INVOcell: A Catholic-friendly treatment for infertility?

Some fertility specialists are touting a new fertility treatment as a “Catholic-friendly” alternative to traditional in vitro fertilization. Catholic couples struggling with infertility—willing to try the procedure if, indeed, it is ethical—need help to cut through the moral hype surrounding INVOcell.

Toward that end, this article answers three questions: 1) what is the INVOcell procedure and how does it differ from in vitro fertilization?; 2) does its intravaginal incubation, that is, conception within the woman’s vagina, make INVOcell a morally acceptable alternative to IVF?; and 3) are there genuinely Catholic-friendly approaches to infertility treatment that honor the essential unitive dimension of human conception?

What is the INVOcell procedure and how does it differ from IVF?

The INVOcell procedure is described as an assisted reproductive technique where specialists achieve fertilization and early embryonic development within INVOcell™, a patented, gas-permeable, air-free plastic device that is placed into the woman’s vaginal cavity. Prior to vaginal incubation, the woman’s ovaries are mildly stimulated with the goal of aspirating fewer than seven eggs from ripe ovarian follicles. The aspirated eggs, together with 30,000 motile sperm/mL—typically obtained previously by the man through masturbation—are loaded into the fertilization-inducing culture media in the INVOcell device. To encourage fertilization of eggs by sperm and healthy early embryonic development, the INVOcell device with its appropriate culture media is placed inside the woman’s vaginal cavity for 72 hours. After three days, the specialist withdraws the INVOcell device, observes the embryos under a microscope, and then transfers a few of the “best” embryos to the woman’s uterus, in hopes of implantation and gestation to term. Embryos morphologically normal but not chosen as the “best” are frozen, and although the INVOcell literature is not clear, precedent set by IVF standards would suggest morphologically abnormal embryos are destroyed.

The “Catholic-friendly” feature highlighted by some providers is also the principal protocol distinguishing INVOcell from IVF. INVOcell affords both fertilization of egg by sperm and the incubation of the early embryo within the woman’s body (in vivo). This INVOcell feature is advertised as morally superior not only because IVF employs external fertilization—bringing egg and sperm together in a petri dish in a lab, that is, ex vivo, outside the woman’s body—but also because IVF incubates the early embryo ex vivo, that is, in an external mechanical incubator. In short, INVOcell marketers approach infertile Catholic couples who supposedly reject IVF on grounds  that it facilitates conception outside the woman’s body, and introduce them to the “morally superior” INVOcell procedure that enables conception within the woman’s body.

Does its intravaginal incubation make INVOcell a morally acceptable option to IVF?

Donum Vitae, the instruction from the Congregation of the Doctrine of Faith that assesses the morality of infertility treatments, defines the act of marital intercourse—the bodily act of reciprocal self-gifting love of husband and wife—as the morally contextual requirement for the conception of a baby.

In the first place, then, Donum Vitae teaches that fertility treatments that assist the infertile couple’s act of sex to achieve conception are morally good, that is, they contribute to the true fulfillment of couple and baby, affording both what is due to them and worthy of their dignity. But the question is: what constitutes fertility treatment that assists the marital act? Genuine assistance to the conjugal act would have to mean that the fertility specialists concentrate on resolving whatever pathologies prevent the infertile couple from conceiving—male and/or female factors—so that, after these roadblocks to natural conception are worked out, the couple could conceive within their natural act of intercourse.

In the second place, Donum Vitae explains that any infertility treatment that replaces the conjugal act of bodily union is morally defective, that is, the treatment will neither fulfill the couple nor render to couple and baby what is due to them in justice. Based on the above descriptions of INVOcell and IVF, one recognizes immediately there is no act of intercourse in either procedure; INVOcell is merely a variation of IVF. Taken together, they’re like the treble and bass clefs of the IVF industry’s current treatment options. Within both fertility techniques, the woman’s eggs and the husband’s sperm are brought together not within an act of genital intimacy but, for IVF, within a petri dish in a lab and, for INVOcell, within the INVOcell device. By replacing the act of marital love with laboratory procedures, both INVOcell and IVF produce, rather than conceive, new human life.

An important passage from Donum Vitae explains the moral difference between conception of a baby within a loving act of its parents’ bodily union and the production of a baby that occurs within infertility treatments like INVOcell and IVF:

In his unique and irrepeatable origin, the child must be respected and recognized as equal in personal dignity to those who give him life. The human person must be accepted in his parents’ act of union and love; the generation of a child must therefore be the fruit of that mutual giving which is realized in the conjugal act wherein the spouses cooperate as servants and not as masters in the work of the Creator who is Love. In reality, the origin of a human person is the result of an act of giving. The one conceived must be the fruit of his parents’ love. He cannot be desired or conceived as the product of an intervention of medical or biological techniques; that would be equivalent to reducing him to an object of scientific technology. No one may subject the coming of a child into the world to conditions of technical efficiency which are to be evaluated according to standards of control and dominion. The moral relevance of the link between the meanings of the conjugal act and between the goods of marriage, as well as the unity of the human being and the dignity of his origin, demand that the procreation of a human person be brought about as the fruit of the conjugal act specific to the love between spouses. [Part II, section B, chapter 4C]

Therefore, when an infertile couple, cured of the underlying medical roadblocks to conception, conceive a child within their bodily act of unitive love, they recognize it was not they who “made” or “created” their baby; rather, a Power beyond theirs—God—did it. As a result, they can welcome the new life of their baby only as it truly is: a pure gift, the crowning gift of their marital love. The child conceived within his parents’ act of intercourse is not the object of his parents’ making or producing. The baby is the fruit of their love. Conceived as he is within an act of his parents’ self-gifting love affords the child the ability to relate to his parents as an equal, as someone who, like them, desires to be loved in and for himself.

By contrast, the production-oriented actions of the INVOcell procedure and IVF—the technical simulations of the mere procreative structure of the marital act—sunder the link between procreation and the act of sexual love. These technical actions deny a new human being the reciprocal self-giving act of its parents’ marital love. The act of generating new human life either by means of  IVF or the INVOcell device becomes an artificial technique whose fundamental character is completely different from the natural process of fertilization within the marital act. Separated from the interpersonal communion of spousal love, the fertilization of an embryonic human being in a petri dish or in the INVOcell device becomes nothing more than a rational, productive action oriented to a goal. The parents’ intention to generate a child by means of INVOcell or IVF treats the child as a product and reduces the baby to the object of their production.

The production of a baby in a petri dish or in a vaginal incubator is an intrinsic moral evil not only because it circumvents one fact of nature—the natural link between intercourse and conception—but also because it is against the whole of human nature. The will of the parents to generate their baby within an act of production (with all of its quality assurance requirements) contradicts the unconditional acceptance of the child that alone accords with reason, that is, corresponds to the child’s nature as a human person.

Is there a genuinely Catholic-friendly approach to infertility treatment?

Yes, there is. And its thoroughly moral approach to infertility is a component of the women’s health science called NaProTECHNOLOGY®. Developed by Dr. Thomas W. Hilgers and his medical colleagues at the Pope Paul VI Institute [Editor’s note: the author is the director of the Center for NaProEthics at the Pope Paul VI Institute], this approach to infertility has evolved over four decades of clinical research. Natural Procreative Technology (NPT or NaPro for short) utilizes a standardized and prospective system of cyclic charting whose biofeedback is critical in helping women understand their gynecologic health and possible pathologies underlying infertility.

A case of a 42-year-old patient from California who presented at the Pope Paul VI Institute with infertility is the best way to showcase NPT’s management of infertility.

Evaluation: This patient presented to Dr. Hilgers with a history of regular length cycles. Her “Female General Information Form” revealed that her previous diagnostic workup was limited to annual gynecological checkups and that she failed two cycles of IVF/ICSI (intracytoplasmic sperm injection). The “Male General Information Form” indicated that the patient’s husband had undergone vericocele surgical repair after being diagnosed with oligospermia and very low sperm motility. The woman reported that her former gynecologist was convinced she was ovulating normally, and her former fertility specialist suggested that, given her age, the age of her eggs, and her husband’s suboptimal sperm, IVF with intracytoplasmic sperm injection represented her best shot at a pregnancy.

Diagnostic protocols: Dr. Hilgers directed the patient to a Creighton Model FertilityCare practitioner in California so she could learn to chart her cycles. Two months later, she returned to Omaha and presented Dr. Hilgers with two months of charting for his evaluation. The biomarkers of her charts revealed limited mucus cycles (suggestive of endometriosis, PCOS, or hormonal abnormalities), no unusual bleeding, a normal post-peak phase length, and a normal menses. Dr. Hilgers ordered a full series menstrual cycle hormone profile, a follicular ultrasound series, and a diagnostic laparoscopy and hysteroscopy. Results of the hormone profile indicated suboptimal postovulatory progesterone and beta endorphin levels. The follicular ultrasound series revealed normal ovulation with a single follicle showing a complete rupture on day 17 of the cycle with normal folliculogenesis. The diagnostic laparoscopy and hysteroscopy showed endometriosis.

Treatment protocols: The patient’s husband was given low-dose Clomid (5 mg. twice a day) to improve his sperm count. The patient’s endometriosis was lasered at the time of the diagnostic laparoscopy. The patient returned to California and began a cycle-by-cycle treatment with Clomid to induce ovulation and to help correct the underlying hormonal dysfunction. This segment of the treatment was monitored long-distance by Pope Paul VI Institute clinicians.

Outcome: During the eighth cycle of treatment, the patient conceived. The pregnancy was supplemented with natural progesterone. At term, the patient delivered a healthy baby girl.

NaPro’s approach to infertility, illustrated in this case, encourages couples to work cooperatively with their natural procreative cycle. In other words, to use their reason not primarily to calculate the most expeditious way for the greatest number of infertile couples to get pregnant but to discover and appreciate the laws of their nature, the natural law, and to freely cooperate with and respect these human realities. Couples who have been treated successfully for infertility through NaPro, and conceive as a result, do so within their own acts of intercourse, that is, within the only context worthy of the conception of a new human being. All of NaPro’s medical and surgical infertility treatments unambiguously assist the couple’s act of conjugal union to attain conception of their baby.

NaPro infertility protocols also help parents to appreciate and respect the right of their children to be conceived within and, therefore, to be connected to the protection, security, and, yes, intimacy of their bodily union and unconditional love.

The defining characteristic of NaPro’s approach to infertility is enabling the couple to respect the procreative and unitive meanings of marital intercourse, evidenced in their natural generosity and desire to conceive their baby within their act of love.

Conclusion

The take-home message for infertile couples is twofold. First, the INVOcell procedure is neither a moral alternative to IVF nor a moral infertility treatment considered in and of itself. It is a technical act of production that, because it replaces the marital act of love, deprives the baby of its parents’ unconditional love and denies the spouses an opportunity of conceiving new life out of their reciprocal self-gifting act of bodily union. But that’s not the end of the story. There is a moral option to INVOcell and IVF. The NaPro approach to infertility does assist the couple’s act of marital love and, after resolving the underlying pathologies to the infertility, does help many infertile couples to achieve a pregnancy—in some cases, at a rate twice that of INVOcell and IVF.