2.

5 Infertility and New Reproductive Technologies

Marriage as a Vacation Guidelines for Catholics on the Evaluation and Treatment
Resource Allocation of Infertility
Infertile couple
Therapeutic Options

Marriage as a Vacation 1. Artificial Insemination

• A gift and a mission
• Ends of marriage:
– Good of the spouses
– Good of the children
“The children are considered the fruits of the conjugal love
and should not be taken as burden for the couple.”
Resource allocation
• In a country concerned about ever- increasing health
care costs, unregulated infertility medicine =
expensive treatments for difficult pregnancies with
multiple fetuses— treatments that might have been
avoided by more conservative implantation practices
and by efforts to alleviate the conditions that give rise
to infertility in the first place.
• Human reproductive cloning is unjustified and
unnatural for it offends human dignity and violates
the individual rights to genetic uniqueness
Infertile couple
• Inability to conceive or give birth forces the couple to
re-evaluate the meaning of their relationship.
Effects on the Infertile Couple
• Grief
• Sadness and Frustrations
• Anger
• Feeling of Loss
• Possible Indifferences
• Divorce/Annulment/Separation
Therapeutic Options
For Women:
• Stimulating ovulation with fertility drugs
• Intrauterine insemination (IUI)
• Surgery to restore fertility
For Men:
• Treating infections
• Treatments for sexual intercourse problems
• Hormone treatments and medications Surgery
• Assisted Reproductive Technology (ART)
• Fertility Drugs
• Artificial Insemination1
• Donor Sperm
• In Vitro Fertilization (IVF)2
• Intracytoplasmic Sperm Injection (ICSI) Donor Eggs3
• Surrogacy
• Donor Embryos Reproductive Surgery Gamete
• Intrafallopian Transfer (GIFT)6
• Zygote Intrafallopian Transfer (ZIFT)6
- assisted method of reproduction in which sperm
is directly inserted into woman’s cervix, fallopian
tubes or uterus
- can be used for many kinds of fertility problems
- provided by means of masturbation
How is it done?
• Ovulation kits, ultrasound or blood tests
• Masturbation for the collection of semen
• Seminal processing which involves washing and
purification
• Insemination of the purified and segregated male
germ cell into the cervix and uterine cavity
Categories of Artificial Insemination
a. Homologous Insemination
- artificial insemination by the husband
- insertion of the semen from the husband directly
into the uterine cavity at the time of ovulation
b. Heterologous Insemination
- insemination by donor
- third party who serves as donor (not the
husband) produces sperm to be injected into the
body of husband’s wife
c. Artificial Insemination outside Marriage
- takes place between unmarried man and
woman who may not regard marriage act as the
only licit means of transmitting life
Is artificial insemination moral?
✘ Transgression of the will of God expressed in
of Nature
- arbitrary exclusion of the marital act from
procreation
- distortion of the meaning and purpose of
sexuality
✘ Usurpation of God’s creative power of
authorship over life
✘ Against human dignity
2. In Vitro Fertilization & Embryo Transfer
- IVF = ‘fertilisation in glass’, test tube baby
- joining of a woman's egg and a man's sperm in a
laboratory dish, where fertilization occurs
- The resulting embryo or embryos is/are then
transferred to the woman's uterus to implant and
develop naturally.
- assisted method of reproduction in which sperm
is directly inserted into woman’s cervix, fallopian
tubes or uterus
- can be used for many kinds of fertility problems
- provided by means of masturbation
cont. In Vitro Fertilization & Embryo Transfer
- NTK: Louise Brown, born in England in 1978, was
the first baby to be conceived outside her
mother's womb.
Why it’s done
• Advanced maternal age
• Damaged or blocked fallopian tubes
- can be caused by pelvic inflammatory disease
or prior reproductive surgery
• Endometriosis
• Male factor infertility
- including decreased sperm count and blockage
• Unexplained infertility
3. Intra-cytoplasmic sperm injection (ICSI)
- used to enhance the fertilization phase of in vitro
fertilization (IVF) by injecting a single sperm into a
mature egg.
- used to treat severe male infertility, as when little or
no sperm are ejaculated in the semen.
- Under high-power magnification, a glass tool
(holding pipet) is used to hold an egg in place. A
microscopic glass tube containing sperm (injection
pipet) is used to penetrate and deposit one sperm
into the egg.
4. Assisted Hatching
- a newer lab technique that was developed when
fertility experts observed that embryos with a thin
zona pellucida had a higher rate of implantation
during IVF
- An embryologist uses micromanipulation under a
microscope to create a small hole in the zona
pellucida. This happens on the 4th day of embryo
development when the embryos contain an average
of six to eight cells.
5. Embryo Transfer
- 2-3 days after the eggs are fertilised, the best quality
embryos are selected to be transferred to your
womb.
- The doctor or nurse doing the embryo transfer inserts
a speculum into your vagina. A fine tube (catheter) is
passed through the cervix, normally using ultrasound
guidance. The embryos are passed down the tube
into the womb.
How Many Embryos are Transferred?
- related to age and embryo quality
Age # of Embryos
>35 2
35-37 2-3
38 3-4
>40 up to 5
Church Teaching on In Vitro Fertilization
• A child has the right to be conceived in the marital
embrace of his parents. Human sexuality has two
components, the unitive and procreative.
o IVF separates these components and makes
the procreative its only goal.
• It makes the child a commodity produced in a
laboratory, and makes doctors, technicians, and
even business people part of the conception
process.
• The sperm used is usually obtained by
masturbation, which the Church teaches is
immoral.
• The sperm or eggs used may not come from the
couple desiring the child; because one of the
spouses may be infertile, it may be necessary to
use the sperm or eggs from an outsider. (sanctity
of marriage?)
• Most of the embryos conceived—which the
Church holds should be respected new human
lives—die, are frozen indefinitely for later
implantation, are used for research, or are
discarded.
6. Gamete Intrafallopian Transfer (GIFT)
- Sperm and eggs are placed in a fallopian tube (via
laparoscopy) to allow fertilization in the natural site.
- The woman must have at least one normal, open
fallopian tube.
- ZIFT:
7. Tubal Ovum Transfer
- Eggs are aspirated from the ovary and placed in the
prepared semen sample. Fertilized embryos or
zygotes are transferred into the fallopian tube
Bioethical Issues:
• Conception with human assistance
- Gamete intrafallopian transfer may stir some
ethical debate over the fact that conception is
only possible with human assistance
- This may be seen as usurping God’s creative
power of authorship over life and an act against
the power of stewardship
- The fetus’s life may be seen as ‘biological
property’ rather than a life of his/her own, thus
violating the dignity of the unborn child
Is GIFT morally acceptable: debatable
✓ Procedure can only be performed for married couples
using only the gametes of the wife and husband.
✗ The husband’s semen cannot be collected by means of
masturbation.
✓ The semen must be collected as part of a conjugal act
in which a perforated Silastic sheath is used
✓ The ovum should be collected on the same day as the
conjugal act
✓ The husband’s sperm must be used within 72 hours of
its collection so that it is not used after its natural
viability
✓ An AIR BUBBLE must separate the gametes as they
are transferred through the cathether so that if
fertilization occurs, it will occur at the natural site of the
fallopian tube
8. Surrogate Motherhood
- the procedure by which one woman is hired by
another to bear children that the first, for whatever
reason, was unable to conceive or carry.
- surrogate mother: a woman who becomes pregnant
usually by artificial insemination or surgical
implantation of a fertilized egg for the purpose of
carrying the fetus to term for another woman
Types of Surrogacy
a. Traditional Surrogacy (Straight method)
- surrogate is pregnant with her own biological
child with the intention of relinquishing the
child to be raised by others
b. Gestational Surrogacy (Host method)
- surrogate becomes pregnant via embryo
transfer with a child of which she is not the
biological mother
- gestational carrier
In Terms of Payment:
a. Altruistic Surrogacy
- surrogate receives no financial reward for her
pregnancy or the relinquishment of the child
b. Gestational Surrogacy (Host method)
- a gestational carrier is paid to carry a child to
maturity in her womb
Private Issues:
• Risk to the family
- Contracting couple may be ridiculed or
unsupported by their family
- Time and money spent
- Health risk in egg harvesting
- IVF: higher risk of birth defects
- How to tell this child about how it was
created/born
• Risks to the family of the surrogate
- They must bear with her and aid her through
what may be a difficult pregnancy
- other children of the surrogate
cont. Surrogate Motherhood
Social Issues:
• Commercialism of the Human Body and Body
Parts
- service idea commonly been seen as analogous
to prostitution
- child is purchased from the gestational mother
• Exploitation of the Surrogate Mother
- The combination of desperate infertile couples,
low income surrogates, and surrogacy brokers
with varying degrees of moral scruples raises
the prospect that the entire commercial
enterprise can be EXPLOITATIVE
Legal Issues:
• The legal status of surrogacy has not yet been
settled. The 1987 Constitution has no outright
prohibition of surrogacy.
• The closest law the Philippines has regarding
surrogacy is in The Family Code of the Philippines.
Art. 163. The filiation of children may be by nature
or by adoption. Natural filiation may be legitimate
or illegitimate.
Art. 164. Children conceived or born during the
marriage of the parents are legitimate. Children
conceived as a result of artificial insemination of
the wife with the sperm of the husband or that of
a donor or both are likewise legitimate children of
the husband and his wife, provided, that both of
them authorized or ratified such insemination in a
written instrument executed and signed by them
before the birth of the child. The instrument shall
be recorded in the civil registry together with the
birth certificate of the child.
Ethical Issues
- Based from Section 4: The Vatican Instruction on
Respect for Human Life in Its Origin and on the
Dignity of Procreation (Donum Vitae)
Why is it wrong to generate human life outside the
marital act?
✗ Techniques that entail the dissociation of
husband and wife, by the intrusion of a person
other than the couple are gravely immoral.
✗ These techniques infringe the child’s right to be
born of father and mother known to him and
bound to each other by marriage. They betray
the spouses right to become a father and
mother only through each other.
✗ They dissociate the sexual act from the
procreative act.
- “under the moral aspect procreation is
deprived of its proper perfection when it is
not willed as the fruit of the conjugal act...”
Is it moral?
• No, for it is contrary to the unity of marriage and
to the dignity of the procreation of the human
person.
• Surrogate motherhood represents an objective
failure to meet the obligations of maternal love, of
conjugal fidelity and of responsible motherhood;
• it offends the dignity and the right of the child to
be conceived, carried in the womb, brought into
the world and brought up by his own parents.
Guidelines for Catholics on the Evaluation and
Treatment of Infertility
Resources:
• Dignitatis Personae, Instruction on Bioethics, William
Cardinal Levada as Prefect of the Congregation for the
Doctrine of the Faith
• Donum Vitae (The Gift of Life), Instruction on Respect
for Human Life in its Origin and on the Dignity of
Procreation: Replies to Certain Questions of the Day,
Joseph Cardinal Ratzinger as Prefect of the
Congregation for the Doctrine of the Faith
• Catechism of the Catholic Church
How do I know when a reproductive technology is
morally right?
Donum Vitae:
• Any procedure which assists marital intercourse
in reaching its procreative potential is moral.
• Any procedure which substitutes or suppresses a
need for marital intercourse to engender life is
immoral.
Reproductive Technologies in Disagreement with
Catholic Teachings:
✗ Obtaining a semen sample by means of masturbation
✗ Artificial insemination using sperm from a donor (AID)
or even the husband (AIH) if obtained by
masturbation
✗ In-vitro fertilization (IVF), zygote intra-fallopian
transfer (ZIFT), and intracytoplasmic sperm injection
(ICSI), ovum donation, "surrogate" uterus
Reproductive Technologies in Agreement with Catholic
Teachings:
✓ Observation of the naturally occuring sign(s) of fertility
(Natural Family Planning). Time intercourse on the
days of presumed (potential) fertility for at least six
months before proceeding to medical interventions.
✓ General medical evaluation of both spouses for
infertility.
✓ Post-coital test to assess sperm count and viability.
✓ Appropriate evaluation and treatment of male factor
deficiency. Seminal fluid samples can be obtained
from a non-lubricated, perforated condom after
normal intercourse.
✓ Assessment of uterine and tubal structural
competence by imaging techniques (e.g.,
ultrasound, hysterosalpingogram, etc. ).
✓ Appropriate medical treatment of ovulatory and
hormonal dysfunction.
✓ Appropriate (usually surgical) correction of organic
problems underlying male or female infertility
 Quick Summary
Human reproductive • human dignity
cloning • rights to genetic uniqueness
Artificial Insemination • God’s will
- marital act
- meaning & purpose of sexuality
• God’s creative power of authorship
of life
• human dignity
IVF • child’s right to be conceived
• components of sexuality
- separates unitive & procreative
components, with procreative
the only goal
• child = commodity
• use of sperm & gametes from an
outsider
respect for persons (embryo)
Conception with Human • God’s creative power of authorship
Assistance (in general) of life
- Artificial Insemination • Stewardship
- IVF & Embryo
Transfer
- Tubal Ovum Transfer
- GIFT & ZIFT
- ICSI
- Assisted Hatching
GIFT Accepted EXCEPT if sperm is
collected through masturbation
Techniques that • Dissociation of husband and wife
generate human life • child’s right to be born of father &
outside the marital act mother known to him & bound to
- Surrogacy each other by marriage
- Heterologous • spouses’ right to become father &
Insemination other only through each other
- Artificial Insemination Dissociation of the sexual act from the
outside Marriage procreative act
PROBLEMATIC: ✗ masturbation
✗ IVF
✗ ZIFT
✗ ICSI
✗ ovum donation
✗ surrogacy