Alive!

Alive! was dropped through my letterbox recently.

And as ever it’s a fascinating read. I’ve got to be honest, it doesn’t irritate me as much as some. In part because what some people believe doesn’t exercise me as long as it doesn’t impact negatively on me. Of course, that only takes one so far living in this state, but it does make for a somewhat more pleasurable reading experience.

Still no end of material to engage with. For example, Fr. Owen Gorman has a nice article about ‘helping childless couples’ and IVF. I’m always interested in this area, indeed I mentioned the impression a book I read last year about ART and related issues in comments here.

Fr. Owen has bad news though. Having run through the history of IVF from the first ‘test tube’ baby Louise Brown onwards he notes that ‘although the Church rejoices at the birth of every new child and welcomes him or her to the human family, it does not consider IVF morally good’. And worse… ‘many Catholics are not aware of the ways in which IVF seriously transgresses the moral law’.

He continues:

IVF presents us with a mixture of moral violations. First of all, the male semen used to fertilisethe female eggs is usually acquired through masturbation, a violation of sexual ethics.

Okay, way to go making new friends and influencing real living breathing human people…

But he goes on and notes that mixing sperm and eggs ‘in a glass petri dish to produce several embryonic human beings…violates the basic right of every human being to be conceived through the personal, one-flesh communion of their parents’.

And he concludes…

But by far the most serious violation of the moral law concerns what happens to the human embryos that are not implanted in the womb. They are discarded, frozen or handed over for scientific research. Thus a culture of death involving the killing and manipulation of human life is intrinsically part of IVF.

Again, none of this particularly irritates me. I’m a bit dubious about his line about the issue of embryos not implanted in the womb. As IVF technologies have improved the numbers produced have decreased. Moreover he should be aware that realistically – and dependent upon age and other criteria, the numbers of eggs produced from such procedures tend to be on the low side and if there’s an excess that’s unusual enough. Then there’s the issue about how fertilised eggs ‘naturally’ conceived don’t implant either. They too are ‘discarded’.

All this is, in fairness, his belief, and who am I to argue with that?

But the following does irritate me, at least a little bit.

He presents the following alternative.

…morally licit treatments that married couples can use in order to help them conceive a child. One such procedure is NAPRO.

NAPRO Is essentially the Catholic Church’s line on IVF made manifest. It isn’t IVF, but instead supposedly ‘natural’ investigations and processes to encourage fertility. Or as its proponents say themselves:

Natural procreative (NaPro) technology. NaPro technology was developed by obstetrician and gynecologist Thomas W. Hilgers in Omaha, Neb. Central to the technique is educating women and couples how to precisely monitor and chart female bodily “markers” that indicate fertility and fertility problems. This allows the NaPro technology practitioner to zero in on abnormal menstrual bleeding patterns, poor cervical mucus flow and subtle hormonal deficiencies that are often not detected by routine gynecological evaluation. Once the biological problem is identified, a precisely targeted solution can be undertaken.

This solution doesn’t involve the techniques that IVF does such as developing embryos and so on. Anyhow, Fr. Gorman argues that ‘it has an overall success rate of about 40%’.

This is very problematic. As a piece in the Washington Post noted in 2006…

Experts also question how “natural” … techniques are if they employ hormonal supplementation, and they criticize him for not publishing studies in medical journals so … methods can be evaluated independently.

Indeed the deficit of clear information about NAPRO is deeply troubling. One clear issue in the studies actually released by proponents of NAPRO is that they do not break down age, and other cohort information. This means that a clear means of assessing success rates or otherwise and contextualising them with IVF clinics is impossible.

And in both the UK, the US and elsewhere best practice is for IVF clinics to break down outcomes according to age of the woman. Indeed the US Centers for Disease Control and Prevention carries that data for all and any to see.

This isn’t a mere detail. For those facing infertility time is often, though not always, of the essence. But so is information. If NAPRO is treating cases of younger individuals with issues more amenable to less complex processes then it is possible that that skews their statistics. But without the hard data on those statistics other than broad general percentages one simply will not know. There are broader issues. Infertility is a symptom of many issues, many more than listed in the quote above. And NAPRO, per definition due to its aversion to various IVF techniques is simply unable to address that fact.

None of which is to say that NAPRO won’t work for some. It will for those in certain cohorts and there’s a clinic in Galway that offers it and as long as the information on what it can and cannot do is fully transparent that’s fine. But to suggest that it is a replacement for IVF is a stretch.