In Vitro: Life at the Cost of Lives
Author: Tadeusz Wasilewski
It is an irrefutable scientific fact that human life begins at the moment of conception. We need to remember that, statistically, in order to bring one child to life the IVF method must destroy five or six other human beings.
I finished my studies in 1984. Before becoming professionally involved in the treatment of infertility, I specialized in obstetrics and gynecology. I made my first and second degree of specialization in 1993. After working in a hospital for several years, I accepted a position in a clinic specializing in assisted reproductive medicine. This was one of the first private clinics in Poland in which the treatment of infertility was conducted with all the available methods that reproductive medicine offers married couples today.
I pursued this line of work until 2007. It was then that God and His Divine Mercy intervened in my life, and I came to understand that the IVF program was not one we should be pursuing. Not just me, but all of us—all of medicine. I walked out into the street not knowing what I would do next. But that wasn’t important: I simply did not wish to destroy any more human beings, since such destruction follows inescapably from in vitro fertilization.
I sought a place for myself, and found one. Every day, by small steps, God led me to the point where I could go on using my knowledge and experience to help infertile couples; but now using a totally different method, a method that respected the life and dignity of every human being.
The problem of infertility
A perfectly healthy married couple under the age of thirty-five trying for pregnancy has about a 20% chance of conceiving a child within a single menstrual cycle. According to the definition formulated by the World Health Organization (WHO), the maximum expected time for pregnancy (TFP) of a married couple is twelve months. If within that time a pregnancy does not occur, then a case of infertility is recognized. When it comes to observing our organism—our fertility—WHO considers us total illiterates, since a woman who knows how to chart her fertility (i.e. is able to recognize the days of her menstrual cycle when she is most likely to conceive a new human being) has a 30% and even higher chance of conceiving in that period. The TFP is thus shortened to as little as six months.
Infertility affects every fifth or sixth married couple. It is estimated that in Poland alone there are up to two million people suffering from infertility. So it is in every society on the globe. The more developed and “civilized” the society is, the greater the incidence of infertility. This is no accident. Among other things, we pay for our growth of civilization by the simple fact that our level of fertility decreases. Regardless of whether fertility is the result of other existing illnesses or whether we should speak of it as an illness in its own right, the phenomenon has such wide social and familial ramifications that it demands redress. Hence the birth of a branch of medicine, which addresses the problem of infertility, which describes it, probes its causes, and seeks ways of preventing it. This branch of medicine we call reproductive medicine.
The distribution of the locus of infertility can be envisaged as follows: if we have sitting before us 100 randomly selected married couples who have problems conceiving a child, then chances are that the cause lies on the side of the woman in 40 of these couples, on the side of the man in another 40, and on either side in the remaining 20. Such is the equality of the distribution.
Hormonal factors account for 20-30% of all cases of infertility. These are chiefly associated with problems of ovulation, but not exclusively. A low sperm count can also be of hormonal origin. Mechanical factors account for another 20-30% (i.e. the same number) of cases. These include: oviduct blockage, adhesions within the small pelvis (i.e. where the reproductive organ is situated), and endometriosis. The male factor accounts for up to 40% of infertility cases, while immunological factors account for 5% (even more, in my estimation). So infertility is a consequence of “civilization” as manifested in the chemicalization of life and the use of synthetic products, including the food we ingest.
Apart from these factors there are also unknown ones, which account for 10-20% of all infertility cases. This is so-called idiopathic infertility, i.e. fertility the causes of which doctors are unable to explain.
The war on infertility
Once the doctor knows where the infertility lies, how often it occurs, and what, more or less, is causing it, he begins to seek ways of eliminating it. Today reproductive medicine relies on three kinds of procedures. The first consists in observing the woman’s menstrual cycle (through ultrasound analysis, gynecological examination, and analysis of the sexual hormone activity in the woman’s organism) with the aim of indicating the time when normal marital coitus has the highest chance of leading to the conception of a child. Of course the woman’s menstrual cycle can be “primed” by the use of medication, i.e. by stimulating ovulation, by administering so called “supplementary drugs” in the cycle’s second phase after ovulation. This is an absolutely and entirely natural method with medicine providing discreet assistance. This method is also approved by naprotechnology doctors, and elicits no ethical and moral concerns. All married couples suffering from infertility would dearly wish to avail themselves of this method.
But assisted reproductive medicine goes further that this. In addition to carrying out all the observations and procedures described above, it replaces the conjugal act that is carried out in the privacy and intimacy of the home with artificial insemination. This method consists in the depositing of the male sperm into the cervix or uterine cavity (intrauterine insemination), or directly into the oviducts. It is obvious that this method allows for the use of male sperm belonging to another man, not the husband. This is precisely what assisted reproductive medicine does. The sperm donor is usually a man under the age of thirty-five who is supposedly healthy (of course, he cannot be screened for all diseases) and has the requisite sperm count. Three or four times a month he pops into a clinic pretending to “treat” infertility, and there donates his sperm sample, for which he is, to put it simply, paid. This second procedure is not approved by everyone and is certainly ethically erroneous.
The third method offered by reproductive medicine today is the most controversial one. It consists in extrasomatic (outside the human body) fertilization and is called the in vitro method (IVF ET).
The technical procedure of the IVF program
How does the IVF program proceed? First of all the couple undergo a brief diagnosis (2-3 hours) in the form of interviews, a gynecological examination, an ultrasound, and hormonal analyses. Then comes down the pronouncement: “To be of assistance to you, we must resort to extrasomatic fertilization; otherwise our help will be ineffective.”
I have no doubt at all that the IVF program today is being terribly abused. In too many cases, assisted reproductive medicine starts from the premise that pregnancy need not be achieved in the natural way and therefore it is best to proceed with the IVF program and obtain results in the shortest time possible. And so, many of these couples, not having the vaguest notion about the reasons for such a proposition, or about other possibilities, simply agree to the IVF method.
What happens then? After testing the sperm parameters, the doctors have a printout of the results; meanwhile the sperm is deposited in the incubator, where it is kept under special conditions. Upon the couple’s consent to proceed with the IVF program, the sperm undergoes cryopreservation, i.e. it is frozen in liquid nitrogen at -193° C. With this, the man’s role in the IVF program is at an end. For all that it matters, he can go off to the other side of the world and return two or three years later, only to hear his child in the other room asking its mother, “Mom, is it true that this man is my father?” Of course the IVF program can make use of fresh sperm. But all too often it will use sperm that has undergone precisely such a freezing and thawing process.
Meanwhile the woman must undergo two further stages of the IVF program. The first is the pharmacological stage, in which the woman takes daily doses of drugs for stimulating growth in the ovaries and the development of follicles, which are then constantly observed. Known as Graffian follicles, these are growths or sacs in the ovaries, which contain mature egg cells. In the natural cycle one such Graafian follicle appears. In the IVF program there must be more of these, since more egg cells are required. This pharmacological stage takes 10 to 14 days.
The second stage involves manual or technical manipulation. When tests indicate that the time is right, the doctor, guided by USG, inserts a needle through the vaginal vault into each of the two ovary glands, punctures the follicles, and draws out their contents. The laboratory specialist then locates the egg cells in the follicular fluid. There must always be more than one of these cells; otherwise the IVF program will not obtain positive results. These egg cells are then united with the sperm. The sperm cells are thawed (a portion of them will have died off, but there were millions of them to start with, and so a good many of them are alive and motile); or, conversely, a fresh sperm sample is used. In the classical IVF method the egg cells are immersed under a microscope in a Petri dish containing a sperm-rich medium. Thus one sperm cell will chance upon one egg cell, another sperm on another egg cell, and so on. This process mimics to some degree what occurs in nature. Another—newer—method is carried out by so-called micromanipulation, i.e. the intracytoplasmic injection of the sperm into the egg cell (ICSI for short). This is not a new in vitro method, but a more recent operation integral to the IVF program.
Next, these fully human embryos obtained as a result of uniting the egg cell with a sperm cell are removed in an appropriate medium to the incubators. A difference of ± 0.1° C in incubator temperature results in the death of these embryos; they simply cease to develop. And here I make my observation: even if we wanted to come up with what the mass media call a “Catholic” in vitro program, it simply would not be possible, since our apparatus and instruments are unreliable. A power outage, a slight equipment malfunction, a tiny inadvertent error by the handler—and all the human beings we have artificially brought into existence simply perish. Thus there is no way of carrying out IVF program without risking the death of human beings.
How human beings are treated in the first days of their existence
What happens to the new human being after it is conceived in a laboratory Petri dish? For the first 24 hours these human beings are carefully observed and someone knowledgeable in these matters announces: “We have fertilization.” In the second 24-hour period, i.e. 48 hours after union of the egg and sperm cell, the human embryo is a four-cell organism. Two divisions have occurred and there are four cells. Human embryonic cells are called blastomeres; and the human embryo has four blastomeres. In the third period, i.e. after 73 hours, the human embryo consists of 8 cells—eight blastomeres. In the fifth period it is already a blastocyst—a more advanced stage in the development of a human being. It is in these second, third, or fifth 24-hours periods that the selection of the best embryos (normally two) is made. On what basis? On the basis of three conditions: the rate of embryonic development, cell symmetry, and cell granularity. The selection of these two embryos need not be the “right” one, and all too often life shows that it was not the “right” choice.
What happens to the remaining embryos? They call them surplus embryos. I take great exception to this, for they are human beings—“surplus” human beings! They are human beings in the first stage of growth—the first stage of development. So as to keep up the pretences and appear to be acting ethically, reproductive medicine provides for the freezing of embryos as well. There is even a computer program that runs you through the steps of the cryopreservation. A frozen human being can be preserved at the temperature of liquid nitrogen for many years. The duration of preservation is not important. What is important is the stage of freezing and then the thawing. In most cases the human embryo does not survive the freezing and thawing processes. In most cases it simply perishes. You might compare this to suddenly having to run one marathon race (i.e. freezing) and then another one (thawing). Imagine the consequences of running over 42 kilometers without training. Small wonder that 70-90% of human embryos die off as a result of cryopreservation.
Once the two embryos are selected, the doctor proceeds with what is called “embryo transfer”—the embedding of the embryos in the uterine cavity. After this the woman goes home, takes her medication, and, after fourteen days, takes a blood or urine pregnancy test. Then she calls up the doctor who carried out the extrasomatic fertilization procedure, and says, either jubilantly, “It worked!” or, tearfully, “It didn’t work!” In the latter instance, the doctor will remember the frozen embryos. Now there is no need to induce or stimulate ovulation, or to repeat the pharmacological process, or to puncture the follicles, or to unite the egg and sperm cells. All you have to do is prepare the woman’s organism and transfer the previously frozen embryos at the appropriate phase of the cycle.
Only living embryos may be transferred; but it turns out that when the prepared patient arrives for the transfer, you thaw out the straw containing the embryos only to discover that both embryos are dead. So you take out another straw and find one living and the other dead. So you transfer the living one to the uterine cavity. And yet all the frozen embryos had been living human beings! Such is the typical practice of the in vitro program.
Note that after the transfer of previously frozen embryos, the success rate compared to that when using “fresh” embryos in the IVF program is minimal—success being understood as the birth of a healthy child.
The necessity of killing in the in vitro program
In reproductive medicine we fear two complications. One of these is the ovarian hyperstimulation syndrome, the other—multiple or multifetal pregnancies. The ovarian hyperstimulation syndrome (or OHSS for short) is a complication that arises only when the procedure is successful and the patient is pregnant. Hence the misfortune. The pregnancy progresses, you can hear the beating heart of the child in the uterus, you can already see the child on the ultrasound; but then the woman’s ovaries become enlarged, cysts (larger or smaller ones) form inside, fluid collects in the abdominal cavity and other body cavities (the coelom and pericardium), electrolyte imbalances ensue along with a lowered white blood cell count and bleeding disorders—all of which threaten the woman’s health and life.
OHSS can arise from any of the three treatment methods described above. A naprotechnology doctor administering drugs to stimulate ovulation must be prepared to deal with the syndrome. But the syndrome occurs a hundred thousand times more frequently in the IVF program. Why? Because the program strives to cultivate an unnaturally large number of follicles all at once. If the IVF program proceeded on the basis of a single follicle with one egg cell then the chances of success would be less that 5%; and the cost of the program would remain the same. Today IVF clinics must fight for patients. But in order to fight for patients they must boast results much higher than 5%. The best IVF clinics in the world today achieve results of 40 to 45% in a single course of the extrasomatic fertilization method. There are centers whose success rate is 10%. But under the prevailing competitive conditions no clinic can allow itself to go below a 10% success rate. Last year’s average success rate in Europe was around 28%. In order to achieve this 28%, the drug-induced stimulation process must yield from six to a dozen or more egg cells. Thus the doctor must administer large doses of medication, which provoke hyperstimulation of the ovaries.
Multifetal pregnancies are the other medical complication. It has been statistically proven that before selecting the best two embryos, we must have from 6 to 8 of them at our disposal. With fewer than six embryos (e.g. if we select the best two embryos out of three), the chances of a positive end result are considerably lower. On the other hand, when the number of embryos exceeds eight, there is no commensurate increase in success. Thus, statistical study has shown that the optimal number of embryos from which the selection is made is from 6 to 8.
It has also been statistically proven that the optimal number of embryos to be transferred to the uterus is two. When only one is transferred, the chances of success are lower. When two are transferred, the chances are best. When 3-4, or even 5, embryos are transferred, then naturally the success rate is still higher, but so also is the risk of incurring multiple pregnancies. Even with the transfer of two embryos, the probability of incurring twin pregnancies is around 25%. When three embryos are transferred, the probability of incurring twin pregnancies is over 35%. Needless to say, triplet pregnancies will also occur.
Why do we fear multifetal pregnancies? The reason is quite simple. God enabled us to carry single (or singleton) pregnancies. 99.9% of women carry singleton pregnancies. That is how it is with the human species. Twin—or multifetal—pregnancies always run the risk of ending before term. The lumen of the uterus does not keep up with the increased body weight of the children developing in the womb. Stretched to the limit, the muscle fibers suffer stress, and this leads to miscarriage or premature birth; i.e. the pregnancy ends before term, when the children are not yet capable of supporting life. As a result, they soon die, or they are stillborn, or there is a premature birth. Prematurity, low birth body weight, lowered immunity, and frequent infections—all these factors contribute to this being the most common cause of perinatal death. In other words, multifetal pregnancies make for a more complicated pregnancy in general and an increase in deaths occurring immediately before and after birth. Or, put another way, it is a crushing defeat for reproductive medicine.
Now picture this: the couple sit down with the doctor for the fifth time. “We’ve been here four times now,” they tell him. “Four times we’ve resorted to the IVF program and not once have we had a positive result. This is our fifth and last time. So far we’ve spent 100,000 PLN working non-stop for two years, sacrificing our vacations—all this for a cure so as to have baby.” All this accompanied by sobs and tears. But there is also monumental determination! The doctor is ambitious. He is equal to the challenge. Finally, after repeating the whole procedure anew, he gets four embryos under the microscope. Now he is faced with a decision. He wants to increase the chances of obtaining a pregnancy. But he knows he runs the risk of provoking hyperstimulation. He knows he runs the risk of incurring multifetal pregnancies and what the consequences of these pregnancies are. But the couple insist, and the doctor decides: “I’ll transfer four embryos in the uterine cavity.” Two weeks later, his patient calls back with news: “I have a positive test.” Transports of joy! She is the happiest being on the planet—for a while. Two weeks later she shows up, undergoes a USG, and learns that there are four pregnancy follicles in her womb. Four human beings have implanted themselves and are developing. Four times before that not one embryo had taken. This time all of them have. I have seen this happen. But it is not man who decides such things. What happens then? Earlier, there had been intense joy; now, just ten weeks later, there is crying and sobbing. A miscarriage! And so we come up with yet another idea—one that is technically possible in medicine; namely, we remove two pregnancy follicles by killing off two fetuses. Now it is the eighth, ninth, tenth, eleventh week. Two fetuses have been killed, and we have a twin pregnancy. The pregnancy progresses, and the chances of bringing these children close to term increase considerably. No complications in the form of a miscarriage or stillbirths arise. This is what is called embryo “reduction”—another very clever word behind which stands the terrible reality of killing off human beings. Of course no one talks about it openly. But this is what happens.
The problems of a generation conceived in vitro
The first in vitro child was successfully born in 1978, that is, just thirty-three years ago. Thus the technique is still very young. Many couples who undergo the IVF program and obtain their longed-for pregnancy cut the umbilical cord, forget about the institution they patronized, and are reluctant to discuss the in vitro program and its long-term effects.
The longer the IVF program exists, the more information we have about children conceived by this method. Among these children we observe a marked increase in genetic abnormalities. Typically, we observe abnormally delayed psychomotor development during the second to fifth year of life. Later, this psychomotor development begins to level off, and the children catch up those who are conceived naturally. But the genetic abnormalities remain. It has been reported that children conceived and born as a result of IVF ET have a 30-40% increased risk of incurring genetic defects. And these reports are on the increase.
Blessed John Paul II always took the position that science must be allowed to progress—this for the good of every human being, for the good of us all. But he always cautioned the world that this progress should not collide with the dignity and life of any human being. How does this stack up with the IVF program?
Here life is not for all children. The IVF program calls this “selection”—out of six to eight embryos, we select what we deem to be the best two. “Life for a life” That is what the IVF method is. We strive to conceive life at the cost of the lives of other human beings through freezing, embryo reduction (i.e. killing off these “surplus” children developing in the womb), and preimplantation diagnosis, which is now taking the medical salons by storm. You can sample a single cell of an eight-cell embryo—factorize a number, image the chromosome costume to determine the cell’s genetic makeup (or the whole embryo’s, since every cell will be the same)—and decide that the embryo is defective; it has a genetic defect. Such an embryo will certainly not be allowed to live.
Preimplantation diagnosis also enables us to choose traits for our offspring. One percent of American couples reporting to clinics for the IVF program do so in order to place an order for a “customized” child. The child must be burdened with the “defect” that it cannot differ from its parents’ conception of itself. Most often these parents want children of a specific sex, a specific color of eyes, hair, and so forth. Preimplantation diagnosis is not good for society.
John Paul II’s words, “from the beginning of the human being’s existence to natural death,” warrant special attention. Today’s civilization impinges especially on two stages of our life: when we are embryos and when we are ninety years old or so, when we forget what our name is and where we are. We are a “burden” on the people around us. Euthanasia is now almost upon us. Unless we meet its practice with solid resistance and a decisive “no,” it will be here in Poland before we know it, like the IVF program. A grown person will not suffer harm done to him. But an embryo cannot escape. That little homunculus is at our mercy under the microscope, at the mercy of the doctor who answers for this. The same applies to the little gray-haired old man. That is why, when fighting for the life of every single human being at every stage of development, it is so important that we see ourselves in that human being and give glory to God who is the creator of life on earth.
Treating versus preventing infertility
Reproductive medicine talks a lot about the causes of infertility and of ways of treating it. Ninety-nine percent of its attention is devoted to these questions. On the matter of preventing infertility it remains silent. In fact, it ignores it altogether. I do not attribute this to bad will. I imagine the people, the doctors, who do not discuss this are simply too busy. But, generally speaking, infertility is a “business” generating colossal amounts of money. It doesn’t pay either to prevent it or to heal it. Where is the profit in discussing the prevention of this rapidly growing phenomenon of infertility?
Would any doctor in his right mind go on national TV and talk about the virtue of chastity? They’d hoot him down! He’s taken leave of his senses. Pushing chastity in the twenty-first century! But I know from observation that early sexual activity is linked with multiple sexual partnerships prior to entering into marriage. Early sexual activity and multiple partnerships mean that we often catch sexually transmitted diseases. They do not have to be syphilis; they do not have to be gonorrhea. There are thousands of other microorganisms that stealthily, almost asymptomatically, degrade a man’s or a woman’s fertility. They degrade the ability of the cervix to produce mucous, and mucous is the bridge by which the sperm travels into the uterine cavity and oviducts. If there is no mucous, the sperm cells do not travel higher. These infections also impair the man’s reproductive system. They take a toll on his sperm count and weaken the sperm’s motility.
Chastity needs to be promoted. In fact, doctors ought to say to their patients when they appear for their checkup, “I see you are twenty-four years old. The fact that you are a virgin is no mean achievement. You ought to be proud of this and give yourself a pat on the back.” But very few of us do this.
We need to eliminate the harmful factors—contraception chief among them. We go to the store and buy a pack of cigarettes. On the package it says, “Tobacco kills” or “Tobacco smoke hurts children.” Contraceptive pills do not carry such warnings, and yet they are not indifferent to our health or fertility—quite the contrary. Gynecologists today are far too prone to prescribe the pill for any complaint, even without the patient requesting it. Only pharmaceutical companies that manufacture the pill send representatives to the gynecologist. Other companies do not send representatives. Ninety-five percent of the medications prescribed by gynecologists today are contraceptive pills. So no surprise that almost every visit to the doctor ends with him writing out a prescription for a contraceptive. The pill is prescribed everywhere, even to young girls, so as to inoculate them into today’s “culture medium.” I will pass over the matter of carcinogenic estrogens. Estrogens are necessary. They are our hormones—female hormones, but their systemic use, when uncontrolled and of long duration, leads to a higher risk of breast cancer and tumors of the uterine body—only not at the age of twenty-five, but later, at the age of fifty or sixty, when we have forgotten that we ever took contraceptive pills. This fact has been reliably verified and is well known in medical and scientific circles.
Hormonal contraception causes premature aging of the cervix. The patient ages a year in the metrical sense, but her cervix ages three years. After ten years of using the pill, a woman may be thirty years old, but her cervix is fifty years old. Then there is the problem of conceiving. You may have good sperm cells, good egg cells, but there is no bridge. Hence the invention of artificial insemination. Hence the in vitro program. And yet all we need do is seek other methods, other ways.
But everyone knows the pharmaceutical industry is a colossally lucrative business with contraceptive products holding pride of place. Who is going to part with this? Several hundred or several thousand individuals make vast sums of money experimenting on others without respecting their health. Small wonder we receive no objective information from the mass media. Just about every woman’s magazine runs articles about “living in freedom” and being “a liberated woman.” Liberated from what? So as to die of breast cancer after thirty years? Putting out such information across the ether is simply a criminal act. But such is the world we live in.
To avoid infertility we also need to lead a healthy lifestyle. No need to elaborate on this point. What is even more important is changing our model of when to have that first pregnancy. At age 20 we are healthier and more fertile than at age 30. Instead, at the age of 25 or 30 we struggle to get a good education so as to secure a good profession so as to attain that level of prosperity—today’s material minimum, a car, a house, etc. etc. And so we blithely propel ourselves into that segment of the population which suffers from infertility.
But let us not forget the most important positive Factor—God, who is the giver of life and fertility. Without His will the world would not have come into being; neither would our parents, nor would we ourselves. Without His role we would be unable to conceive children. Let us respect His view in this matter, and let us live in harmony with Him.
Tadeusz Wasilewski, M.D., Białystok, Poland