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Evaluation and Treatment of Infertility
Clint Leonard, MD, December 21, 2009 (Science and NFP)

A child is a gift from God, the fruit of the love of a husband and wife. Naturally, a child is conceived as a result of the loving embrace of the parents which ensures the proper dignity of its creation and rearing. However, despite the best intentions and actions of a husband and wife, sometimes they are unable to conceive on their own and need some assistance.

It is important to respect the dignity of the spouses who suffer from infertility while maintaining the integrity of the process of procreation. In this regard, the evaluation and treatment of infertility involves identifying any possible causes and treating them by cooperating with a body's own normal functioning or restoring it to a healthy state. Any treatment that replaces the normal act of marital intercourse or fails to respect the dignity of the parents or the newly created child is immoral.

Several factors must be present in order for new life to be conceived: fertile cervical mucus to allow and facilitate sperm transport, mobile and healthy sperm, successful ovulation (an egg!) and adequate ovarian hormonal support, open and healthy fallopian tubes for sperm and embryo transport, lush endometrium to receive the new embryo, and the loving cooperation of the parents.

Approximately 20% of couples in the U.S. suffer from infertility, and a problem with one of these factors is often a cause. A couple may suffer from a low or absent sperm count, fallopian tubes damaged from previous infection or endometriosis, a lack of ovarian function due to age or metabolic disorder such as polycystic ovarian syndrome, or uterine fibroids which may impinge on the uterine cavity preventing implantation of the new embryo.

Charting a woman's fertile signs (using natural family planning, or NFP) can help a couple identify the optimal time to have intercourse to increase their likelihood of conceiving. These fertility charts can also help her physician identify hormonal or anatomic problems that may exist. This would be the start of an infertility evaluation. Additionally, hormonal blood tests, ultrasound, and a hysterosalpingogram (HSG) to evaluate the uterine cavity and tubes may help. Sometimes minimally invasive surgery is needed to evaluate the internal organs to identify medical conditions such as endometriosis. A semen analysis can be performed by collecting the semen during an act of intercourse using a perforated condom to keep the act itself open to life, and then evaluating the quantity and quality of the sperm.

Moral treatments include: changes in lifestyle such as stopping smoking, starting to exercise or getting regular sleep; using NFP; treatment of any identified medical problems; optimization of ovarian function using hormonal agents; enhancing the production of and quality of cervical mucus; and repairing any structural defects such as removing polyps from the uterine cavity. An ethical approach to infertility evaluation and therapy is possible and often successful.

Some couples, unfortunately, are unable to conceive a child on their own despite assistance from these moral treatments, and these couples may need support to accept this.

There are some responses to infertility that are inappropriate. In vitro fertilization, IVF, for example, is gravely immoral as it involves several harmful steps. It starts with harvesting eggs and sperm through processes that do not respect the dignity of the human body. Then fertilization is allowed to occur under lab conditions resulting in the creation of several embryos, several of which may be discarded or frozen for later use. Selected embryos are then used to attempt implantation in the uterus. Many embryos are destroyed or lost even though the purpose of IVF is to give a child to the desiring couple which is one major reason why it is never acceptable.

There are physicians in the diocese of Phoenix* who know, understand and implement moral principles in their approach to infertility and women's health. They are a great aid to the many couples who suffer from this condition.

Clint Leonard, MD Morning Star Obstetrics and Gynecology

*Drs. William Chavira, OB/GYN; Jim Statt, OB/GYN; Deidre Wilson, Women's Health; and Teresa Orth, OB/GYN resident, also provide health care for women in the Diocese of Phoenix in accordance with the Magisterium of the Roman Catholic Church.