Life and Death in the Lab: New Method Ends Lives

HOUSTON — A new method of making test-tube babies is increasing the role of a doctor as giver of life and death in the lab.

A pioneer method of in vitro fertilization is designed to reduce the risk of multiple births, but it also increases the likelihood that fewer human embryos fertilized in the lab will ever live within their mothers’ wombs.

Like the more common method of in vitro fertilization, the new method violates the dignity of these tiniest humans, Catholic bioethicists say.

With the technique known as “blastocyst transfer,” fertility doctors observe the growth of human embryos, artificially fertilized in a petri dish, for five days instead of the usual three, said Dr. Timothy Hickman, whose Houston in vitro fertilization clinic has performed the method since it opened in 2001.

Then, instead of transferring multiple embryos into the mother's womb, in hopes of having at least one successfully implant and grow to birth, the doctor transfers a single one judged most likely to implant. The remaining viable embryos are frozen, and those that fail to grow are discarded, Hickman said.

The method was reported recently in the Wall Street Journal as an effort of a small but growing number of fertility clinics across the country. First performed in the late 1990s, blastocyst transfer is reportedly as successful in producing a viable pregnancy as the three-day method — a range of 30% to 70%, depending upon the clinic and factors such as health and age of the mother. But the five-day method avoids the risk of health complications for mother and child with multiple births.

According to Catholic bioethicists, however, blastocyst transfer comes no closer than any other kind of in vitro fertilization to respecting the human dignity of the newly conceived lives, most of whom do not survive the laboratory procedure.

“All of this is against Catholic ethics, whether you do it in three days or five,” said Richard Doerflinger, associate director for pro-life policy development for the U.S. Conference of Catholic Bishops. “Instead of putting several in the womb, you're putting fewer in the womb and more in the freezer. It's designed to provide babies instead of to destroy babies, but there are lots of embryo losses.”

Hickman and other reproductive endocrinologists maintain that many embryos are lost anyway throughout the natural reproductive life of a married couple.

“When we harvest eggs, we see that of those mature eggs probably 70% will fertilize. Of those that fertilize, only a certain amount go on to divide and progress, which we are sure is what is happening naturally,” he said. “If you take a fertile couple that's trying to conceive monthly, they only have a pregnancy one out of three months. We're seeing the same thing in the lab … fertilization may or may not occur and if it occurs, you may not have progression.”

Whether embryo loss in nature is equal to embryo loss in the lab cannot be known, Hickman acknowledged, calling it the “black box” of reproduction.

Dr. Robert Saxer, president of the Catholic Medical Association, said even if the losses were equivalent, it has “absolutely nothing to do with the debate” about the morality of in vitro fertilization.

“That's not our problem [if embryos are lost naturally]. We're not intentionally doing that; that's nature, that's God's province,” he said. “We are not responsible for that, but we are responsible if we're sitting behind a microscope and saying which ones live.”

‘Scoring System’

According to Hickman, the new in vitro fertilization process of evaluating the tiny human embryos uses a “blastocyst scoring system” to determine which ones are most likely to survive and implant.

“Two things we look at are the growth of the cells in the culture and the rate of their growth, and then we look at the degree of fragmentation that we see within the embryo,” he said. “If it's very clear, with even cells, it is a higher-quality embryo — that is better than irregularly shaped cells and fragmentation inside.”

“Those that are not transferred we continue to grow, and if they are viable embryos at Day 5 then we suggest that the couples freeze these embryos for later use,” an option, he said, which couples choose “almost completely.” The majority of the embryos stop growing and are discarded, he said.

An interesting phenomenon has been observed among the couples who ask the lab to freeze their embryos, said Marie Davidson, Ph.D., a staff psychologist for Fertility Centers of Illinois.

“If they feel their family is complete and all they can handle, they tend to defer” the decision of what to do with the frozen embryos, she said. “There's been some research suggesting that people have an odd way of just forgetting.”

It was worldwide news a few years ago when a fertility lab in the United Kingdom announced that parents needed to confirm they still wanted their frozen embryos or the tiny humans would be destroyed.

“There were a lot of people who couldn't be found,” Davidson said.

Another study indicated that many parents who thought they might want their frozen embryos destroyed after a period of time later changed their minds, Doerflinger said.

“A lab asked parents, ‘What do you want done with the embryos that are still frozen after three years?’ Quite a few said to discard them. Then, when three years came up, 59% said, ‘No, wait,’” he said. “When push comes to shove, parents know there's something there.”

Although the effort to provide healthy pregnancies for otherwise infertile couples is “well intentioned,” the new in vitro fertilization seems to be a form of eugenics, which the Church has always opposed, said Conventual Franciscan Father Germain Kopaczynski, director of education for the National Catholic Bioethics Center in Boston.

“Basically the Church teaching is that IVF is an affront to human dignity because it puts the embryo at risk, for one thing, but it also is a demeaning of the holiness of the conjugal act,” he said. “It's interesting that we find that the Catholic Church is one of the great defenders of good old-fashioned sexual congress.

“Human beings should come about as a result of their parents’ love rather than by technical means. Human beings should be born in the warmth of love rather than being put in the deep freeze.”

The first Church document to specifically declare the immorality of in vitro fertilization was Donum Vitae (On Respect for Human Life), published in 1987 by the Congregation for the Doctrine of the Faith. The Church does not rule out all technological assistance for couples desiring children but states the assistance cannot replace the conjugal act, Father Kopaczynski said.

The teaching of life-giving love is reinforced in Pope John Paul II's 1995 encyclical Evangelium Vitae (The Gospel of Life).

“This particular Pope has been spending a lot of his pontificate urging people to be aware of the dangers of the technological imperative,” Father Kopaczynski said. “If you have the technology to do something, it doesn't necessarily mean that that's a good thing to do. We have a world of technical titans but moral midgets.”

Implantation?

Some Catholics remain unaware of the Church's opposition to in vitro fertilization, and there are Catholic couples among the parents of the more than 1 million “test-tube” babies worldwide.

“I'm not sure that the message has gone out in a clear voice from the pulpits,” Father Kopaczynski said. “When the trumpet is uncertain the troops don't know how to rally.”

One justification given for in vitro fertilization is the notion that human life does not actually begin at conception but at implantation — a very convenient argument for in vitro fertilization supporters, Catholic Medical Association's Robert Saxer said.

“The terms are beginning to change,” he said. “If you say that life begins at implantation, then you can do anything you want to this little creature. If you fertilize it outside the mom, that little creature has no rights, no value.”

Hickman of the Houston clinic said after struggling with the question of when life begins, he decided it begins at implantation. Otherwise, he said, he could not understand the loss of possibly “hundreds of embryos” throughout a fertile woman's reproductive life.

“I've kind of come to that conclusion, right or wrong — it's the one that made sense to me,” he said.

Saxer, however, said there is no denying life begins at conception, which is just another name for fertilization.

“It's a beautiful, magnificent concept,” he said. “At conception, when sperm penetrates the egg, you are a complete human being. The blueprint of your whole life and the builder is all there. The only thing that you depend upon your mom for is shelter and some nutrition. You don't depend upon any outside force for your growth and development; you're self-contained.

“This little thing that is smaller than the period at the end of a sentence is the whole deal. It's all there.”

Couples at the fertility clinics also wrestle with questions about when life begins and with their responsibilities to their embryonic children, according to psychologist Marie Davidson.

“It's not uncommon for me to meet with couples who are talking about moral and ethical concerns,” she said. “It's not just Catholics; evangelical Christians are also concerned. And [also] just sort of plain old folks who don't necessarily come from a religious position but are uncomfortable pushing on the natural boundaries of reproduction. People vary a lot in their level of comfort.”

There are couples who come to the clinics eager to have children but stop short of in vitro fertilization, she said.

“Some patients, to their great credit, really,” Davidson said, “after talking with the doctor or perhaps to me will decide, ‘Enough. I've done this, I've done that, and I'm not comfortable with the next step. We can do good things in the world and be a family whether or not we directly parent children.’”

Ellen Rossini writes from Richardson, Texas.

How the Church Views In Vitro Fertilization

The challenge of infertility drives many couples to seek whatever means possible to achieve the joy and promise of a child.

Not all means are moral, however, nor are all possible: Even after spending up to $10,000 per in vitro fertilization procedure, for example, 50% to 70% of couples still leave with empty arms.

For Catholics, the moral guidelines for assisted reproduction are contained in the document Donum Vitae (On Respect for Human Life), released by the Vatican's Congregation for the Doctrine of the Faith in 1987. In summary, any method used to enhance a couple's ability to conceive must ensure that a child be conceived in the context of the marital embrace, befitting his human dignity and the meaning of the marital act.

Additionally, it must be recognized that however desirous a couple may be for a child, the child is a gift, not a right, of marriage, said Conventual Franciscan Father Germain Kopaczynski of the National Catholic Bioethics Center in Boston.

Compatible with Catholic teaching are such measures as: Eobserving the natural signs of fertility and timing intercourse accordingly;

Emedical evaluations of both spouses;

Etests examining post-coital fluids; Eimaging techniques such as ultra-sound;

Eappropriate surgery to open the fallopian tube.

Other technologies are permitted for now but are the subject of theological debate. The question of how to evaluate new technologies was addressed by Cardinal Joseph Ratzinger, the Congregation for the Doctrine of the Faith's prefect, upon the release of Donum Vitae.

“When the discussion is still open and there is not yet a decision by the magisterium, the doctor is required to stay informed, according to classic theological principles and concrete circumstances,” he said. A physician must “make a decision based on his informed conscience.”

One of these controversial but for now allowed forms is gamete intra-fallopian transfer. According to “Reproductive Technology Guidelines for Catholic Couples” on the Web page of the U.S. Bishops’ Pro-Life Activities office, the technique works in this manner: Nearly ripe ova are obtained from the woman's follicles by ultrasonically guided aspiration techniques. But one ovum, separated with an air bubble from a prepared seminal fluid sample, is immediately reinserted with a plastic tubing into the woman's fallopian tube so conception will occur within the body. Sperm are retrieved by intercourse using a perforated condom, which allows retrieval while not preventing natural procreation.

Like in vitro fertilization, gamete intra-fallopian transfer can cost $6,000 to $10,000 per procedure, with a similar success rate.

Another method under study is intrauterine insemination, which uses semen obtained during normal intercourse that is then technologically enhanced or “washed” to improve fertility and injected into the uterus.

Some theologians consider gamete intra-fallopian transfer and intrauterine insemination to be merely assisting natural reproduction and therefore allowable. Others disagree, suggesting the technology, not the conjugal act, becomes the sufficient cause of the uniting of the sperm and ovum.

On the subject of infertility, the Catechism of the Catholic Church, quoting from Donum Vitae, has this to say: “The Gospel shows that physical sterility is not an absolute evil. 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. They can give expression to their generosity by adopting abandoned children or performing demanding services for others” (No. 2379).

— Ellen Rossini