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Since the birth of the first test tube baby in the United Kingdom in 1978, more than eight million babies conceived through in vitro fertilizationfertilizing human eggs in a laboratory and then implanting them into a womans uterushave been born, the vast majority of them in Europe and North America. Between 1 and 2 percent of all children born in the United States each year are conceived through in vitro fertilization. For many couples who struggle to conceive naturally, IVF allows them to become parents in a way unimaginable only two generations ago.

Who could find fault with that?

In reality,the methods by which children are conceived through IVF can be problematic for anyone who believes that human life begins at conception and should occur through natural means. That is the teaching of the Catholic Church,which also teaches that the removal of the conception of a child from the sexual relationship between spouses is a problematic notion.Many other many religious traditions worldwide accept IVF technology, with varying definitions of what processes should be allowed.

Over the last four decades, bioethicists and church leaders have tried to reconcile church teaching on these issues with the fact that, for many couples, technological assistance is necessary to conceive. We are not anti-science, the church has argued, but we are against treatments and procedures that violate the dignity of human life and discard a central reason for marriage.

The church objects to IVF on two separate grounds, the first being that fertilizing an egg in a laboratory removes the conception of the child from the marriage act. In a 1998 article for the U.S. Conference of Catholic Bishops, Begotten Not Made: A Catholic View of Reproductive Technology, John Haas, then the president of the National Catholic Bioethics Center and a consultant to the N.C.C.B. Committee for Pro-Life Activities, stated the rationale behind this objection:

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The Vatican made a similar argument in a 1987 clarification issued by the Congregation for the Doctrine of the Faith and signed by Cardinal Joseph Ratzinger, then the prefect of the C.D.F., titled Donum Vitae (The Gift of Life). Implanting a fertilized egg into the uterus in the hopes of a pregnancy, the document stated, objectively effects an analogous separation between the goods and the meanings of marriage because it is seeking a procreation which is not the fruit of a specific act of conjugal union. In other words, sex between married persons is meant not just to be unitive, bonding the couple in love, but also procreative, meant for the conception of children. A parallel understanding of sexunderpins the churchs teaching in Humanae Vitae (On Human Life), the 1968 papal encyclical affirming the churchs ban on artificial birth control.

Donum Vitae further stated, citing Canon 1061 of the Catholic Churchs code of canon law, that fertilization is licitly sought when it is the result of a conjugal act which is per se suitable for the generation of children to which marriage is ordered by its nature and by which the spouses become one flesh. But from the moral point of view procreation is deprived of its proper perfection when it is not desired as the fruit of the conjugal act, that is to say of the specific act of the spouses union.

Similarly, a 2008 document from the C.D.F., Instruction Dignitas Personae on Certain Bioethical Questions, signed by its prefect at the time, Cardinal William Levada, argued that any medical techniques used for the treatment of infertility must respect three fundamental goods: a) the right to life and to physical integrity of every human being from conception to natural death; b) the unity of marriage, which means reciprocal respect for the right within marriage to become a father or mother only together with the other spouse; c) the specifically human values of sexuality which require that the procreation of a human person be brought about as the fruit of the conjugal act specific to the love between spouses.

Medical efforts that assist procreation, the document states, are not to be rejected on the grounds that they are artificial. As such, they bear witness to the possibilities of the art of medicine. But they must be given a moral evaluation in reference to the dignity of the human person, who is called to realize his vocation from God to the gift of love and the gift of life.

Dr. Haas noted that Donum Vitae was not meant to be seen as a negative reaction to the use of medical technology to assist couples trying to conceive; rather, it teaches that if a given medical intervention helps or assists the marriage act to achieve pregnancy, it may be considered moral; if the intervention replaces the marriage act in order to engender life, it is not moral. For example, the church accepts NaProTechnology, a form of natural family planning that incorporates scientific research and advanced medical techniques for predicting ovulation and levels of fertility, as a valid method for assisting couples trying to conceive.

Catholics in the pews have a reputation for being somewhat cavalier regarding the churchs teachings on human sexuality and reproduction. While the church obviously does not determine the morality of an action or trend by the percentage of Catholics who perform it, one study, released in 2011 by the Guttmacher Institute, suggested that 98 percent of sexually active Catholic women in the United States between the ages of 17 and 44 had used artificial contraception at some point, in direct contravention of church teaching.

IVF, however, may cause other ethical dilemmas for the faithful. Many attempts to implant an egg into a womans uterus involve fertilizing a number of eggs and implanting a number of embryos in the uterus at once, then reducing the number of viable fetuses through abortion surgeries before the full number come to term. In many other cases, excess embryos are frozen and stored. Church teaching is that life begins at conception, and that from the moment of conception the fertilized egg is a person. For anyone who accepts this premise, the conclusion is inescapable: The selective elimination of implanted embryos is the killing of innocent human beings, and the storage of embryos in a frozen state is a violation of their human dignity.

Most studies suggest that over 90 percent of embryos conceived through IVF will dieand not just from selective abortions, as the medical process has an extremely high failure rate. To be fair, natural conception also does not always offer great odds of success: The U.S.C.C.B. estimates that 15 percent of known pregnancies end in miscarriage, while the Centers for Disease Control estimate that half of all pregnancies in the United States end in miscarriage or stillbirth, and many millions of women never know that they suffered a miscarriage.

The pastoral response to this is difficult for parish ministers and health professionals. Most couples marry with the expectation of a family. When infertility becomes an obstacle, it is not just an issue of the procreative nature of marriage but its unitive nature as wellif people marry with the assumption that children will follow, and that proves impossible, the unitive element of marriage can be badly hurt. The theologian Lisa Cahill hasargued that the church's ban on IVF even when it does not include donors or surrogates "fails to foreground its teachings about sex, love and parenthood in the actual experiences of married parents or of infertile would-be parents" (America, March 28, 1987). Many pastoral ministers know of couples who have suffered as they parsed out what it meant that one or both spouses could not conceive naturally.

As reproductive technologies improve and proliferate, the ethical dilemmas will affect more and more couples. Most American Catholics now know adults, themselves now sometimes parents, who were once upon a time called test tube babies. Their witness enters the conversation as well.

And now we move to the most difficult ethical question: What about the embryos that were frozen? The teaching of the church is that each and every one is a unique human being who deserves to be born and to flourish. So should the church allow infertile couples to become pregnant through IVF using embryos currently in storage? It might violate the principle that a child should be conceived through sex, but it could also be seen as a mercy to the embryos themselvesand a grace to childless couples seeking to live out the procreative nature of their marriage.

One problem? There are at least 400,000 frozen embryos in the United States alone. Other estimates suggest the number might approach a million.

What to do with those 400,000 or more embryos, the castoffs of a well-funded industry that carefully euphemizes what is required and lost to implant a viable embryo in a healthy uterus? Couples who choose IVF face cruel choices yearly because they are typically asked to pay $600 or more a year to keep their embryos frozen rather thanhave them discarded. But what if they could offer those embryos to parents who are struggling with conception? What if childless couples could adopt such embryos and raise them as their own?

It would require some clarification of the teachings of the Catholic Church on the issue, or at least a nuance added to existing doctrine, because Donum Vitae states that the notion that embryos could be put at the disposal of infertile couples as a treatment for infertility is not ethically acceptable and would also lead to other problems of a medical, psychological and legal nature. But with the teachings already applied to vaccinesthat what has already been created is licit to use, even if its origins were not necessarily licitmight it be possible to give childless couples the chance to bear the forgotten?

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Why does the Catholic Church object to IVF? It's more complicated than you think. - America Magazine