time of ovulation . If the ovum is fertilized , the resulting embryo travels down the fallopian tube to the uterus (womb) . This usually takes about 3-4 days . Having arrived in the uterus , the embryo will begin implanting itself in the uterine wall .

Infertility

Most couples who wish to have a child and have regular intercourse will normally conceive within half a year . However , this doesn’t mean that a couple is infertile if they take longer to conceive . I am hesitant to define infertility but usually , a couple is not described as infertile unless they have been trying unsuccessfully to have a child for at least two years . About one in six couples are infertile in the sense of experiencing difficulty in conceiving .

In the case of men , the most common cause of infertility – or sub-fertility - is poor sperm quality . This , in itself , represents a variation of disability of the sperm as well as their causes .

For women , partially due to the complexity and loaction of fertilization , there is a list :

1. Blocked or defective fallopian tubes ; either the ovum is prevented from entering the tube , or the passage through the tube of either ovum or sperm may be obstructed . Often the cause of blocked tubes is an infection . Women with several partners are more prone to infections .  Procured abortion is also another cause of infection .

2. Endometriosis (misplaced uterine lining) .

3. Immunological factors . Women may develop anti-sperm antibodies preventing the survival of the sperm . It should be noted that these antibodies may also be found in men’s semen . Hormone treatment may help .

4. Unexplained infertility . Note that these account for 42% of cases . 

 Different forms of treatment

Here , i shall endeavour to explain the possible solutions to infertility with minimal medical-scientific jargon , hopefully without compromising details and precision . 

Natural Procreative Technology (NaProTechnology)

where treatment is aimed at restoring function and allowing conception by means of intercourse :

1. Hormone treatment may overcome infertility in women ho do not ovulate regularly , thus enabling them to conceive by normal intercourse .

2. Surgery may correct blocked or defective fallopian tubes , allowing the ovum to be fertilized by intercourse . Surgery may also be used to correct other structural defects in the female reproductive tract .

3. Immunological problems are sometimes resolved by means of hormone treatment .

4. Endometriosis is sometimes successfully treated by surgery as well .

NaProtechnology is also specifically directed at the programme developed at the Pope Paul VI Institute for the Study of Human Reproduction in the United States that involves teaching couples how to track the woman’s cycle and observe physical changes in her body in order to understand her fertility . The system monitors the reproductive function of women and can be used to identify what form of hormone treatment(s) she may need or identify ovarian cysts as well as the effects of stress , assess chronic discharges and unusual bleeding , whether to promote natural conception or to protect the woman’s health as a whole .

Treatments that by-pass sexual intercourse

When people speak of reproductive technologies , they usually have in mind those that by-pass the sexual conception :

1. Artificial Insemination by Husband (AIH)

The man’s semen , usually obtained via masturbation , is deposited in the woman’s uterus by means of a syringe .  

This is offered to couples in the case of low sperm count or poor sperm quality . It may also be offered if the woman’s cervical mucus contains anti-sperm antibodies or is otherwise abnormal . It may likewise be used in the case of cervical structural problems blocking the passage of the sperm from the vagina to the uterus .

Medical risks are small . Pregnancy  rate varies . Usually , IVF is the preferred option .

     2. Donor Insemination (DIH)

The insemination procedure is similar to that of AIH , with the difference that the semen deposited originates from sperm donors aged 18 to 55 already screened for diseases including AIDS , syphilis and hepatitis B . They are also screened to ensure that they are not carriers of a gene for cystic fibrosis and other hereditary diseases .

This is offered in the case of male infertility . Note that there has been a decrease of its use since the emergence of IVF , suggesting that most couples prefer to have a child that is genetically completely theirs . 

DI is also offered if husbands risk passing on a medical condition to the next generation . In addition , it may be used to allow lesbians couples or single women to have children , despite the Human Fertilization and Embryology Act 1990  specifically mentioning that the child’s need for a father must be taken into account before a decision is taken about medically assisted conception involving sperm donation .

Despite screening , there is still a certain risk of infection .  It must be noted that in the case of donor insemination with the help of a male ‘friend’ and a DI kit , there is a small but non-negligible risk that the donor will pass on a hereditary condition . 

It may also be commented that the very fact that the donor is paid shows that the child itself , as well as the donor’s sperm , is being treated as a commodity .

     3. In-Vitro Fertilization (IVF)

IVF is a complicated and burdensome procedure :

• Stimulation of the ovaries to promote super-ovulation : Different hormonal drug regimes may be used first to suppress the body’s own hormone regulation and then to stimulate the ovaries to over-produce , that is to produce instead of one , but a multitude of mature ova , to apparently increase the chances of success . Note that women may have to be subjected to daily injections for an extended period and may experience unpleasant side-effects .

• Egg collection : When the ova have matured , they are collected via ultrasound probe into the vagina to visualize the ovaries then guiding a needle through the top of the vagina to suck up the ova or through the abdominal wall .

• Sperm collection : obtained via masturbation in the morning the same day as egg collection .

• Fertilization : The ova are usually incubated for a short time before sperm are added separately to each ovum . Usually several embryos will result from this process .

• Embryo transfer : Two or three days after egg collection , embryos may be transferred to the uterus . The transfer only occurs after the embryos have been examined under microscope , and the ‘high quality’ ones are selected . Thus , there are a number of ’spare’ embryos where ‘high quality’ ones may be frozen and stored for future use of the couple or they may be used for research whilst many opt for their destruction , all requiring the couples’ consent .

IVF exposes the child to special medical risks , mainly because it is associated with multiple pregnancy and low birth weight . The main medical risks are associated with the women who were subjected to ovarian stimulation . Note that the success rate ranges between 20-30% .

     4. Intra-Cytoplasmic Sperm Injection (ICSI)

ICSI is a specialized IVF technique in which a single sperm is injected directly into the centre of the ovum under microscope using a very fine needle . This is also used to overcome male infertility or if there has been poor fertilization of ova during conventional IVF treatment . The sperm is obtained via masturbation and the ‘best quality’ sperm is selected .

Note that offspring of men with low sperm count is associated with increased risk of inheriting genetic anomalies and infertility . There are also certain risks attached to the piecing of the outer and inner membranes of the ovum ; it is possible that minor abnormalities disrupt the development of the embryo .

     5. Gamete Intra-Fallopian Transfer (GIFT)

Sperm and ova are deposited together directly in the fallopian tube or fertilization to occur there . Like IVF , GIFT involves ovarian stimulation to produce several mature ova in the same cycle . The ova are retrieved as in IVF (via laproscopy) . The following steps are also similar . 

The procedure is offered when women have at least one functional fallopian tube (obviously) and when the cause of infertility is unknown , when women have endometriosis , when anti-sperm antibodies are present in the cervical mucus , when in the case of male infertility and when DI has failed .

     6. Zygote Infra-Fallopian Transfer (ZIFT)

This is a variation of both IVF and GIFT . The difference between GIFT and ZIFT is that in ZIFT , the newly conceived one-cell embryos (zygotes) , rather than gametes are transferred to the fallopian tube . This means that the ova are fertilized in a dish as in IVF , but the resulting embryos are not ‘cultured’ and so not allowed to start cell division as they would in IVF .

Respect for the Human Embryo

One of the main reasons why there is controversy over IVF and similar technologies is the wastage and discarding of ’spare’ embryos , ultimately resulting in a disrespect for the human embryo and a growing culture that increasingly devalues life .

For the longest time , society has constantly debated when human life begins ; when do we regard the embryo to have the identical human rights we have . For the sake of completeness , i shall present them here .

The answer is : at fertilization ; from the moment a sperm has entered an ovum , a new being has come into existence with intrinsic potentialities quite unlike the two gametes that contributed to the phenomenon .

There are a radical amount of individuals who suggest that human life does not start at fertilization , that the embryo cannot be regarded as a human being , thus justifying embryo wastage and to a clear extent , abortion .

1. The Twinning Argument : In the Human Fertilization and Embryology Act 1990 the fourteenth day after conception , the time of the appearance of the primitive streak , is taken as a decisive cut-off point . Thus it is legal to experiment on embryo or allow it to develop up to the fourteenth day but not beyond . Why is the fourteenth day considered so special ? Each primitive streak marks our one embryo only and the orientation of the developing embryonic body . The early embryo may cleave and two embryos instead of one may result . The argument is faulty ; Firstly , majority of embryos do not twin . Secondly , despite the destination of twins , they undeniably share the same origin .   

2. The Placenta Argument : Some say that because some of the cells in the early embryo will develop into the placenta which is discarded later , the embryo cannot be regarded as an individual human being . I don’t even know where to begin to describe the absurdity of this ‘argument’ . It’s as though they are suggesting that the foetus may only be identified with those cells that later develop into the proper foetus . That is like saying that our soul and body isn’t integrated together ; that they are not part of functional unity for our purpose on earth .

3. The natural wastage argument : Some point out that the majority of the naturally conceived embryos perish and thus , the early embryo is not a human individual . A considerable number of naturally conceived infants and young children perish too . So , applying the same argument , we would have to draw the conclusion that we shouldn’t regard them as human individuals as well ? No doubt few will buy that argument .

 All different ‘cut-off’ points and suggested criterion are arbitrary . I won’t even bother to argue anymore the significance of the moment of conception when the sperm enters the ovum . To me , that should not be the essential question . Applying Pascal’s wager here , let us assume that logical reasoning by itself cannot decide when exactly the embryo should be regarded as a human being , then we must wager if we cannot prove .

Let’s say we lay our bet on the opinion that the human embryo should be regarded as a human being regardless of the stage of development , and it turns out we’re right , what do we lose ?

On the other hand , let’s say we put our bet on the opinion that opposite ; that the human embryo can be defined as a human being with accordance to certain requirements and we’re wrong , we’re guilty or mass murder .

Assess both bets again and tell yourself the logical conclusion .

These being said , it is not a question of empirical observation whether or not the early embryo can be described as a human person . Nevertheless , how could a human individual not be a human person ?

For this reason , the Church insists that from the time of conception , the embryo must be shown the utmost respect and should not be treated as a disposable object .

Thus the fruit of human generation , from the first moment of its existence , that is to say from the moment the zygote has formed , demands the unconditional respect that is morally due to the human being in his bodily and spiritual totality . The human being is to be respected and treated as a person from the moment of conception ; and therefore , from that same moment his rights as a person must be recognized , among which in the first place is the inviolable right of every innocent human being to life

Donum Vitae , chapter 1 , paragraph 1

‘The dignity of life is linked not only to its beginning , to the fact that it comes from God , but also to its final end , to its destiny of fellowship with God in knowledge and love of Him’

Evangelium Vitae , paragraph 38

Who are we to judge the existence and deprive another human being or their rights , to deprive someone of God ?

For if the human embryo is destined to become (and will become unless it succumbs to an accident or is intentionally destroyed) a mature person in the image of God meant for union with God , then the human embryo must surely already be our neighbour , worthy of protection from harm and exploitation .

Such respect should also apply to all aspects of embryo manipulation , such as research that involves the destruction (instant or eventual) of embryos , even if these processes constitute risk of harm and death , despite the potential for their results to provide and deliver promising benefits in the future (near or far) , for the means do not justify its ends . In other words , experimentation on embryos which is not directly therapuetic is illicit .

We were (and still are) entrusted with the stewardship of the earth , but this does not translate into a license for s to adopt an instrumentalist attitude towards the rest of creation , not the least before our own children . That children must not be (mis)treated as mere human products or possessions follows from the understanding of the child as a gift from God , in the image of God , received in human co-creation . Viewed as a gift from God entrusted to our care as our neighbour (and more) , the child cannot be viewed as an object that may be disposed of as we wish . To (mis)treat them as such is incompatible with care and respect called for by the parental vocation delegated by God . The child must be protected from the time of conception and he or she ought to be truly begotten , not made , of one being with his or her parents and flesh of their flesh .

Respect for the sexual act

The term procreation suggests the creative involvement of God every single time a new human life begins . It also importantly suggests human co-creation rather than a purely human act . By contrast , the term reproduction merely implies the biological factors of an act , that the child is man-made and solely the result of a human project .

Techniques of artificial reproduction that bypass the union in the flesh encourage the view that the child is solely a human project . Not only does this depersonalize the ‘concept’ of the child , but also depersonalize the very process of generating new life . An act designed by God for personal self-giving is turned into a form of engineering .

It is not an improvement on the miracle of fertilisation, but a relocation from the warmth and sanctity of the human body to the laboratory where the technicians can pursue their objectives to the limit of what our man-made laws will allow .

When these ‘interventions’ are coupled with gamete donation , this depersonalization of procreation and the commodification of the child are taken a step further , for not only has the child been treated as a product , but also a transaction involving an exchange of goods .

“Every human being is always to be accepted as a gift and blessing of God . However , from the moral point of view a truly responsible procreation vis-a-vis the unborn child must be the fruit of marriage”

Donum Vitae , chapter 2 , paragraph 1

Although gamete donation does not denote infidelity , there is the undeniable potential to drive a kind of wedge between the couple as well as between them and the child . In other words , it affects the child’s identity as well as the parents’ relationship . Thus , it is neither compatible with the proper exclusiveness of marriage nor with that of the parent-child relationship .

A child should be born as the result of the union of the flesh of husband and wife and thus , a living reflection of their love , a permanent sign of conjugal unity and a living and inseparable synthesis of their being a father and a mother . When the family is founded in the spousal embrace of mutual self-giving , it becomes , as does the child itself , a sign of God’s salvific covenant with man and of the Triune mystery :

“Human fatherhood and motherhood , while remaining biologically similar to that of other living beings in nature , contain in an essential and unique way a ’likeness’ to God , which is the basis of the family as a community of human life , as a community of persons united in love (communio personarum) .

In the light of the New Testament it is possible to discern how the primordial model of the family is to be sought in God himself , in the Trinitarian mystery of His life .”

Letter to families , paragraph 6

Apart from the deep symbolism in the family and the child , at the personal or relational level , the child springing from the intimate and physical communion of spouses enriches and deepens their relationship at the personal level .

Thus , not only does gamete donation violate the spousal union and distort the child’s meaning as an expression of that union , but it is also an insult to the dignity of the child and a grave injustice that affects its very identity .

On the issue of bypassing of the sexual act , it must be emphasized that a child needs to be begotten strictly within marriage for the sake of his or her healthy psychological development , which is only compatible with responsible parenthood and respect for the parent-child relationship . 

Human beings are not meant to be alone but are called to interpersonal union and communion with God and neighbour . The very order of creation has normative implications ; it tells us about right and wrong . Our dual nature as man and woman as well as the spousal relationship divinely instituted by God lay down certain rules . The very order of creation lays down rules for the relationship between husband and wife and also the parent-child relationship .

However , we humans are also prone to create our own rules . Human hubris is the root of the lack of humility reflected in the secular liberal idea of autonomy , which fosters selfishness and represents a denial of the Christian concept of freedom ; that which entails a capacity for discerning good and right for the human being according to man’s divinely ordained nature . In particular , it entails a capacity for realizing the truth of God’s plan for marriage and the family .

Every family has the mission to guard , reveal and communicate love as this is the living reflection of and a real sharing in God’s love for humanity . The family which is founded and given life by love is a community of persons ; family which springs from the union of husband and wife forms a truly personal community in which each member is loved and respected as a person . This carries the moral implication that the community of the family ought to be the fruit of the full union and communion of spouses . Through their mutual self-giving in the body , man and woman beget a child , and the child too becomes a part of the horizon ‘we’ the spouses , and enters , as a gift from God , their union to make it a community of love , destined for union with God .

I may be circling the bush , but my messages should remain clear : human procreation should be the result of the union in the flesh of man and wife .

“In his unique and unrepeatable origin , the child must be respected and recognized as equal in personal dignity to those who give him life . The human person must be accepted in his parent’ act of union and love ; the generation of a child must therefore be the fruit of the mutual self-giving which is realized in the conjugal act wherein the spouses co-operate as servants and not as masters in the work of the Creator who is Love .

In reality , the origin of a human person is the result of an act of giving . The one conceived must be the fruit of his parents’ love . He cannot be desired or conceived as the product of an intervention of medical or biological techniques ; that would be the equivalent of reducing him to an object of scientific technology”

Donum Vitae , chapter 2 , paragraph 4 .

In summary , it matters whether the child is co-created in the warmth of sexual embrace . Manipulative techniques of assisted conception encourage the view that procreation is a solely human project and the child a product , inherent in which view is a disrespectful attitude towards the child . The intervention of a third party , a party that may be more actively involved in the conception of the child than the spouses themselves , also reduces the parents to raw material for a process of making ; manipulators rather than pro-creators .

 

In conclusion , i applaud the commendable intention for the development of technology that assist conception , but not the way choices remain for parents to bypass the union of flesh and how it has brought us down a slippery slope away from God . These being said , i must include a couple of postscripts . Firstly , adoption is not to be equaled to the above mentioned technologies that bypass the sexual act , for adoption is merely the acceptation of care of a child who has been orphaned or because his or her natural parents cannot take care of the child . The child is still conceived through the union of flesh , and the respect of parent-child realtionship is not aborted . Secondly , i apologize for those who may find these writings offensive , particularly because of the possibility that a reader may be the result of the above-mentioned technologies . As such , it is essential for me to add here that there is a difference between condemning the act , which is expressed above , and condemning the individuals involved in the act , which i have no intention for because there shouldn’t be reasons to .