In the following dialogue, Mary and Charles represent a composite of my patients who have struggled with infertility. Many couples never have money or consistent insurance coverage to pursue an infertility evaluation. However, after years of saving, they finally sit down to conduct research on in vitro fertilization on the internet. Then, they come to ask questions. The following represents a typical conversation:
MARY: We have some questions about IVF, which my OB doctor has recommended us looking into due to my infertility issues.
CHARLES: You know we are both believers. There seem to be some issues with IVF that concern us. Can you give us some insight on where to avoid violating our Christian convictions? All of this is so new and confusing to us.
DR. JACKSON: It’s still new and confusing even to many doctors. The technology is advancing so rapidly. Basically, IVF is a medical process designed to overcome infertility and produce a pregnancy wherein the ovaries are stimulated by hormones and eggs are aspirated from ovarian follicles. These eggs are fertilized in the laboratory (in vitro), after which one or more embryos are transferred into the uterine cavity. This takes about two weeks and is called an “IVF cycle.” Does all that make sense so far?
(Mary and Charles nod.)
DR. JACKSON: There are no moral or ethical issues with ovarian stimulation or oocyte (egg) gathering or fertilization of the eggs. Nothing in these three phases would violate the right to life or the personhood of the fertilized egg, which equates to a brand-new human being. The first ethical consideration arises prior to the next phase: uterine transfer. Many infertility specialists will practice (with their patients’ consent) embryo selection, which involves selecting out embryos (babies) with genetic issues to be discarded. More than that, some parents will specify a certain sex for their child in advance. If the embryo (baby) doesn’t match the desired sex, it may be aborted. In that scenario, only healthy embryos and desired sex embryos are transported into the uterus. Again, undesirable (wrong sex and unhealthy embryos) are discarded, killing an unborn human being, although that unborn baby has not been placed in the mother’s womb.
MARY: Does location matter? The embryo is still a human being with 46 chromosomes, right?
DR. JACKSON: (I can’t help but smile.) Yes, ma’am. Your understanding of embryologic development is right on. I sometimes wonder why some doctors, lawyers and judges can’t see what you so clearly understand.
CHARLES: So, if we see an infertility specialist and pursue IVF, we will need to specify that all fertilized eggs should be implanted regardless of their health or sex?
DR. JACKSON: Yes, sir, you would. In order to avoid violating your conscience and the right to life of the baby (the embryo), you would need to have that discussion with the specialist in advance.
MARY: What if he tells me the embryo has a genetic problem?
DR. JACKSON: Let me answer that with a question. What if you conceived naturally and the doctor informed you at 20 weeks that your baby had a health issue? What would you do?
MARY: We’ve already had this discussion, Dr. Jackson. We would have the baby regardless of its health issue and take care of the baby as a gift from God.
(I just stare at them until the light turns on.)
MARY: Oh, I see. This would be the same situation, only we would know much sooner. (She looks at Charles.) That settles that.
CHARLES: What other ethical issues do we need to know about?
DR. JACKSON: To increase the odds of success, the infertility specialist will place multiple embryos inside the mother’s womb. If all of the embryos implant and prosper, which would then lead to multiple gestation (twins or triplets), the doctor will perform a fetal reduction (abortion) on one or more of the embryos to increase the odds of the remaining embryos surviving.
MARY: Oh, my goodness. You mean that after all that effort, they would kill those little babies in the mother’s womb?
DR. JACKSON: Precisely.
(Mary looks quite troubled for a moment.)
MARY: Two of my girlfriends went to an IVF clinic out of state. After the transfer of embryos, they were both called back on the same day for a “procedure” that wasn’t clearly defined for them. They were just told it was “protocol.” They had an ultrasound and a procedure. (By now, Mary has tears streaming down her face.) Do you think they unwittingly had a fetal reduction?
DR. JACKSON: Mary, I wasn’t there, so I cannot say for certain. However, based on what I know, the odds are pretty good that is what happened. They probably were not informed.
MARY: Oh, my! They both go to church with me. One of them volunteers at a crisis pregnancy center. (She just stares off into space.)
CHARLES: How do we prevent that from happening to us?
DR. JACKSON: You would need to have a clear understanding in writing with your specialist that he would not introduce more embryos than you, Mary, are willing to risk carrying to term. You must also make plain you will not be complicit in any fetal reduction procedure because that violates your sincerely held convictions. You will have to accept a diminished likelihood of success, since you will be agreeing to the transfer of only one or two embryos in order to honor your convictions and maintain a clear conscience.
CHARLES: Dr. Jackson, this is more than we were anticipating. Do you mind if we go home and think about it for a few days?
DR. JACKSON: Sure, I’ll be happy to answer any further questions at any time.
— Robert Jackson is an author and family practice physician in Spartanburg.