Struggling With Infertility
Kevin Allen · May 2, 2008
6 million women between the ages of 15 and 44 are clinically infertile. Infertility presents a heartbreaking struggle for many Orthodox couples who wonder whether it is God's will for them to be childless, or whether new fertility technologies (and which ones?) are appropriate. In this edition Kevin speaks with Orthodox theologian and ethicist Fr. John Breck about infertility and what options Orthodox Christian couples have to deal with it within an Orthodox context.
Today my guest and I will address a heart-rending subject that affects an estimated 6 million women between the ages of 15 and 44. Our subject today is infertility. We’ll talk about some of the causes as well as the ethical, theological, and ecclesial issues that go along with the discussion of this subject – especially for the Orthodox Christian. My guest has written and counseled extensively on this subject in his books—The Sacred Gift of Life: Orthodox Christianity and Bioethics, which was co-authored with his wife; Stages on Life’s Way: Orthodox Thinking on Bioethics; God With Us: Critical Issues in Christian Life and Faith; and Longing for God: Orthodox Reflections on Bible, Ethics, and Liturgy. All of these are published and available through St. Vladimir’s Seminary Press. Fr. John Breck was Professor of New Testament and Ethics at St. Vladimir’s Orthodox Theological Seminary from 1984 through 1996. Currently, he is Professor of Biblical Interpretation and Ethics at St. Sergius Theological Institute in Paris, France. He and his wife, Lynn, also direct the Saint Silouan Retreat near Charleston, South Carolina.
Kevin Allen: Fr. John Breck, welcome to The Illumined Heart.
Fr. John Breck: Thank you very much. It’s a pleasure to be with you.
Kevin: It’s my pleasure to have you. Let’s begin with a general question. Probably most people know what fertility means when they hear it, but is there a clinical or better definition than what we normally hear that you’d like to lay as a foundation?
Fr. Breck: Usually people think of it in terms of a certain period of time, normally a matter of half a year to a year, when a couple has been having regular sexual relations—without contraception of course—and no pregnancy has occurred.
Kevin: I was think about this this morning before we spoke. It’s really kind of a classical biblical issue. This is not a new problem. It’s as old as Sara in the Old Testament.
Fr. Breck: Exactly.
Kevin: How many couples are affected? What does the data say? How many couples are affected by infertility issues in this country?
Fr. Breck: Statistics that go back at least 10 years or so seem to hold generally that there are about 1 in 8 couples, of child-bearing age, in this country alone, who are affected by what we call infertility.
Kevin: How many actual couples would that be? I think I’ve heard about two million or so.
Fr. Breck: That’s what I understand as well. As you pointed out, the women who have some kind of impaired ability to conceive number around 6 million. Again, these are statistics that go back a decade or more, but they seem to hold today as well.
Kevin: What are some of the factors that contribute to fertility? We’re not going to get into all the medical specifics, but maybe generalize for us.
Fr. Breck: Well there are all sorts of factors. We tend to think, especially of the woman, of blocked fallopian tubes, problems with ovulation, various genetic difficulties, immunological, and so forth. Of course, age also plays a significant role as a woman approaches menopause. In the African nations, there is a very high incidence of infectious disease that can also affect fertility. Malnutrition goes along with that as one of the major factors, at least in certain areas of Africa particularly. I think it’s important to take into consideration the male factors as well. One of the major reasons why a couple can’t conceive has to do with low sperm motility, for example. Or, what they call asospermia, where the man is simply incapable of producing sperm. Then, of course, anybody who watches television today is aware of this phenomenon referred to as “ED”, Erectile Dysfunction, inability of a man to ejaculate. All of these can contribute to the whole problem of infertility.
Kevin: There have been traditional methods that have gone back many years, and some are newer, but let’s talk about some of the traditional methods that are often employed to address the issues of infertility. Could you outline those for us?
Fr. Breck: One of the most widely recognized is surgical intervention to unblock fallopian tubes, for example. We’ve become more and more sensitive to the problem of various solutions—toxic substances—in the environment that have an impact on fertilization, on fertility. It’s very difficult to know just what role these play, but there’s no question that they do. With regard to factors of pollution, these may be becoming more and more important as we go along. In order to deal with the questions, one thing that has traditionally been done is to almost use the flip side of a form of contraception that has been accepted for many years within the Roman Catholic tradition, and also by many Orthodox, and that is what is usually called Natural Family Planning. This is usually used in order to prevent conception. But nowadays it’s possible to do a very close analysis of the mucus secreted by the woman to know really when her fertile period is, and then to try to concentrate sexual relations right around that period in hopes of creating a pregnancy.
Kevin: Now, are these traditional methods that have been employed? Are they approved by the Orthodox churches in North America officially as means of having a pregnancy occur?
Fr. Breck: Basically, yes. I think most of us are aware of the All-American Council proclamation that was made back in 1992, the 10th All-American Council, in the document that has been widely disseminated to our parishes—marriage, family, sexuality, sanctity of life. This statement really gives a rather blanket permission for a number of different medical procedures in order to enhance conception. There are various medical means that can be used. There is a problem with some of these, though, that I think has to be considered. Maybe we can get to that, especially with in vitro fertilization. Very little has been said—either by the Orthodox Church in America or other jurisdictions in this country, or by traditional Orthodox countries (Russia, Greece, Romania, and so on)—in any form or way. I think there is a reluctance to enter too deeply into these matters and to leave the discernment really up to the couple with the guidance of the spiritual father.
Kevin: There has been significant improvements—if you want to call it that—or upgrades in technology, discoveries of new technology, that have introduced new procedures. Are some of these more problematic, from an Orthodox perspective, than some of the traditional. And, please do get specific about which of those technologies might be more problematic.
Fr. Breck: I think we can look at two major procedures: one would be artificial insemination; the other would be in vitro fertilization. With regard to artificial insemination, the churches, in the various statements they’ve put out—here I’m thinking of the statements that have been issued particularly in recent years by the Church in Greece—there seems to be a very clear distinction made between artificial insemination that’s called homologous, and that which is called heterologous. Homologous would be using the sperm of the husband, whereas heterologous would be using the sperm of an anonymous donor, for example. The moral distinction there is based on the rule of thumb that there should be no third party in the procreative process. And this means that those specialists in moral theology who accept any form of artificial insemination would want that to be strictly homologous—that is it would be only the gametes of the husband and wife that would be used. Any heterologous, or donor, sperm or ova would simply not be morally acceptable.
Kevin: Let me make sure I understand. So the donation of sperm or eggs that come from the actual couple involved is okay, but the donation of sperm or eggs from a third party is not.
Fr. Breck: Right, basically speaking. Then there is also the question of in vitro fertilization. I think opinion is rather mixed still in this regard for one major reason. That has to do with what they call the extra or surplus embryos. There are rather intuitive objections to in vitro fertilization expressed by some of our ethicists just because of the invasiveness that it involves. It means going in to hyperstimulate the woman’s ovaries so that she produces a number of ova, rather than a single one, in the month period. These are harvested, they’re put into a petri dish in culture, and treated specially. The sperm is removed and treated. And then the attempt is made to create embryos outside of the body, extrauterine. Once a few embryos have been created, a selection process is made. The most viable are then transferred to the woman’s uterus in hopes that there will be implantation and then a pregnancy. But in vitro infertilization, although it too was pronounced acceptable by that All-American Council in 1992, does pose some problems that many of us have underscored. Although I’m not sure that they are so objectionable that it means the whole procedure itself has to be bad. I can give you simply an example. With in vitro fertilization, normally because the procedure is difficult, expensive, and somewhat dangerous even, generally the medical team will try to harvest a number of embryos—6, 7, 8—and these will be placed in the petri dish. Some will be fertilized, others will not. But if 4 or 5 embryos are created, then certainly they’re not going to transfer all 5, for example, back to the woman’s uterus because of the risk of a multiple pregnancy. In any case, a multiple pregnancy can occur and that is even if they transfer 3 back to the mother’s womb. That leaves the moral question as to what we do with a third child growing in the womb if the couple feels they can’t manage that many children—don’t want to have triplets on their hands. Then there is a process of embryo reduction—as it’s euphemistically called—which means simply terminating the life of one or more of the embryos, killing the embryos, in the womb. Another problem has to do with the extra embryos. Say, half a dozen are fertilized. You’re going to transfer 2, possibly 3, to the woman’s uterus, then you’re going to have leftover embryos. The question is, what do you do with them? Normally they are cryopreserved—that is, they are frozen—in case the first embryos simply do not implant. So they can go thaw these extra embryos out and use at least some of them in hopes that a pregnancy will occur. The problem there is that very often these extra embryos are either allowed to die—that is, after a period of 5 years they’re considered no longer viable. But more often today they’re used for experimentation. They’re used to harvest their stem cells. And all of this poses serious problems from an Orthodox point of view simply because we consider that human life does begin with fertilization.
Kevin: What is the position—and perhaps you have touched it but I didn’t hear it clearly enough and I want to make it as clear as possible—what is the position of the Church on surrogate motherhood?
Fr. Breck: There, again, surrogate motherhood would not be an acceptable practice for us simply because, once more, you’ve got a third party really intruding in the whole of the procreative process.
Kevin: Maybe it would be helpful, since we’ve discussed a lot of both the technologies and some of the ethical questions that these technologies raise, we’ve kind of lumped them together. And I want to get to some of the theological. Maybe you could state very concisely, if possible, what the position of the Orthodox Church on these newer technological advancements, in fact is.
Fr. Breck: Again, I think it depends on these advances. For example, I received a phone call some time ago from one of our priests, who had been a student of mine, asking if he and his wife, who are now approaching forty years of age, could morally use in vitro fertilization. I told them I can’t make that decision for them, it’s one that they have to make in consultation, in prayer, with their spiritual father. I didn’t hear from them for quite awhile. I told them of my objections, particularly with regard to extra embryos, and that this is generally the Orthodox view which casts quite a negative light on the process of in vitro fertilization insofar as there are extra embryos created. Well, a year later I received an email from them with a marvelous picture of the mother holding their newborn and the father, who is a priest now, just beaming, radiant, absolutely delighted. The point is that there is a reluctance, with regard to in vitro fertilization, largely because of this problem of extra embryos. This couple demanded that the medical team extract only 3 ova and that only 3 ova—no more—be fertilized. I believe that all 3 were transferred and one pregnancy occurred. So in other words, the Church, I think, has to take these case by case with regard to these new technologies, realizing there are fundamental problems, especially with the creation of extra embryos. With regard to artificial insemination, the procedure is so routine today and so simple that there seems to be no real moral problem with it at all.
Kevin: Again, I’m feeling pressured to make clear for listeners that are listening and don’t have the depth of knowledge that you have. So correct me where I’m wrong. The Church permits corrective surgery, intrauterine insemination of the husband’s sperm, the use of medications, and to some extent, and in consultation with one’s spiritual father and in prayer, in vitro fertilization.
Fr. Breck: Yes, I believe it’s quite fair to say that. Once again, the problem is that we often look for rules and regulations where none can really exists.
Kevin: I understand.
Fr. Breck: Simply because, first of all in the Christian life there’s an enormous amount of freedom that needs to be respected—of course, freedom in the spirit, which means in the whole of the perspective of the Church’s theological stance. But each couple is going to approach this question of infertility from a different point of view with different sensibilities. All of that needs to be taken into consideration.
Kevin: Moving along from some of these medical challenges and issues and technologies that we’ve been discussing, into more theological and ecclesiastical, perhaps. A couple, simply because there is barrenness present, that doesn’t necessarily mean that’s it’s an expression of God’s will?
Fr. Breck: Absolutely. There are all kinds of things that can affect our life. When you say “God’s will” I think we have to make a very clear distinction between two forms of God’s will. The fathers will make a distinction between God’s intentional will and God’s accepting will—if we want to use that kind of language. God’s will covers everything, including tragedy, life, death, and so on. Even though God never created us for death. God’s will is also involved in some mysterious way in tsunamis and other tragedies in human existence. Nothing is outside of God’s will, from a particular point of view. But that doesn’t mean that God desires it, that God intends it. God accepts it as a consequence of life within this fallen world of ours. If we consider the question of God’s intentional will, then I think this simply leaves us in prayer. For a couple that finds themselves infertile, first of all I believe that much of our science is inspired by God, given to us by God. And like any medical treatment, the couple has not only a right but perhaps even an obligation insofar as they feel really called to live out their conjugal life in God’s will to explore various possibilities for some kind of corrective measures—medical, surgical, whatever it may be. But again, I think a tremendous amount of discernment is necessary in all of this. So much depends upon the particular case, upon the particular couple.
Kevin: So there’s not, on the other side, simply an entitlement to pursue these life-creating measures simply because they’re available.
Fr. Breck: No. But on the other hand, there is nothing that inherently prevents that. In other words, I don’t believe that the simple fact that a couple finds themselves to be infertile means that this is God’s will that they be this way, they stay this way. If they can unblock fallopian tubes, concentrate the sperm so that it has greater motility or greater possibility for fertilizing an ovum, then perhaps these medical techniques, these medical procedures, fall very much within the sphere of God’s will. That’s something that I think only the couple can discern for themselves, again, within the framework of the whole of their life within the Church.
Kevin: How can it be reconciled the fact that fertility treatments are expensive? I see in the research that there are 9.5 million women using various infertility services. Somebody has to pay for it. Maybe insurance covers some of it, maybe all of it. But it’s not available, I would assume, to everyone. How do you reconcile that fact? Is that a moral/ethical issue?
Fr. Breck: Absolutely. It’s one of my biggest objectives to in vitro fertilization, frankly. Not only the problem of the extra embryos, but the fact that the procedures are so expensive only the wealthy can have access to them. And I think there’s a fundamental injustice built into that whole problem. We can say that medical insurance covers a lot of it, but with 44 million of our citizens without medical insurance—well you see my point.
Kevin: I do.
Fr. Breck: We live in a situation of a very unjust distribution of goods. It’s getting more and more pronounced here, and in other countries as well. So that really is a major question that you’re raising there.
Kevin: I think, not wanting to politicize that issue, that it really goes beyond politics and simply redistribution of wealth and becomes—as you’re, I think, implying—an ethical issue that we all have to wrestle with.
Fr. Breck: I think it does. Again, it’s not just a matter of evening out the wealth so that everyone has the same amount of money—that’s not the problem, that’s not even feasible, of course. What is the problem is the fact that society itself doesn’t seem to be sensitive enough. We, as a people, a culture, don’t seem to be sufficiently sensitive to the fact that a great deal of new technology—whether it be with regard to fertility or anything else—is out of the reach of a very significant proportion of our population. Largely because of this gap that exists between those who can afford it and those who can’t.
Kevin: Interestingly, a little bit off our subject but not so much, I think it’s safe to say that the termination of life—in terms of its technology and availability—exceeds that of the procreation of life.
Fr. Breck: You mean the problems of euthanasia and physician-assisted suicide?
Kevin: Well, I think terminating pregnancy—abortion—is a lot easier to attain, than procreation—these technologies.
Fr. Breck: Ah, abortion. Oh sure. What’s been called the abortion holocaust really still is that, of course. It’s a major major moral problem in our society. The fact that we destroy so many lives in the womb simply because we refuse to recognize them as bearers of God’s image and his personal being.
Kevin: It seems somewhat ironic to me that you’ve got 9 million women struggling and willing to pay the price—financial, emotional, etc.—to have babies, and yet at the same time we’ve got this incredible number of pregnancies which are aborted.
Fr. Breck: Exactly. It’s the kind of logical/moral contradiction we’re living today that is really appalling. We just don’t step back and look at it.
Kevin: I’m hearing it and seeing it now though, Father. It’s become quite clear in this conversation. As we’re coming to the end of our very important interview and conversation, how would you advise a couple that calls you on the phone and says, “Father, we don’t know if infertility treatments are right for us. What would you counsel us?” What would your response be, depending of course on the circumstances?
Fr. Breck: I think the only possible response that can really lead to what is—in ethical language—most appropriate, right, just, is to lay all of it with the whole of our life before God in prayer. It sounds almost like a glib answer, “go pray about it.” But in fact I think it’s the most important step any of us can take whether it’s a question of infertility or not. I think it’s a fundamental given in Orthodox experience that God is totally involved in every aspect of our lives, and that means that God is also deeply, intimately, personally, and lovingly involved in the choice of gametes, in the choice of creation—in utero, in any case—of a child. This means that when a couple is faced with infertility, struggling, hurting, longing, wanting so much to be able to fulfill their conjugal life by bringing forth children, the most important thing they can do is pray about it. Turn it over to God as thoroughly as they can, but, I would also say, in the context of the life of the Church. They’re not going to pronounce or make some announcement at the end of the liturgy that they’re struggling in this regard, but they certainly can talk to trusted and beloved members of the community. Ask them to pray for them. They can turn to Orthodox medical professionals and ask their advice and their help. They can, of course, go to the priest or their spiritual father or mother (if it happens to be a person outside of the community) and simply ask them as well to intercede for them in prayer. And just beg that God’s will be done through all of it.
Kevin: Are there any Orthodox resources that you would refer people to that might be available to help infertile couples, listening to this conversation today, navigate the waters of this subject that we’ve been discussing on infertility?
Fr. Breck: I think it’s important to recognize the fact that it may very well be God’s will that this given couple, a given couple, not be able to have children. We pray during the marriage ceremony that this couple have children as may be expedient for them. And in God’s providence it may not be expedient for a couple to have children. Which may lead them to adopt. If adoption is an option, then of course there are a number of possibilities: Hogar Rafael in Guatemala; Project Mexico; any number of organisms within the Orthodox Church around the world who can offer children for adoption in good circumstances. But there are lots of other things too. I think a couple who is faced with this can find one of the best resources simply in the counsel of Orthodox medical professionals, in the pastoral support of the priest, but again also of the parish. It’s essential for all of us, but equally for a couple that finds themselves faced with the problem of infertility, simply to go back to scripture and tradition in order to immerse themselves once more in what we call the mind of the Church, to give a sense of balance to it all. To recognize the fact that we are members of one another, we belong to one another, we are there for one another, we offer one another up in our supplication, in our prayer. If a couple is infertile, their own experience might bring enlightenment to other people within the parish who are facing similar problems. They might find themselves called to exercise a particular ministry among poor children, for example, in some of the homes—whether they be Orthodox or not—homes that are created to care for abandoned children, things of this sort. But I think another thing, this is not really a resource, it has to do more with a perspective, but I think it may fall under this question that you just raised. And that is, it’s really important for an Orthodox couple faced with infertility to recognize the fact that that condition of infertility in no way diminishes the ultimate value and meaning of their conjugal relationship. It may leave them with a great deal of heartache, wanting to have children of their own but not being able to. Nevertheless, it really is important for us to make it clear to our faithful that God joins them together, not only for purposes of procreation but also for purposes of creating an ever deeper union in Christ with one another as a reflection of the love between Christ and the Church. This does not require that they procreate, that they bear children.
Kevin: Thank you for that. I think that was a Holy Spirit led answer, thank you very much for that. Fr. John Breck, Professor of Biblical Interpretation and Ethics at St. Sergius Theological Institute in Paris, and Director of the Saint Silouan Retreat near Charleston, South Carolina, with his wife Lynn. Thank you very much for speaking with us about this issue. Hopefully someone or someones listening will have been helped by it.
Fr. Breck: It’s been a real pleasure. Thank you, Kevin.
Kevin: Before signing off, I want to thank Gail Shepherd for providing research for this program. Thanks Gail. And to all of you, thanks for listening. Hope you’ll join me next week.