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 and Medical Management, femmhealth.org) pioneered by Dr. Pilar Vigil, or NaProTechnology (Natural Procreative Technology, see www.naprotechnology.com), led by Dr. Tom Hilgers, Both are Catholic ob/gyns with great track records in helping to resolve underlying 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.



- Father Tadeusz Pacholczyk, Ph.D. earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the diocese of Fall River and serves as the Director of Education at The National Catholic Bioethics Center in Philadelphia,