There are, however, forms of infertility that cannot be cured. At this point, people tend to adopt one of two attitudes: either they accept this reality and turn toward other forms of parental love, among which adoption is the most noble, or they refuse to accept the limitations of nature and pursue, by any available means, the fulfillment of their desire to “have” a biological child.

Modern medicine responds to this desire to “possess” a child by offering techniques of artificial reproduction (commonly known as assisted reproductive technologies), the most widely recognized of which is in vitro fertilization (IVF). Unfortunately, most people have only a vague understanding of the detailed course of the IVF process, the successive stages of human development in the prenatal period, or the earliest days of pregnancy. Our lack of knowledge, indifference, and ignorance of basic medical and embryological facts can lead to acceptance of eugenic practices and to a growing loss of respect for human life and dignity. In assisted reproduction, the role of deciding about the life or death of a conceived child (or children) is assumed by the physician, who becomes, in effect, the one who “produces” a new human organism according to the parents’ “order.” The use of donor egg and sperm banks, as well as the services of so-called surrogate mothers, is becoming increasingly common – all in the name of “having one’s own child” and of a supposed “right to a child.” Although parents may perceive the outcome of these procedures as beautiful, because it is the conception of a child, one must remember that the means used to achieve this goal are morally questionable and cannot remain indifferent to either conscience or reason.

In the in vitro fertilization procedure (IVF-ET, i.e., in vitro fertilisation and embryo transfer), artificial intervention is required at the following stages of the process leading to fertilization:

• Stimulation of follicle growth and maturation and induction of ovulation in the woman – to obtain multiple oocytes in a single cycle, controlled ovarian hyperstimulation is used. Hormonal drugs stimulate the development of several to a dozen ovarian follicles. In one stimulation cycle, the ovaries are therefore forced to perform work that would normally take several months or even a year to complete.
• Retrieval of oocytes from the woman – the eggs are collected by puncturing the ovaries under ultrasound guidance using a transvaginal probe.
• Collection of sperm from the man – this is done by masturbation; in cases of very low sperm count, sperm are obtained directly from the testes by needle aspiration.
• Sperm preparation (capacitation) – this is the next stage of sperm maturation, which under natural conditions takes place in the fertile cervical mucus. In IVF, it occurs in a specially prepared laboratory medium.
• Fertilization – sperm are added to each retrieved oocyte placed in a culture dish, resulting in the formation of several to a dozen embryos.
• Embryo transfer – after fertilization, the embryos considered by the embryologist to have the “best prognosis” are transferred into the uterus. There are two possible timings: 2-3 days after fertilization (at the 4-cell stage), or 5-6 days after fertilization (at the blastocyst stage). Transferring only a single embryo results in a very low implantation rate; therefore, to increase the chances of implantation, it is common practice to transfer at least two embryos into the uterine cavity.
• Cryopreservation of remaining embryos – the unused embryos are frozen and stored in liquid nitrogen, theoretically for possible future transfer or for medical research. A very large proportion of these newly conceived human beings are lost during selection, freezing, and thawing – according to various sources, between 60% and 80%. Because storage time is often not clearly regulated by law and storage itself is expensive, this area is open to potential abuse and unethical practices.
• The effectiveness of IVF ranges from about 5% to 28% (depending, among other factors, on the woman’s age), and a single treatment cycle costs approximately 10,000-15,000 PLN. Each year of embryo storage costs several hundred PLN, and the same applies to the storage of frozen sperm. In addition, there are significant costs for medications, amounting to several thousand PLN.

It should be remembered that IVF does not cure infertility; it merely bypasses existing obstacles by carrying out fertilization outside its natural environment. After the procedure, the couple usually remains infertile, and the underlying causes of infertility often remain untreated and sometimes even undiagnosed.

The use of assisted reproductive technologies makes it possible to bypass – or rather deliberately circumvent – the natural barriers present in the bodies of both women and men. These barriers act as natural “filters,” separating healthy reproductive cells from those that are damaged or carry genetic defects. In nature, the proper course of fertilization is determined by several such mechanisms:

• Growth and maturation of ovarian follicles and the release of a high-quality oocyte during ovulation. In assisted reproduction, this process is strongly stimulated by hormonal drugs.
• Cervical mucus, which under natural conditions traps weak or poorly functioning sperm while nourishing and facilitating the transport of healthy, normally formed sperm, plays an important role in the fertilization process.
• Efficient tubal transport, which enables sperm to reach the oocyte released from the Graafian follicle and allows the embryo to travel toward the uterus for implantation and further development.
• Genetic integrity of male gametes. A major natural barrier is damage to the male genetic material, i.e., male infertility caused by abnormal semen parameters or impaired sperm transport. Such infertility may be rooted in genetic or inherited diseases that, with high probability, could be passed on to the next generation – something nature tends to prevent. Under natural conditions, sperm that are not fully functional are unable to fertilize an egg. In artificial fertilization, however, various techniques are used to bring together randomly selected gametes from the parents. This raises the question of whether infertility might sometimes serve as a natural protective mechanism against the further spread of genetic mutations and serious diseases—and whether it is always wise to fight it at any cost.
• Even more natural barriers are bypassed in the ICSI technique (intracytoplasmic sperm injection), in which a sperm cell selected by a laboratory specialist is injected directly into the cytoplasm of the oocyte, forcing the union of the gametes. With ICSI, it is technically possible to create embryos from defective parental gametes, although many of these embryos are later subjected to selective elimination. The natural processes associated with fertilization – such as sperm capacitation, the acrosome reaction, and the interaction with the zona pellucida—are omitted. This further increases the risk of congenital anomalies and the transmission of genetic defects to the child, a fact now openly acknowledged even by proponents of in vitro fertilization.

• The vast majority of human beings conceived during assisted reproduction procedures die during selection, transfer, and freezing/thawing. According to data from various centers, this amounts to 60-80%.
• The likelihood of multiple pregnancy increases by about 50%, which is associated with pregnancy complications, a higher risk of preterm birth, increased perinatal mortality, and other health problems for the children [1][2].
• The risk of developmental defects also rises, such as Beckwith-Wiedemann syndrome [3][4] or cerebral palsy [5] (particularly with the ICSI procedure), as well as the incidence of certain cancers, for example retinoblastoma [6].
• Assisted reproductive technology “transfers” damaged genes between generations: where nature sets barriers, these technologies bypass them. As a result, not only are genetic mutations preserved, but new changes may also be introduced into the human genome, the long-term consequences of which are impossible to predict.
• The risk of ovarian hyperstimulation syndrome in women increases [7][8] as a result of the hormonal stimulation used before oocyte retrieval, as does the risk of breast cancer due to the administration of hormones and large amounts of medication [9].

Fairness requires that parents undergoing assisted reproduction be informed of all medically known negative consequences for the child, including those that may persist and manifest in future generations, as well as of the potential threats to the mother’s health.

Because of its complex legal, ethical, and religious implications, in vitro fertilization remains the subject of many scientific debates and continues to provoke social controversy. There should be no doubt, however, that a human embryo is a human being, since nothing other than a human being can develop from it. Genetically, it is the same organism from the very beginning of life – from the moment the parents’ reproductive cells unite – until the moment of death. The same, yet not the same in appearance: a human embryo looks different from a fetus, a newborn, a young child, an adult, or an elderly person. At each stage of life, a human being grows, matures, and eventually ages, while the body and outward appearance change with the passing of days, months, and years.

A highly controversial issue connected with assisted reproductive technologies is the creation of an excessive number of embryos, their selection according to their “future prospects”, and then freezing and thawing, during which a significant proportion of embryos – new human lives – do not survive. Attention should also be drawn to advances in detecting disabilities, genetic and developmental defects not only in children at the prenatal stage, but already at the embryonic stage. This leads to eugenic selection of human embryos and their elimination – plainly speaking, the killing of those in whom genetic abnormalities are detected. It seems that we are only one step away from the “production” of children to order, in which a parent–client would specify the desired traits and appearance of the “product” – the child – where all children would have to be healthy, fully intellectually and physically fit, and any defects or imperfections would be detected and eliminated already at the embryonic stage.

Yet in many cases of prenatal (fetal) surgery described around the world, it is evident that the development of medicine could follow a very different path from prenatal eugenics. In particular, advances in ultrasonography should create opportunities for early therapeutic intervention, whereas today they are often used mainly to detect developmental anomalies and diagnose prenatal defects, serving as support for arguments in favor of abortion.

On the one hand, the law states that there is an obligation to defend human rights from the moment of conception until natural death, and to provide special protection for children and people with disabilities. On the other hand, it allows the killing (abortion) of children, for example on the grounds of suspected developmental defects, including conditions such as Down syndrome. What seems crucial here is the lack of unequivocal legal regulations that would ensure respect for human life at the embryonic stage – regulations that are clearly violated by the procedure of in vitro fertilization.

Why, despite numerous attempts at legal regulation, adopted resolutions, directives, or rulings of the European Court of Justice affirming the human potential of the embryo and the need to protect it, are there still no implementing provisions that would ensure their enforcement and make it possible in practice to protect every human life from its beginning (regardless of the method of conception) until natural death?

To illustrate the problems arising from the use of assisted reproductive technologies (is it truly “assistance” to procreation?), let us recall a few real cases that have already occurred worldwide in connection with their use:

• pregnancy and childbirth in women far beyond the natural reproductive age, for example over 60 years old, and the problem of the child’s early orphanhood;
• a mother-in-law giving birth using the reproductive cells of her daughter-in-law and her own son;
• withdrawal from a contract by a so-called surrogate mother, giving rise to numerous legal disputes;
• the “resale” by a surrogate mother of a developing child conceived from the gametes of the intended parents to another couple;
• the increasingly frequent occurrence of pregnancies using donor gametes from outside a marriage, or using embryos already created and stored frozen in laboratory banks;
• pregnancies in lesbian and transgender relationships;
• pregnancies using the gametes of a deceased partner or former partner, creating numerous legal and inheritance problems;
• efforts by deaf women to give birth to deaf children, made possible by using sperm from a donor who had been deaf for several generations;
• the birth of a dark-skinned child to a light-skinned couple who underwent IVF using (allegedly) their own gametes…

The statement of Jacques Testart (the “converted” pioneer of IVF in France) seems increasingly true and relevant: “Not everything that is technically possible should be put into practice (…) we are faced with the problem of a threshold beyond which man becomes the enemy of his own species.”

What does modern medicine offer in place of an approach based on the assumption that “infertility is a disease, and pregnancy (achieved through assisted reproductive techniques) is its cure”?

For several years now, a new branch of fertility science has been developing—NaProTechnology (Natural Procreative Technology). According to this approach, infertility is not a disease in itself, but rather a sign of underlying disorders or illnesses in the body. Proper diagnosis and treatment of these conditions lead to an improvement in health and fertility in both women and men. NaProTechnology focuses the efforts of scientists and physicians on developing diagnostics and treating the real causes of infertility, while at the same time striving to restore natural procreative mechanisms. This direction represents a far more valuable use of human intellectual potential than promoting laboratory techniques aimed at the “production” of “perfect” human beings and the earliest possible elimination of weaker, less “perfect” embryos, who nevertheless possess the full potential for development, for being loved, and for one day giving love to others.

Based on:

[1] “Perinatal outcomes in sinletons following in vitro fertilization: a meta-analysis”, R. Jackson, K. Gibson, Y. Wu, M. Croughan, Obstetrics & Gynecology, Vol. 103, No. 3, March 2004.

[2] “In vitro fertilization is associated with an increase in major birth detects”, C. Olson, K. Keppler-Noreuil, P. Romitti, W. Budelier, G. Ryan, A. Sparks, B. Van Voorhis, Fertility and Sterility, Vol. 84, No. 5, November 2005.

[3] “Beckwith-Wiedemann syndrome and IVF: a case study”, J. Halliday, K. Oke, S. Breheny, E. Algar, D. Amor, American Journal of Human Genetics, No. 75 (3), September 2004.

[4] “Rare congenital disorders, imprinted genes and assisted reproductive technique”, R. Gicquel, J. Trasler, D. Lucifero, M. Faddy, The Lancet, Vol. 361, June 2003.

[5] “Cerebral palsy among children born after in vitro fertilization: the role of preterm delivery a population based, kohort study”, D. Hvidtjern, J. Grove, D. Schendel, M. Væth, E. Ernst, L. Nielsen, P. Thorsen, Pediatrics, Vol. 118, No. 2, August 2006.

[6] “Is there an increased risk of congenital malformations after ART? Results from a prospective French long-term survey of a cohort of 15.162 children”, G. Viot, S. Epelboin, F. Olivennes, Human Reproduction, 25: i53–i55, 2010.

[7] “Incidence and prediction of OHS in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles”, E. Papanikolaou, C. Pozzobon, E. Kolibianakis, M. Camus, H. Tournaye, H. Fatemi, A. Van Steirteghem, P. Devroey, Fertility and Sterility, Vol. 85, No. 1, January 2006.

[8] “Outcomes from Assisted reproductive technology”, B. Van Voorhis, Obstetrics and Gynecology, Vol. 107, No. 1, January 2006.

[9] “Risk of cancer after use of fertility drugs with in vitro fertilization”, A. Venn, L. Watson, F. Bruinsma, G. Giles, D. Healy, The Lancet, Vol. 354, November 1999.