The Department of Health and Human Services (DHHS) is currently trying to determine whether infertility treatments should be included in individual and small-business health-care policies that will be made available through state-based insurance exchanges in the new health-care plan. If these treatments are deemed an “essential health benefit,” they will be covered when these policies are made available in 2014. But if they merely constitute a “life-enhancing” but not essential benefit, coverage won’t be provided. An Institute of Medicine (IOM) panel is currently weighing these matters.
There is, of course, a range of treatments when it comes to infertility, everything from nutrition and fertility drugs to in vitro fertilization (IVF). Based on the news coverage, however, the IOM seems to have boiled the whole issued down to the cost of providing IVF.
In IVF, a woman’s egg cells are removed from the ovaries and fertilized in a fluid medium outside of the mother’s body. The fertilized eggs are then put into a special growth medium and permitted to develop until they consist of six to eight cells each. Some of these embryos are then transferred to the mother’s uterus with the hope of an eventual birth.
Typically, numerous eggs are fertilized and permitted to become embryos in this process. Laboratories then judge the quality of those embryos based on the number of cells, evenness of growth, and degree of fragmentation. Scientists may also perform genetic diagnosing or screening in order to weed out those embryos with inheritable diseases. Only those embryos judged best by a doctor end up being implanted, though several may be implanted at one time in order to improve the ultimate chance of a successful birth. The number of embryos to be used depends on the number available, the age of the mother, and other health and diagnostic factors.
IVF is quite expensive. A typical treatment costs about $12,000, and one treatment rarely gets the job done. Success rates vary widely depending on the mother’s age and the specific fertility problems involved. According to the Center for Disease Control and Prevention, women under age 35 who complete one treatment have a 40 percent chance of giving birth. By the time a woman reaches 43 or 44, the figure drops to 5 percent.
Those who want the new health-care plan to cover IVF have been arguing that infertility coverage is a vital need, fundamental to the human condition, and thus it should be covered regardless of the cost. On a recent TV news program, one advocate argued that the decision whether to procreate is a life-sustaining action and what separates us from the animals. She also argued that coverage for IVF is actually less expensive than not providing coverage.
According to this argument, without IVF coverage, many couples will turn to (less expensive) inter-uterine insemination, and that will lead to even higher costs because of the increased likelihood of multiple babies (which means long bed rest for the mothers, more premature babies, long neonatal intensive care unit stays, and an increased number of birth defects). Multiple births are less likely with IVF because only a small number of embryos are implanted.
Lost completely in the IVF debate is the moral issue related to the unborn embryos that are created but not implanted and ultimately destroyed because the scientists find them less than perfect. In fact, many “perfect” embryos can also end up being destroyed. In some cases, embryos may be frozen for potential future use. Too often, those situations end up in very difficult custody disputes.
The Catholic Church has great compassion for couples suffering from infertility, and there are morally legitimate treatments for couples who are unable to conceive a baby, but not all technologies are morally acceptable. IVF entails the creation of multiple embryos with the full knowledge that some will be selected for destruction. That is beyond what the Church can condone, and it does not become morally acceptable just because other, legitimate methods have failed.
In cases where couples cannot conceive even after trying morally legitimate treatments, adoption is a logical and moral choice. At any given moment, there are about 125,000 children waiting to be adopted in the
Philadelphia’s Justin Cardinal Rigali recently said that there is great confusion among Christians when it comes to infertility treatment. He is right: Cost is not the only or even the most important issue when it comes to the life issues that surround IVF. As the DHHS continues with its planning, let’s hope that people of faith and good will are up to the task of at least getting the moral issues on the table.