DIFFICULT MORAL QUESTIONS

Question 52: May an infertile married couple try tubal ovum transfer with sperm?

We have been married five years and have no children. The first two or three years, we were not concerned, but then we began seeking medical help. Wishing to follow the Church’s teaching, we have gone only to Catholic doctors. Our family doctor thought that NFP might solve our problem, and she taught us how to use it. After we had tried that unsuccessfully, the gynecologist my wife used to see thought in vitro fertilization might work for us, but we found out that the Church says it is wrong, and neither of us liked the idea very much anyway.

Now we have another doctor who has told us about something called “TOTS” (tubal ovum transfer with sperm), which is different from in vitro fertilization.¹⁹¹ Working through a very small opening in the wife’s abdomen, the doctor removes an ovum from the surface of her ovary. The couple have intercourse using a special kind of condom with a small hole in its tip; part of the semen is caught and part of it leaks into the vagina. (We did this once before to provide a semen sample for testing and were assured by a very solid priest that it is morally all right.) The doctor prepares the ovum and the semen, then puts them both into a thin tube with an air bubble between to keep them apart until they are injected into the wife’s fallopian tube, where, if all goes well, conception occurs just as it normally does.

We are not very enthusiastic about this either, but, unlike in vitro fertilization, it does not involve making several babies and then, perhaps, discarding or freezing some of them. The doctor tells us the Church has never said tubal ovum transfer is wrong and some theologians who support the Church’s teaching on contraception think there is no moral problem with it. What do you think?

Analysis:

This question calls for the derivation of a moral norm regarding TOTS. Since the ovum and semen used in TOTS do not pertain to any act of marital intercourse, this procedure, when successful, produces a baby by technology rather than contributes to a marital act’s fruitfulness. Whenever babies are produced by technology, they are intended by those who want them as means to parental fulfillment. Using technical means to assist the marital act’s natural fruitfulness is morally acceptable, but doing so to satisfy desire for a prospective child as a means to parental fulfillment vitiates any use of technical means.

The reply could be along the following lines:

You not only manifest your faith by your commitment to follow the Church’s teaching but conscientiousness by your readiness to question the moral acceptability of a procedure whose morality has not been addressed by Church teaching.¹⁹² Though you are not very enthusiastic about either IVF or TOTS, it is clear that no one has explained to you why IVF is wrong and how TOTS compares to it. Yet understanding these matters is essential to answering your question. Therefore, I will try to explain them and will begin by discussing the desire for children.

It is natural for people who marry to hope for children. The good of marriage is centered in one-flesh communion, whose natural basis is the exercise and fulfillment of the reproductive function (see LCL, 555–74). Hence, having a baby does fulfill the couple precisely as a married couple. Human instincts and feelings naturally and strongly favor this fulfillment, especially in the case of women, whose erotic inclination tends toward not only engaging in intercourse but nurturing a baby in the womb and at the breast. These emotions coalesce with the marital commitment, the husband’s and wife’s mutual willing of the good of marriage for themselves and each other. So, a married couple naturally and reasonably want children and hope for them as part of their own fulfillment precisely as a married couple.

There is no entitlement to children, however. Sometimes couples who find themselves infertile feel not merely disappointed and unfulfilled but actually cheated, as if they had a right to beget and bear offspring. Couples able to marry, have children, and bring them up no doubt have a right to do so in the sense that other people and communities, such as political society, should respect and support marriage and family life, not suppress or interfere with them. But fertility is a gift of God, who owes nothing to anyone. Since no one has a duty to provide married couples with children, they can have no right to have them.

Moreover, married couples’ natural desire for children can be partially fulfilled in other ways (see CCC, 1654, 2379). Adopting children and raising them exercise many of the couple’s specific capacities and fulfill them in many respects: the moral unity resulting from their mutual consent to marriage, their capacity to nurture and care for new human beings, and their cooperation with God in raising children for him. In other words, marriage as the fount of life is partially fulfilled by raising adopted children. But in one respect it is not fulfilled: No adopted child is precisely part of the fulfillment of marriage as a one-flesh unity, and the feeling motivating toward this fulfillment remains unsatisfied. Then, too, adoption may not be an option for some people. It may be impeded by the lack of a baby to adopt or other factors, or a couple may rightly judge that their negative feelings toward adopting would make it too risky for a prospective adopted child, and so rule it out. Still, every married couple can exercise their capacity for parenting by helping other parents in some way or by doing other things analogous to parenting, such as helping to care for retarded, handicapped, or elderly people who cannot care for themselves or need help in doing so.

Of course, some sterile couples will remain deeply dissatisfied. In general, however, there are many prospective goods for which we can act; and usually, having encountered a serious obstacle to accomplishing anything, we give up after a certain point—unless there is a strict obligation to press on—and start using our available resources of time, energy, and money in the pursuit of some other purpose with better prospects of success. Consequently, while it is understandable and right that couples with fertility problems make some effort to overcome them with medical help, it is hard to see any good reason for going to the great lengths that some do. In some cases it appears that the emotion involved is so strong that a couple become fixated on the goal of having a baby from their own flesh.

That fixation is morally questionable. The emotional focus is on having the prospective baby as a concrete state of affairs—a goal, a desired object. Volitionally, a baby may be sought to satisfy this intense emotional desire and to fulfill the married couple precisely insofar as that fulfillment is their own good. If so, the baby is not willed for his or her own sake, but as an instrumental good. This motivation is different from the normal case of a couple uprightly choosing to marry and have a family. They too, of course, can experience a strong desire to have a baby. But for such a couple, having and raising children are included in the benefits of marital fulfillment, and they hope for this whole, complex good of marriage as an end. Thus, the couple need not and usually do not seek a prospective child precisely as a goal instrumental to an ulterior benefit for themselves.

Your motivation in seeking to have a baby seems sound. Your dislike of IVF and TOTS may arise from a suspicion that both are used wrongly to satisfy a morally questionable desire for a baby. If so, I believe the suspicion is correct and points to the answer to your question: No couple entirely clearheaded about these methods could choose either with upright intentions. With both techniques, the baby is produced by technology to satisfy the couple’s desire, and his or her coming to be cannot fulfill their one-flesh unity since it is not the fruit of a marital act. That is obvious in IVF, where the ova are taken from the wife’s body, the semen obtained (even if from the husband) by masturbation, and the two combined in the laboratory. It is less obvious, but still the case, with TOTS.¹⁹³

Since with TOTS the ovum is taken from the wife’s body prior to intercourse, that act of intercourse could not fertilize it, and since the semen used to fertilize the ovum is the portion of the ejaculate that is intentionally gathered by the sheath, it could not pertain to marital intercourse, as did the ejaculate which, leaking into the vagina through the hole in the sheath, constituted their act as intercourse. The latter point can be further explained. If there were no hole in the sheath, no semen would reach the vagina, and so the act, not making the couple one flesh, would not be intercourse. The semen that is intentionally prevented from reaching the vagina obviously does not pertain to intercourse but is incidental to it.

Thus, a child’s coming to be by means of TOTS cannot fulfill the couple’s one-flesh unity, for that child is in biological continuity with his or her parents, not insofar as they are one flesh, but only insofar as they are two distinct sources of the elements used by the technician. Not being the fulfillment of the couple as a one-flesh unity, the baby’s coming to be cannot be willed by them as an aspect of their willing of that benefit, and so (assuming they clearly understand what they are doing) they cannot hope for the baby as a gift in hoping for fulfillment of their one-flesh unity. Rather, when a couple choose to use technology to produce a wanted baby, they seek his or her coming to be, not as part of their fulfillment as parents, but as a goal subordinated and merely instrumental to that fulfillment.

Someone might object that the couple, though acting to satisfy their desire to have a baby of their own, can hope for the child, not as instrumental to their own fulfillment, but as a great good, entirely separate and distinct from any fulfillment of themselves. But that is impossible. One always realizes oneself by acting, and so never acts without self-fulfillment in view. Therefore, one can love the good of another person only insofar as that good is not entirely separate and distinct from one’s own fulfillment but is joined with it in a common good. If the baby’s good were entirely separate and distinct, however, the couple and the child would have no good in common, and so the couple would have no reason to act for the child as an end in himself or herself.

The opponent might object: The adopted child can no more fulfill the couple’s one-flesh unity than the child conceived through TOTS; therefore, if the argument were sound, it would exclude not only TOTS but adoption. But adoptive parents can act with a common good in view: community with the already-existing child who needs parents. In seeking to produce a child by technical means, however, people cannot be acting for the sake of community with that child, since there is, as yet, no one with whom to initiate community. Hence, in seeking to produce a child, a couple must be acting for their own fulfillment as parents, and since the child to be produced is, as such, extrinsic to that, it is inevitable that he or she initially be sought as an instrumental good, not loved for his or her own sake.

Technical means sometimes are used, not to produce a baby, but to assist the marital act by removing obstacles to its fruitfulness, just as technique is used to assist other bodily functions when abnormal conditions interfere with them. In assessing the morality of technical assistance to the marital act, one must consider both the intrinsic character of what is done and the motives for doing it.

Assisting the marital act is not wrong in itself, so long as the couple engage in a genuine marital act that remains the real cause of the child’s conception. Instead of the actual procedure used in TOTS, suppose that after the couple engaged in a normal act of intercourse, the semen were taken from the vagina and/or the ovum from the ovary, and one or both elements, perhaps after treatment of some pathological condition or conditions, were moved to the fallopian tube where they could meet. Provided the intention motivating such procedures were precisely to assist the marital act, these steps would do that. Somewhat similar technical maneuvers, however, could violate rather than assist the marital act, if they were intended, for example, merely as a scientific experiment or as a way to delay conception by freezing the elements so that the couple might choose to have a child later.

Such complex procedures may or may not be possible. If they become available, couples still should examine their motives. Those who are not trying to produce a baby by technical means but are only using technique to assist marital intercourse, and even those who are engaging only in unassisted intercourse, may nevertheless be acting with the unsound motivation, inherent in IVF and TOTS, of wanting a child for their self-fulfillment. In times past, parents who did not love children for themselves sometimes wanted them merely as heirs to carry on the family line or as hands to work the land. Today, economic considerations are more likely to motivate contraception and abortion, but perhaps more people than in former times have other motives, such as the prospect of emotional gratification, for wanting a child without loving him or her as a distinct, unique person. All married couples who desire a child should examine their motives and criticize them, to ensure that they are not interested in the baby as one among the many things they consider necessary or helpful for their self-fulfillment. They should hope for a baby as a gift who, while making their love fruitful, will be loved for his or her own sake. Having intercourse with that hope in mind is not using the marital act as a means of producing a child.

191. The procedure described sometimes is called GIFT, but some people use GIFT to refer to a slightly different procedure; see Nicholas Tonti-Filippini, “‘Donum Vitae’ and Gamete Intra–Fallopian Tube Transfer,” Linacre Quarterly, 57:2 (May 1990): 68–89, not only for terminological clarifications but for a moral analysis of the procedure.

192. For discussion, see Donald G. McCarthy, “TOTS Is for Kids,” Ethics and Medics, 13:12 (Dec. 1988): 1–2; Donald T. DeMarco, “Catholic Moral Teaching and TOT/GIFT,” in Reproductive Technologies, Marriage and the Church, ed. Donald G. McCarthy (Braintree, Mass.: The Pope John Center, 1988), 122–39; Donald G. McCarthy, “Response,” in the same book, 140–45; John M. Haas, “Gift? No!” Ethics and Medics, 18:9 (Sept. 1993): 1–3; Donald G. McCarthy, “Gift? Yes!” in the same issue, 3–4.

193. Though I think my position on TOTS is not only true but implied by what the Church already teaches about IVF, Catholics who think the matter through, conclude that TOTS is morally acceptable, and act on that judgment do not thereby violate anything the Church expressly teaches (as of Jan. 1997). In my judgment, the procedure usually called GIFT, if distinct from TOTS, is morally objectionable for the same reasons as TOTS and perhaps for other reasons too; see Benedict M. Ashley, O.P., and Kevin D. O’Rourke, O.P., Healthcare Ethics: A Theological Analysis, 3rd ed. (St. Louis: Catholic Health Association of the United States, 1989), 284–86. IVF, of course, also is gravely immoral inasmuch as “spare” embryos are discarded, frozen, or used for experimentation.