When Catholic couples expe­rience trouble getting pregnant, they often seek medical help and begin to research what options are avail­able to them. A number of moral considerations and questions gener­ally emerge during this process: Why are techniques like in vitro fer­tilization (IVF) considered immoral? What approaches will the Church allow us to try? What does our in­fertility mean, spiritually and per­sonally, in the face of our fervent but frustrated desire for a baby?

When a couple, after having non-contraceptive sexual inter­course for a year or more, begins to investigate whether there are issues related to infertility, some medical professionals simply encourage them to turn to the infertility in­dustry and try IVF or a related technique like artificial insemina­tion. These approaches, however, raise a host of moral concerns, in­cluding that they substitute an act of “production” for the act of marital self-giving, allow a third party outside the marriage to be­come the cause of the conception, often require masturbation, and may result in significant “collateral damage,” including embryo de­struction, embryo freezing and dis­ruptive effects on a woman’s physi­ology from the powerful super-ovulatory drugs used during the procedures. 

It can be helpful to keep in mind a particular “rule of thumb” for determining whether a proce­dure is morally acceptable: treat­ments that assist the marital act are permissible, while those that replace, or substitute for, the marital act raise serious moral objections. The ideal approach to resolving infertility involves iden­tifying the underlying causes (endometriosis? fallopian tube blockage? problems ovulating? etc.) and addressing those causes so that marital intercourse can now result in a conception. 

While this may seem sensi­ble and even obvious, many ob­stetricians and gynecologists to­day do not offer much more than a cursory workup or exam prior to recommending that the couple approach a fertility clinic and em­ploy their services to produce a baby via IVF. Couples ought in­stead to look into techniques that can methodically diagnose and heal the underlying reasons for infertility, like FEMM (Fertility Education & Medical Manage­ment,     https://femmhealth.org)

pioneered by Dr. Pilar Vigil, or NaProTechnology (Natural Procreative Technology, see  http://www.naprotechnology.com), led by Dr. Tom Hilgers. Both are Catholic ob/gyns with great track records in helping to resolve under-lying infertility issues and help­ing couples to conceive naturally. 

NaPro has been around a little longer and employs a range of ap­proaches which may include, for ex­ample, hormonal modulation of men­strual cycle irregularities; surgical cor­rection of fallopian tube damage or occlusions; fertility drugs to help a woman’s ovaries to release eggs; Via­gra or other approaches to address erectile dysfunction; correcting penile structural defects such as hypo­spadias; addressing premature ejacu­lation; using NFP (natural family planning) to observe naturally occur­ring signs of fertility during the woman’s cycle to time intercourse; using LTOT (low tubal ovum trans­fer), in which eggs are retrieved and transplanted into the uterus or fallo­pian tube at a point likely to result in fertilization following the marital act; and surgical resolution of endometri­osis. Dr. Hilgers has formed and trained a number of other physicians who work as independent NaPro­Technology specialists in the U.S. and abroad. FEMM is building a similar network. 

On the other hand, a number of other widely-available techniques, instead of assisting the marital act, end up replacing it with another kind of act altogether, namely, an act of “pro­ducing” or “manufacturing” children in laboratories. These techniques — like IVF; intracytoplasmic sperm in­jection (ICSI); artificial insemination; hiring a surrogate to carry a preg­nancy; and cloning — obviously raise serious moral objections. 

In some cases, a couple’s infer­tility will end up being irresolvable. Even as a husband and wife face the grief and sorrow of not being able naturally to conceive children of their own, they can still realize their pater­nal and maternal desires in other meaningful, fruitful and loving ways. For example, they may discern a call to adopt a child, providing a mom and a dad to someone whose parents have died or felt that they could not care for the child. They might decide to become a camp counselor or a schoolteacher, or provide temporary foster care to a child in crisis, gener­ously taking on an authentic parent­ing role. They may become a “Big Brother/Big Sister” to youth in the community who yearn for a father or mother figure in their lives. 

Although these solutions do not take away all the grief, they are a means by which God helps to draw good out of their situation. By these means, couples are challenged to “think outside the box” and enter into the mysterious designs of God within their marriage. By stepping away from a desire to conceive and raise biological children of their own, couples facing irresolvable infertility can discover new and unexpected paths to marital fruitfulness, paths that bring great blessings to others, and that can lead to abiding joy and marital fulfillment.

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