Frequently Asked Questions about Infertility, Treatments, and the Church

Answers to the following questions were adapted from Faith and Fertility by Lisa Everett which has received an Imprimatur in 2007 from Bishop John M. D’Arcy of the Diocese of Fort Wayne-South Bend.


(click here for an alternate accordion panel version)

What is the Catholic Church’s view on marriage, sexuality, and procreation?


God is love.  He is a communion of persons who lives in a mystery of love as Father, Son and Spirit. In this communion of persons, God the Father is the lover, God the Son is the beloved, and the love between them is so real that it is actually another person—the Holy Spirit.  Created in the image and likeness of God – Father, Son and Holy Spirit - man and woman have been given a rational mind and a free will capable of knowing what is good and choosing it. But what is more, man and woman also, in a sense, become the image of God by living with and for each other in the vocation of marriage.


Sexual intercourse is intended by God to be the most intimate sign of the mutual gift of self which marriage is called to be.  A husband and wife say with their bodies in a very private way what they said publicly at the altar on their wedding day: “I accept you completely as the gift from God that you are, and I give myself to you completely in return.” Sex is the body language of married love and is not meant to end with the couple, but rather, makes them capable of the greatest possible gift: becoming co-creators with God.  The communion of love between a husband and wife is meant to mirror the love that exists between the Father and the Son, a love which is literally “personified” in the Holy Spirit.  God enables the love between a husband and wife to become “personified” in the gift of their child, who is literally the two of them in one flesh, a living reflection of their love and a permanent sign of their unity.


The love-giving and life-giving meanings of sexual union are intimately linked, like two sides of the same coin, because they mirror the inner life of God who is love.



How does the Catholic Church understand the gift of fertility?


Good stewardship of the gift of fertility is what the Church calls “responsible parenthood.” It requires, first, that we understand the gift of fertility and the biological laws which govern it.  Second, responsible parenthood means making sure that our reason and will are what ultimately guide us in making use of the gift of fertility rather than our instincts and feelings.  Finally, good stewardship of the gift of fertility calls married couples to “a responsible and generous openness to life,” as Pope John Paul II emphasized. In discerning God’s will for the growth of their family, spouses should consider their own good as a couple, the good of the children already born or those foreseen, the good of society and the good of the Church.



Why does the Catholic Church promote Natural Family Planning?


Sexual relations are meant to signify the mutual gift of self that marriage is supposed to be. That is why the Church has traditionally referred to sexual intercourse as “the marital act.”  The marital act is meant to be a renewal of their marriage covenant.  And this very act which expresses their mutual gift of self also makes them capable of receiving from God the greatest possible gift: a new human being.


Out of deep reverence for the way in which God has designed sexual relations, the Church teaches that “each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life” (Humanae vitae #11). Because God has created, in sexual intercourse, an inseparable connection between its capacity to give life and love, married couples must respect the integrity of the marital act whenever they choose to engage in it.


This means that because God has created in sexual intercourse an inseparable connection between its love-giving capacity and its life-giving capacity, married couples must respect the integrity of this act whenever they choose to engage in it.



What is Natural Family Planning?


Natural family planning (NFP) is a term for methods of family planning that respect the inseparable connection between sexual intercourse’s capacity to give love and to give life. Based on daily observation of the natural signs of fertility and infertility which occur in a woman’s body, modern methods of NFP differ significantly from the outdated “rhythm method,” which relied on prediction of a woman’s fertile period based on past menstrual cycles. NFP enables a couple to identify the days when conception is most likely should they desire to conceive a child. This same knowledge also enables a couple to refrain from sexual relations on the days when conception is possible should they desire to avoid a pregnancy. In this regard, international studies confirm that when spouses are properly instructed and follow the rules carefully, NFP can have an effectiveness rate of 98-99%.


The Church promotes NFP because it provides married couples with a concrete way to practice responsible parenthood. First, it gives them a thorough understanding of their combined fertility and enables them to monitor it on a daily basis. Secondly, NFP engages those human faculties that make us most like God – our reason and our will – over sexual passion in service of good stewardship of our fertility. Thirdly, the practice of NFP encourages couples to discern on a regular basis whether or not God is calling them to conceive a child and to use their knowledge of their combined fertility either to achieve or avoid a pregnancy. Every month, in a sense, the question comes up: are we going to use the fertile period of this cycle to try to conceive a child, or do we have a proportionately serious reason to postpone a pregnancy at this point in our married life?



Why does the Catholic Church teach that a child is a “gift” not a “right”?


While marriage gives spouses the right to express their love for each other through the language of the body, we do not have a “right” to a child. A child is, rather, a gift from God that flows from and is the fruit of the mutual gift of self in marriage.


“A true and proper right to a child would be contrary to the child’s dignity and nature. The child is not an object to which one has a right, nor can he be considered as an object of ownership: rather, a child is a gift, ‘the supreme gift’ and the most gratuitous gift of marriage, and is a living testimony of the mutual giving of his parents. For this reason, the child has the be the fruit of the specific act of the conjugal love of his parents, and he also has the right to be respected as a person from the moment of his conception” (# 8, Donum vitae)


This paragraph begins by affirming that a child is not a right and ends by affirming the rights of the child. The first of these rights is the right to be conceived through an act of sexual love between his or her parents.  The only place worthy of passing on the priceless gift of life is the mutual love of husband and wife expressed in the marriage act.


“We have learned that a child is a gift and that each human life, no matter how short its days, is inestimably valuable.  Before our struggle with infertility, we felt that a child is somewhat ‘owed’ to a couple, but this struggle has taught us that each human life is an invaluable gift from God.”  -Michael and Danielle


The love-giving and life-giving meanings of sex are intimately linked because they image the inner life of the Trinity - the love between the Father and the Son is literally personified in the Holy Spirit. God designed sex so that the moment in which the two become one flesh is the means by which the two become one flesh in the person of their child.  That act which expresses the mutual gift of self between husband and wife is the way in which God wants to give the gift of a child.



What does the Catholic Church teach about children who have been conceived as a result of artificial reproductive technologies?


A child conceived outside the setting of the sexual union of spouses is still a priceless gift from God. This brings us to the second right of the child affirmed in Donum vitae:


“A true and proper right to a child would be contrary to the child’s dignity and nature. The child is not an object to which one has a right, nor can he be considered as an object of ownership: rather, a child is a gift, ‘the supreme gift’ and the most gratuitous gift of marriage, and is a living testimony of the mutual giving of his parents. For this reason, the child has the be the fruit of the specific act of the conjugal love of his parents, and he also has the right to be respected as a person from the moment of his conception” (# 8).


Regardless of the way in which a pregnancy is achieved, every child is still a priceless gift, created in God’s image and likeness, and has the right to be respected as such from the moment of his conception.



How does the Catholic Church determine if a scientific technology is an acceptable and moral treatment for infertility?


Technologies which assist sexual union between spouses to achieve conception are acceptable, while technologies which substitute for sexual union are not. Donum vitae describes the difference in these words: “If the technical means facilitates the conjugal act or helps it to reach its natural objective, it can be morally acceptable. If, on the other hand, the procedure were to replace the conjugal act, it is morally illicit” (#6).


The dignity of a child demands that he or she be given life through a personal act that expresses the total self-giving of his or her parents. Medical interventions which assist marital intercourse to achieve conception are morally good, while reproductive technologies which replace or substitute for marital relations are morally wrong.



Why does the Catholic Church teach that in vitro fertilization is not a morally acceptable method for treating infertility?


In vitro fertilization (IVF) fails to be a morally acceptable method for treating infertility because it achieves conception by having technicians join sperm and ova in a laboratory petri dish, rather than through the loving, sexual embrace of husband and wife. The Catechism of the Catholic Church spells out why this widely used reproductive technology is seriously wrong, even more so when it relies on donor sperm or ova:


 “Techniques that entail the dissociation of husband and wife, by the intrusion of a person other than the couple (donation of sperm or ovum, surrogate uterus), are gravely immoral. These techniques (heterologous artificial insemination and fertilization) infringe the child’s right to be born of a father and mother known to him and bound to each other by marriage. They betray the spouses’ right to become a father and a mother only through each other. Techniques involving only the married couple (homologous artificial insemination and fertilization) are perhaps less reprehensible, yet remain morally unacceptable. They dissociate the sexual act from the procreative act. The act which brings the child into existence is no longer an act by which two persons give themselves to one another.” (# 2376-2377).


“Most OBGYNs we sought help from told us, without ever diagnosing why we were struggling with infertility, that in vitro or artificial insemination were our best choices.  So, we took this to prayer, too, and made a promise to each other to keep the faith and not go down these other roads.  I knew these alternatives were against the teaching of our Church, but I didn’t really know why, so I broke out the catechism and started reading.  My research led me to fall more deeply in love with my faith and my spouse.”  - Dianna


The way in which IVF is often carried out in fertility clinics adds to the moral evil involved. First, semen from the man is usually obtained through an act of masturbation, which remains morally wrong even when done for the purpose of procreation. The only morally acceptable way to obtain a semen sample for the purpose of evaluating or treating infertility is to use a non-lubricated, perforated condom during a normal act of intercourse. This procedure maintains the procreative potential of marital relations while retaining some seminal fluid for the purpose of analysis.


Secondly, the practice of IVF commonly involves the creation of “spare” embryos which are subsequently examined to determine which seem the “best.” Those embryos that are deemed “substandard” are typically destroyed, while those that seem healthy are either donated or frozen for future use. Typically two to four embryos are implanted in the woman’s womb to increase the chances of producing a successful pregnancy. If more than one embryo thrives and a multiple pregnancy results, some clinics then offer “selective reduction,” a euphemism for aborting however many “excess” embryos the couple desires to do away with.


When human beings play God and begin to dispense life, they can just as readily begin to dispense death. The document Donum vitae described it like this: “The connection between in vitro fertilization and the voluntary destruction of human embryos occurs too often. This is significant: through these procedures, with apparently contrary purposes, life and death are subjected to the decision of man, who thus sets himself up as the giver of life and death by decree.”



What does the Catholic Church teach about Gamete Intra-Fallopian Transfer (GIFT)?


While IVF is by far the most commonly used “assisted reproductive technology” (ART) today, an earlier and simpler procedure called GIFT was developed in the 1980s. GIFT is an acronym which stands for Gamete Intra-Fallopian Transfer. It requires at least one Fallopian tube that is not obstructed on the part of the woman. The procedure involves obtaining nearly ripe ova from the woman through needle aspiration and a sample of semen that is obtained during normal marital relations with the help of a perforated condom. The prepared semen sample and one or more ova are placed in plastic tubing, but separated by an air bubble to prevent conception. The contents of the tubing are then immediately inserted into the woman’s Fallopian tube so that conception can take place inside her body.


While the Church has clearly condemned in vitro fertilization, it has not formally passed judgment on the GIFT procedure. However, many Catholic moral theologians, including ethicists from the National Catholic Bioethics Center, have serious reservations. They argue that even though GIFT joins sperm and ova in the woman’s body rather than a petri dish, conception is really the result of a technical procedure rather than the marital relations which preceded it. In the absence of a definitive judgment by the Church, it is up to local bishops whether to permit the GIFT procedure in Catholic health care facilities and up to married couples whether to pursue it.



What is NaProTECHNOLOGY and the Creighton Model FertilityCare System?


Creighton Model FertilityCare System (CrMS) is a very standardized method of Natural Family Planning which was developed and researched by Dr. Thomas Hilgers at the Pope Paul VI Institute in Omaha, Nebraska.  CrMS uses mucus-only observations to determine days of fertility and infertility.  It is a very effective method of natural family planning.  For couples wishing to avoid a pregnancy, it has a method effectiveness of 99.5%.  For those wishing to achieve a pregnancy, 100% of couples of normal fertility can expect to conceive within six months.


The very specific observations and charting of the CrMS allowed for the development of certain “biomarkers” of the fertility cycle, such as the length of the cycle, the quantity and quality of the mucus cycle, bleeding patterns and the length of the pre- and post-ovulation phases.  Abnormalities in these biomarkers are predictive of certain disorders of the fertility cycle:  hormone imbalances, progesterone deficiency, infections, ovulation disorders, risk for miscarriage, infertility, PMS and other abnormalities and disorders.


“We began learning the Creighton method of NFP and also started working with a NaPro doctor.  Something that was particularly refreshing about this experience is that these professionals were not only interested in helping us achieve a pregnancy, but they also wanted to help me be as holistically healthy as possible.  It was so nice to have a doctor actually listen to my concerns and take them seriously.”  -Theresa


Using the observations from the CrMS, specifically-trained physicians use NaProTECHNOLOGY to identify the underlying causes of the reproductive abnormalities or disorders specifically-targeted hormonal and ultrasound evaluations and then provide medical and surgical treatments that cooperate completely with the reproductive system.



Is NaProTECHNOLOGY a morally acceptable method for treating infertility?


Yes.  NaProTECHNOLOGY aims to identify and correct the underlying causes of infertility and utilizes therapies that cooperate with the natural reproductive cycle.  They are safe, well-tolerated, very effective and are fully in unison with the teachings of the Catholic Church.



What is the success rate for couples who use NaProTECHNOLOGY?


NaProTECHNOLOGY is able to implement targeted hormonal, ultrasound and surgical techniques to precisely identify and treat the cause of infertility using couple-specific treatment protocols.  When all causes of infertility are included, success rates of NaProTECHNOLOGY are near 80%.  In comparison, according to the 2001 “Assisted Reproductive Technology Success Rates” report from the Center for Diseas Control, the success rate for IVF is about 23%


Furthermore, in 2001 there were 40,687 babies born as a result of IVF.  However, to achieve this number of births, 273,369 embryos were transferred and lost in the process.  This yields an embryo-to-live birth ration of 6.72 to 1.  Unlike IVF, NaProTECHNOLOGY does not create life  by the destruction or selective reduction of other embryos.



What is the Catholic Church’s response to couples experiencing infertility?


The desire to have a child that is “flesh of one’s flesh” is written deeply into the souls of most spouses, and the realization that this dream may never come true is understandably a source of real grief for many couples. The document Donum vitae gives voice to this grief and calls on the Christian community to support couples in this situation:


“The suffering of spouses who cannot have children ... is a suffering that everyone must understand and properly evaluate.... Whatever its cause or prognosis, sterility is certainly a difficult trial. The community of believers is called to shed light upon and support the suffering of those who are unable to fulfill their legitimate aspiration to motherhood and fatherhood” (#8).


An essential, but sometimes forgotten, truth of our faith is that the suffering we experience in this life can be joined to the suffering of Christ for the good of others.  This can be a lifeline for couples who carry the cross of infertility.  Infertility may be an opportunity for “sharing in a particular way the Lord’s cross, the source of spiritual fruitfulness.” (Donum Vitae 8)  The heart of Christ was a pierced heart.  Our faith assures us that no suffering needs to be wasted or pointless – if we offer it to Christ he can join it to his own and make it bear fruit beyond what we can imagine.


“It was through the acceptance of the infertility that I began to piece together all of the little lessons that God had been offering me along the way:  ‘Theresa, I was able to bring eternal, abundant life to the world through my death, trust me that I can bear fruit through your barrenness!’” – Theresa


“Now you are sad, but I will see you again, and your hearts will be filled with gladness, the kind of gladness that no one can take away from you”  John 16:22



What does the Catholic Church propose for those who cannot conceive a child?


For couples who suffer from infertility, marriage retains its full value as a vocation even when procreation is not possible. The mutual gift of self of a man and woman to each other for life is what makes a marriage, not a couples’ ability to have children. Their mutual gift of self is meant to be fruitful, but it might not be in the way that most marriages are.


While many couples naturally feel called to adopt children, the scope for service to the human person that might be considered is vast. In his 1994 Letter to Families, Pope John Paul II suggested that the traditional works of mercy contained in Matthew’s description of the Last Judgment could be broadened to include other situations which contemporary families and children face:


“‘Come, O blessed of my Father ... for I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me’ (Mt 25:34-36). This list could, of course, be lengthened, and countless other problems relevant to married and family life could be added. There we might very well find statements like: ‘I was an unborn child, and you welcomed me by letting me be born’; ‘I was an abandoned child, and you became my family’; ‘I was an orphan, and you adopted me and raised me as one of your own children’. Or again: ‘You helped mothers filled with uncertainty and exposed to wrongful pressure to welcome their unborn child and let it be born’; and ‘You helped large families and families in difficulty to look after and educate the children God gave them’. We could continue with a long and detailed list, including all those kinds of true moral and human good in which love is expressed. This is the great harvest which the Redeemer of the world, to whom the Father has entrusted judgment, will come to reap” (#22).


Whether by adopting children, becoming teachers, coaches, mentors or missionaries, or by whatever path God leads them, married couples who cannot have children of their own enrich the lives of others in lasting ways. In giving of themselves for the good of others, especially those who are young, they witness in a powerful way to the spiritual parenthood to which all married couples are called, and in this way “will come particularly close to God when the spiritual parenthood of which God is the prototype, takes shape in them” (Pope John Paul II, Love and Responsibility, p.261).


“We really thought about our situation and asked the most important question:  Did we want a pregnancy or did we want a baby in our arms and in our lives?  After some careful conversation, we concluded that what we really wanted was a child to raise.  So we placed this cross back in God’s arms and prayed and prayed for a child – whether it was a birth child or an adopted child was up to God.”  -Don and Mary Kay


“Does love know any other way than to open the door eagerly?  We would love to adopt.  Perhaps we may even be convinced to become foster parents.  We don’t want to be heroes; we know we have limits.  But we have become more familiar with unexpected strangers; we have learned a little of what can happen to “some people”, and feel our hearts opening bit by bit to those who may not be welcome where they are.  Please pray for us that these hearts might remain open when He knocks again!”  - Austin


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