|
Artificial Fertilization and the Christian Response PCUC Board of Directors
Artificial fertilization
or artificial reproduction can be
a tempting consideration for the couple who has spent years suffering with the
emotional pain of infertility, however, a number of ethical questions arise.
In order to understand why participation in artificial reproduction
conflicts with the Lord's moral order, we must understand how artificial
reproduction works.
Artificial fertilization is often abbreviated as ART (assisted reproductive
technology).
It is a process in which the gametes (i.e., the sperm and the egg)
are artificially manipulated so as to increase the likelihood of pregnancy.
[Note: the technical name of the egg is an "oocyte"]. There are
three main types of ART which are used today.
In vitro fertilization
(IVF) literally means fertilization that occurs “in a glass” or in a
"test tube". It
involves a number of steps. First a
woman is given a hormonal drug such as hMG (human menopausal gonadotropin)
to make her "super-ovulate".
This means that the drug(s) cause her ovaries to produce many "ripe
eggs" also called "mature oocytes."
She is also given progesterone__a female hormone that
serves to thicken the lining of the uterus, preparing it for the unborn baby.
The process of egg retrieval is performed using a procedure called
"ultrasound guided transvaginal oocyte recovery."
Here, the obstetrician uses ultrasound to guide a biopsy needle through a
woman's vaginal wall and into her ovary. A
number of her eggs __from twenty-five to as many as forty
1 __are removed from the ovaries.
Each of these oocytes is then placed in a "test tube" to which
a certain amount of a man's sperm is added a few hours later. Most of the eggs__about 75% __will
be fertilized and often grown in a culture that is supplemented with fetal cord
serum (i.e., plasma that was taken from a baby's umbilical cord).
These tiny unborn children are often "screened" for genetic
defects by examining one of their cells with instrumentation that can analyze
the cell's chromosomal characteristics. Unborn
babies who have genetic defects such as Down's syndrome or cystic fibrosis are
"thrown out".*
The clinician will then inject three or four unborn children into the
woman's uterus via a vaginal approach__this is considered
“one cycle” or “one attempt”.
The national "success rate" of a single attempt of in vitro
fertilization (IVF) is 16.8%2.
Only one out of three or four unborn children survive in a given cycle of
in vitro fertilization__that is about 28.6% (i.e., 1/3.5).
Since the success of an average cycle is 16.8%, it means that only 4.8%
(i.e., 28.6% x 16.8%) of the babies actually survive.
This means that fewer than one in twenty unborn children survive the
process. The remainder of
the original 20 to 40 tiny unborn children are placed in a super-cooled freezer
(kept at -196 oC)3 in case the initial attempt (cycle) of
in vitro fertilization fails. [Of
note, one third of the tiny frozen babies will not survive the freezing
process]. Williams Obstetrics
(1997) notes that the cost of in vitro fertilization and delivery is about
$40,000 and increases to over $300,000 for triplets 4, p865 .
What if all three or four of the unborn children survive? For example 5% of the couples who use in vitro fertilization
end up with triplets. The clinician
will now offer the woman the "option" of "selective reduction"
of one or more of her children. This
revolting procedure involves reducing the number of children that the pregnant
woman is carrying by piercing a large bore needle through a woman's abdominal
cavity or vagina and "injecting potassium chloride into the fetal thorax
via a needle." [William's Obstetrics, 1997]4.
The second major type of artificial fertilization is called ZIFT
or Zygote IntraFallopian Transfer. This
process is very similar to IVF in that fertilization occurs outside of a woman's
body, but the tiny unborn children (i.e., called "zygotes") are now
placed into a woman's fallopian tube instead of into her uterus.
It carries the same moral problems as IVF.
The last major type of artificial reproduction is referred to as GIFT
which stands for Gamete IntraFallopian Transfer.
In this procedure, eggs are taken from a woman and are placed in a
special pipette with the sperm from a man.
The oocyte and the sperm are separated by an air bubble and do not meet
as long as they are outside the woman's body.
Usually two eggs and the sperm are then injected into both of the woman's
fallopian tubes-thus a total of four eggs are injected.
The national success rate for GIFT in one cycle has been estimated to be
about 26.3%.
There are some who claim that GIFT is "less unethical" than in
vitro fertilization or ZIFT, since with GIFT, fertilization occurs within a
woman's body, however GIFT is also morally flawed.
Why? First, although in
GIFT, four oocytes are placed in a woman's fallopian tube, along with a
separated sample of sperm, no one is sure of how many of the eggs become
fertilized once they are inside a woman's body.
A woman's body is the natural place for conception to take place, and so
one would think that sperm and eggs could have at least as high a rate of
conception as they would in the "test tube setting". But we know that clinicians succeed in fertilizing over 75%
of the eggs that are taken from a woman and fertilized in the test tube 5,6.
Thus, it may very well be that often three if not all four of the eggs
which were placed in the fallopian tube during GIFT are fertilized.
Since three eggs are fertilized in every trial __and
since the national success rate for a single cycle or trial of GIFT is only
about 26% 3 __it means that many of the babies that were
conceived in the fallopian tube, fail to implant into the mother’s uterus and
die. Specifically, this implies
that in order to achieve one successful pregnancy with GIFT, at least 10 unborn
children have to be sacrificed (i.e., 33% x 26% = 8.6% of the babies make it,
while 91.4% die in the process).
GIFT has two additional problems: 1) occasionally couples elect to have
some of their gametes fertilized and stored as frozen unborn children, in case
the GIFT procedure fails, so that the process of "egg retrieval" does
not have to be repeated; 2) GIFT may also involve "selective
reduction" if, for example, all four of the oocytes are fertilized and
succeed in implantation. Of note,
the multiple pregnancy rate in GIFT is reported to be about 25% 7.
In addition to the three types of artificial fertilization described
above, is there a moral problem with the “fertility pills” such as those
used by the McCoys? It appears that
there is __at least when the commonly used fertility drug,
Clomid ® is used. Why? Clomid ® hyperstimulates a woman’s ovaries so that
many eggs are produced. But Clomid
® also decreases the thickness of the inner lining of a woman’s uterus,
called the endometrium 8,9.
This is critical since a number of studies 10,11,12 have shown
that a thin endometrial lining is far less likely to sustain the unborn child
than a thick one. Thus, the
evidence supports the notion that Clomid ® allows a much higher rate of
abortions to occur than in the natural setting because of its effect on the
uterine lining. The Christian
should avoid this. One
additional procedure called artificial insemination needs to be
mentioned. Here a woman chooses to
be artificially inseminated (i.e., the sperm is placed into a woman's uterus) by
the sperm of a man who is often not her husband .
The woman can actually choose the characteristics of the genetic make-up
of the man who donated the sperm (i.e. his IQ, his nationality, etc).
In addition, since single women often choose this procedure __the
unfortunate child often grows up fatherless.
Artificial insemination is different than artificial fertilization since
only one gamete (i.e., only the sperm) is manipulated in the procedure and the
probability for early abortion is theoretically no greater than with a natural
conception.
Obviously, these procedures are ripe with moral evils.**
Let us explore them and their implications in more detail.
The fact that in vitro fertilization and ZIFT involve
outright abortion precludes any further discussion of these methods as a
valid option. No one has the
authority to take the life of another, no matter how good the intention of
wanting to have a child is. God
commanded us to be fruitful and multiply, but He also stated that we should not
kill. We
cannot justify the former by violating the latter.
We must obey ALL His commands.
What about GIFT? It was
noted that there is an extremely high probability that GIFT involves multiple
early abortions but that once the eggs and sperm are injected into the woman's
fallopian tube, no one can say exactly how many of the eggs are fertilized.
Here we have a case in which all of the evidence strongly supports the
statistic that nine unborn children die for every one that survives.
The Christian has been given his or her intellect as well as his or her
emotions-both to serve and be guided by our Creator. But the degree of emotional pain or hope one
experiences cannot justify a complete denial of the evidence that is presented
to the intellect.
Freezing of unborn children is also morally bankrupt. Why? First,
because only two-thirds of children survive the freezing process. Any artificial process that results in the death of one out
of three babies is certainly inherently evil.
But further questions and concerns arise. What happens to these frozen children if the couple conceives
and has "fifteen spare children" frozen at -196 oC?
Do they "give the children away"? throw them
away? [i.e., Precisely this ethical dilemma arose recently when England
allowed the killing of many frozen embryos.]
What happens if the couple divorces?
What happens when a researcher elects to perform “experiments” with
the frozen unborn children? (For
those in the audience who might think that "researchers and/or doctors
would never do that," one need only recall that many of today's
abortionists once took an oath in which they once swore to "give no
abortive remedy.")
"Selective reduction," which involves the killing of a
child by piercing his or her chest via a steel syringe and injecting potassium
chloride is inexcusable . Couples
who have made the mistake of participating in ART should not compound their
error by killing another child, in order to increase the "odds" that
the remaining children will survive. Of
note, 10% of couples who undergo "selective reduction" will lose all
of their children in the process 13, p937.
Genetic selection __here a single cell-of the
tiny unborn child is tested for genetic defects.
A clinician takes one of the cells from the unborn child when he or she
is in the very first few days of life and usually only "eight cells
big" 13, p94. Babies
who carry the gene for cystic fibrosis, Down's Syndrome, or any other genetic
abnormality are destroyed.*
Masturbation. Although
this act does not seem to register on the moral Richter scale of many
Christians, other Christians consider it an "act that is inherently
evil" and can therefore never be justified.
For example, the Catholic Catechism states: "Both the
Magesterium of the Church, in the course of constant tradition, and the moral
sense of the faithful have been in no doubt and have firmly maintained that
masturbation is an intrinsically and gravely disordered action.
The deliberate use of the sexual activity, for whatever reason,
outside of marriage is essentially contrary to its purpose." {verse 2352 of
the Catechism}) But almost every sperm sample is collected via
masturbation. The Christian who accepts the truth of the immorality
of this act cannot engage in masturbation under any conditions.***
One of the arguments that fertility clinicians use to justify the
procedure of artificial reproduction is that even under natural conditions,
women often experience frequent miscarriages.
Williams Obstetrics (1997) estimates
that about 31% of all conceptions end in miscarriage, however they base this
estimate upon the estimates of several medical studies.
The most recent and accurate study appears to be that of Whittaker et al 20
who used sensitive early pregnancy tests to demonstrate that the overall rate of
miscarriage is about 20% (i.e., 8% very early miscarriages and 12% clinically
obvious miscarriages). The
proponents of ART often states that since natural reproductive processes involve
early miscarriages, one can justify the former process of artificial
reproduction since "both processes involve the death of unborn children
after conception."
There are however, two major problems with this type of argument.
First, even if we use Williams Obstetrics high estimate of a 31%
miscarriage rate, clearly the artificial procedures have a far higher death
rate. Whereas in the natural
setting between 20-31% of unborn babies will die, in a setting such as in vitro
fertilization about 96% of the conceived babies will die (i.e., here we factor
in those lost in the freezing process). A second reason is that the processes are theologically
different. In a natural
setting, a couple places themselves under God's natural conditions and cannot
avoid an early miscarriage if it occurs. But
in artificial reproduction, children get destroyed in a process that God never
commanded. As was noted
earlier, if an artificial process violates a commandment of God (Thou shall not
kill) it cannot be justified even if part of it is consistent with another one
of His dictates (Be fruitful and multiply).
Our actions must be consistent with all of His commands.
In addition to the noted moral problems, both legal and health problems
exist. The US has completely shirked its responsibility of establishing legal
guidelines as concerns artificial reproduction.
Many of the countries of the rest of the world have ethical guidelines
concerning ART, with the exception of the US.
For example Germany's law states that "any person transferring more
than three embryos to a woman within one menstrual cycle will be sentenced on
conviction" 17, p194 . It
also states: "Any person producing an embryo capable of differentiation by
fertilization of a human oocyte with a sperm of an animal cell ... will be duly
punished" 17, p193. Australia's
"Infertility Act" of 1984 also banned cloning and the fertilization of
human gametes with those of an animal 18 and Singapore has similar
guidelines 19. In spite
of this, the US remains devoid of any legal guidelines.
Ectopic pregnancy (i.e. a pregnancy that occurs outside of the
uterus, usually in the fallopian tubes) occurs in approximately 3% of GIFT
pregnancies and 5% of in vitro pregnancies 13, p940
while about 1% of natural pregnancies end as an ectopic pregnancy (i.e.,
11 out of 1,000 pregnancies- information taken from the years 1970-1989 [source Williams
Obstetrics, 1997]). Since
almost all of the unborn children
of an ectopic pregnancy die, we once again find that an artificial process
results in a higher rate of mortality for the unborn child than the natural
process. In addition: "Ectopic
pregnancy remains the second leading cause of maternal mortality in the United
States, and is the leading cause of maternal mortality in the first
trimester" 4, p609.
Cancer risk: Clomid
® (clomiphene), made by Hoechst, is a fertility drug which acts upon the
pituitary gland, so that it increases the hormones involved in ovulation (called
LH and FSH), which results in a tremendous increase in ovarian activity. Instead of one oocyte forming in a given cycle, up to
20 or more may form in each ovary. But
Clomid ® "is capable of interacting with estrogen receptors" 14.
Is there an increased risk of cancer when an artificial hormone reacts
with the body's natural receptors and hyperstimulates a woman's ovaries?
Already, Whittemore et al found that women who used fertility drugs
experienced a 180% increased risk of ovarian cancer than women without
infertility and Rossing noted a 130% increased risk 15 (although his
result did not achieve statistical significance). In addition, one must wonder what the long term risk
of fertility drugs such as Clomid ® are upon the risk of breast cancer.
One need only remember a drug called DES (Diethylstilbestrol) which was
an artificial estrogen given to women to prevent premature labor and
miscarriages in the 1950s-1960s. After
twenty five years researchers finally declared that women who had taken it had a
35% increased risk in breast cancer 16.
Will the same thing occur with drugs such as Clomid ® and hMG?
Finally, will the children who are born to the women who have recently
taken Clomid ® experience an increased risk of cervical and vaginal cancer as
did the children of mothers who took DES? Before
dismissing this notion one must note that the PDR (Physician's Desk Reference)
states that "Newborn rats, injected (with Clomid ®) during the first few
days of life, also developed meta-plastic changes in uterine and vaginal mucosa..."
(PDR, 1997). Does HMG (Human Menopausal Gonadotropin-trade name is Pergonal ®) also have a potential to cause ovarian cancer? One would think that a powerful drug which hyperstimulates a woman’s ovaries would have been thoroughly tested but the 1997 PDR notes that: “Long-term toxicity studies in animals have not been performed to evaluate the carcinogenic potential of Pergonal ®.” This is astonishing considering that the PDR’s description of Pergonal ® also notes that: “There have been infrequent reports of ovarian neoplasms both benign and malignant, in women who have undergone multiple drug regimens for ovulation induction; however, a causal relationship has not been established. This brings us to another
important dilemma. About one-third
of couples state that they would abort a child with a chromosomal abnormality
and this number could increase dramatically after "genetic counseling"
is given. It puzzles me that so
many people appear to support the effort called "The Human Genome
Project"__an effort to identify every human gene.
Although finding new genes can eventually help treat people who have a
particular gene, it must be obvious to all that many of the newly discovered
genes will be used as a “discrimination test of the unborn” which
will__and already has__result(ed) in the
killing of thousands of children by many western countries such as the US. If I had the chance, I should like to ask Dr. Francis
Collins (a reported Christian who leads the project) how he can justify
working on a project in the absence of specific legislation which would
protect the affected unborn children. Should
we not insist that legislation
banning any "discriminatory preborn testing" be passed, BEFORE the
search for a particular gene is started? ** The Catechism notes that "artificial
insemination and fertilization...remain morally unacceptable" [verse 2377]. *** Often a man is asked to donate a sperm sample for
analysis if a couple is suffering from infertility.
Some Christians have opted to collect a sperm sample in a perforated
condom at a time of a woman's cycle in which she is not thought to be fertile,
thus leaving open the small possibility of having a child if God so desires.
This author is not sure of
the complete morality of this procedure but it is obviously better than
masturbation. 1) Robinson BJH.
The perioperative nurse's role in assisted-fertility procedures. AORN.
1997; 65: 87-93. 2) American Fertility Society. Assisted reproductive
technology in the US and Canada: 1992 results generated from The American
Fertility Society/Society for Assisted Reproductive Technology Registry.
1994; 62: 1121-1128. 3) Hummel WP et al.
Assisted reproductive technology: the state of the ART.
Annals of Medicine. 1997; 29: 207-214. 4) Cunningham M. et al. Williams Obstetrics (20th Edition)Appleton & Lange.
Stamford, CT. 1997. 5) Laufer N et al. The use of high-dose human
gonadotropin in an in vitro fertilization program. Fertility and Sterility. 1983; 40: 734-739. 6) Wolf DP et al. Sperm concentration and the
fertilization of human eggs in vitro. (?Biology
of Reproduction. 1984; 31: 837-848. 7) Abramovici
H. et al. Gamete Intrafallopian
transfer. Journal of Reproductive
Medicine. 1993; 38: 698-702. 8) Yagel
S. et al. The effect of ethinyl
estradiol on endometrial thickness and uterine volume during ovulation induction
by clomiphene citrate. Fertility
ans Sterility. 1992; 57: 33-36. 9)
Eden JA et al. The effect of Clomiphene citrate on follicular phase increase in
endometrial thickness and uterine volume. Obstet.
Gyn. 19889; 73: 187-190. 10)
Reuter KL et al Sonographic
appearance of the endometrium and ovaries during cycles stimulated with human
menopausal gonadotropin. J Reprod.
Med. 1996; 41: 509-514. 11)
Check JH et al Influence of endometrial thickness and echo patterns on pregnancy
rates during in vitro fertilization. Fertility
and Sterility. 1991; 56: 1173-1175. 12)
Check JH et al. The efect of endometrial thickness and echo pattern on in vitro
fertilization outcome in donor oocyte-embryo transfer cylce.
Fertility and Sterility. 1993; 59: 72-75. 13) Speroff
L et al. Clinical Gynecologic Endocrinology and Infertility (5th Edition).
Williams and Wilkens. Baltimore. 1994. 14) Physicians
Desk Reference (1997): Description of Clomid (R) 15) Mosgaard BJ et al. The impact of parity, infertility and treatment with
fertility drugs on the risk of ovarian cancer. Acta Obstet. Gyn Scand.
1997; 76: 89-95. 16) Colton T, Greenberg ER, et al.
Breast cancer in mothers prescribed diethylstilbestrol in pregnancy. JAMA,
1993; 269: 2096-3000. 17) Krebs D. News
and Views: Reproductive health care
policies around the world: Rules and ethics concerning assisted procreation
established by the government of Germany. Journal of Assisted Reproduction and Genetics. 1996. 193-195.
18) Kovacs Legislation
on the practice of assisted reproduction in the state of Victoria, Australia.
J. of Assisted Rep. and Gen. 1996;
13: 5-7. 19) NG et al News
and Views: Reproductive health care policies around the world: ART in Singapore.
1996: 13; 527-528. 20) Whittaker PG. Unsuspected pregnancy loss in
healthy women. The Lancet.
May 21st, 1983: 1126-1127. Last Updated: 01/01/2000
|