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Can You Do IVF “Ethically?”
Laura Elm, M.B.A. | 08 October 2020
Sacred Heart Guardians and Shelter (SHG) is an organization whose mission is to bury the embryonic human beings who die in IVF labs. When I founded SHG in 2017, I went into it with two pretty big misperceptions: 1) IVF centers would be happy SHG provided burial for arrested or discarded embryos so they wouldn’t have to throw them away as medical waste, and 2) someone who opposes abortion will also oppose IVF.
I also went into this mission with precisely zero experience in right-to-life activism. As I am slowly feeling my way around (still), I’ve found it very helpful to network with experienced pro-life leaders - people whose courage and tenacity I admire tremendously.
I’ve also found right-to-life groups focused on beginning of life issues state abortion as their primary target, followed perhaps by embryo-destructive stem cell research. Surrogacy and human cloning occasionally make the list. IVF (as a “treatment” for infertility) rarely does. Even though, IVF annually accounts for the spontaneous death or deliberate destruction of hundreds of thousands of embryonic human beings, in the United States; as well as an unknown number of small, living human beings who are dehydrated, vitrified, and inventoried under embryology lab counters and in warehouse parks. I know there are limits to resources and capacity. However, I still wonder why fervent pro-life groups seem hesitant to declare IVF as a dehumanizing and dangerous practice per its impact on the youngest, most vulnerable human beings.
So a month or so ago, when Laura Klassen (Founder and Director of Canadian-based Choice42, an anti-abortion organization) asked followers to weigh in on the highly-charged topic of IVF in response to a pro-choicer’s post (see picture), I was really interested to see what people had to say.
I read and re-read the comments in an attempt to pull out key themes to try to better understand why someone who is ardently pro-life would accept, tolerate, or even celebrate IVF.
Ms. Klassen poses the issue to her community. “…Let’s talk IVF.” … “What do you guys think? Is this right? Have we gone too far with science? I know that this is a very touchy topic...”
Several interesting themes and threads developed in the 700+ comments, including a debate about when human life begins; the heartbreak of infertility; similarities and differences between abortion and IVF; Catholic moral instruction; adoption (embryo and live-born), God’s gift of human intellect and scientific discovery, Biblical references; and gratitude for one’s own IVF-conceived child, grandchild, nephew, etc.
Any one of these themes would be interesting to develop and analyze, but one, in particular, showed up again and again, and I wanted to explore it here:
“I’m Pro-Life and I’m Pro-IVF….so long as it’s used ethically.”
Before going further, as a person trying to live a faithfully Catholic life, I need to share why the Catholic Church opposes IVF, even if it were designed and delivered “ethically:”
IVF “entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children.”1
Instruction on Respect for Human Life (). Congregation for the Doctrine of the Faith. 1987.
Moving back to the hypothesis of “ethically-designed IVF,” how would that be achieved? Who would decide what is ethical and what isn’t? I went back through the discussions and pulled out the elements that people thought would need to be addressed to create an “ethical” path forward for IVF.
Per the comments, IVF could perhaps be ok if:
Embryos are not created for the purpose of embryo-destructive stem cell research
No “donated” eggs or sperm are used
No discard of embryos based on lab grade
No discard of embryos based on preimplantation genetic diagnosis, testing, or screening
No discard of embryos based on sex
No cryopreservation of embryos
If cryopreservation is permitted, no thawing of embryos for the purpose of “donating” to research
Embryos cannot be adopted, not “donated.”
No IVF for single parents
No IVF for same-sex couples
No surrogacy (altruistic or compensated)
No selective reduction
One of the more salient proposals was, “if a couple controls the number of eggs fertilized and intends to transfer all of the embryos created, then I think it (IVF) can be ethical.” This approach limits how many embryos are created, rejects preferential selection of the embryos based on observation or testing, and eliminates the risk cryopreservation imposes to the embryo’s life at freeze or thaw as well as to the potential for him or her being discarded or abandoned in frozen storage.
But is this even possible?
Ethics vs. Efficiency When IVF is a Covered Benefit
IVF is expensive. One round of IVF typically costs between $12,000-$15,000; additional services like preimplantation genetic diagnosis, testing, or screening can add considerably to the total cost. RESOLVE: The National Infertility Association, together with the American Society of Reproductive Medicine (ASRM), lobby for mandated IVF coverage at both the state and federal levels, stating that “cost is a key barrier to adoption and medical treatment for infertility” and that “lack of insurance coverage for infertility medical treatments is a major barrier to family building for Americans today.” Their lobbying is successful. Many states now require IVF coverage by fully-insured plans and those states that don't likely have a proposed bill in the works. Large, self-insured employers often cover IVF already, as it is a valuable recruitment and retention tool for their human capital.
But the cost of IVF doesn’t go away when insurance covers it. IVF-related medical expenses are spread across the plan’s membership, and premiums may adjust based on the utilization of the benefit and the plan's membership size. In a competitive market, members may shop elsewhere if they find that their plan's rates increase relative to other available options. If an IVF benefit is added, the entity ultimately responsible for the medical expenses – the insurance company or the self-funded employer – will necessarily put controls in place so that IVF is delivered in efficient, affordable ways while yielding the best efficacy (babies).
The same entity that offers an IVF covered benefit is also responsible for obstetrics, delivery, and NICU medical expenses. A significant cost driver for all of these is multiple pregnancies and births. A 2010 study published in the American Journal of Obstetrics and Gynecology stated that the average adjusted total all-cause health care cost was $21,458 per delivery with singletons, $104,831 with twins, and $407,199 with triplets or more.2 Based on data like this, the insurance company would be highly motivated to impose limits on the number of embryos transferred or potentially create pressure for selective fetal reduction later on.
Restricting the number of embryos transferred per cycle is also a population health issue. The Center for Disease Control’s patient education sheet, Having Healthy Babies One at a Time, shares concern about even twin pregnancies: “Twin pregnancy is risky for baby and mother, whether or not IVF is used.”3
Once considered elective, single embryo transfer is now the standard of care. According to reproductive endocrinologist Dr. Serena Chen MD, this is due to three main reasons: 1) “we are much better at freezing (embryos)," 2) we are "a lot better at growing embryos in the lab," and 3) "a lot of people are making use of preimplantation genetic testing."4 If single embryo transfer is the norm, then there is motivation to select the embryo deemed most likely to implant (good grade, no disease or chromosomal abnormalities), and having a bigger pool from which to choose is most certainly a benefit to the lab.
To carry out “ethical IVF” where no embryos are put in cryopreservation, some in this post proposed an IVF design by which eggs, rather than embryos, were frozen. Each egg could be warmed, fertilized, incubated, and transferred, thereby giving each conceived human being the very best chance to continue living. If fertilization were unsuccessful, the next egg would be thawed, fertilized, and so on.
This scenario is highly unlikely as many IVF centers operate on a fixed schedule to deploy economies of scale. Retrievals, fresh transfers, and frozen transfers may only occur at certain points in the month, or perhaps even during a calendar quarter. Breaking this schedule to do a type of made-to-order IVF process would incur higher costs and likely lower pregnancy rates than the typical batch processing approach. A rise in costs and a drop in efficacy could increase the insurance company’s management of the clinic through vehicles like utilization management, prior authorization requirements, reduced reimbursement rates, or possibly network exclusion. In all likelihood, the insurance company, the clinic, or both would reject this request for “ethical IVF design.”
“Ethical IVF” and the Cash-Paying Patient
Even if a prospective patient is willing and able to pay cash, and insurance company oversight is not a direct factor, their cycle's outcomes factor into the clinic's overall, publicly reported, success measures. It's entirely possible, if not predictable that an "ethical IVF" design would result in higher twin rates and lower pregnancy-per-cycle-started rates. Given the competitive nature of the IVF market and the role of success measures in insurance network status, the clinic is likely to reject this request.
Consider the IVF financing industry, which offers loans, multi-cycle packages, and refund programs, seems to generally base their financial models on a 30% success rate per fresh cycle started.5 These are difficult odds against a $15,000 fee. There is no doubt that many people who would otherwise approach IVF as ethically as possible would succumb to financial and emotional stress and allow practices like genetic testing or cryopreservation to be done.
If “Ethical IVF” is An Illusion, Help Others to Avoid the Near Occasion to Sin
We pray as the Lord taught us to not be led into temptation but to be delivered from evil. But when IVF seems like the only option for people who desperately want to have a child to love and raise, and so many people champion it as good, how difficult it becomes to live this prayer and see the truth. With love, goodwill, and compassion, we must protect those who suffer under the heavy cross of infertility from engaging in this practice, as we know that there is only the slimmest of chances that they can realize their good intentions.