Out the window, Aimee Arnold could see the Embarcadero and the San Francisco Bay beyond it. It reminded her of her time living in the city. She and her husband, unable to conceive a child, had traveled back to San Francisco from Oregon to visit a well-regarded fertility clinic.
“It was beautiful,” she said of the office. “Very tranquil, very comforting. Everyone was so nice.”
Ms. Arnold was 40 when she and her husband began trying to conceive a child. She described herself as business-oriented, and her career became part of her identity. Her husband supported her in that.
She was fit, and members of her family had many children, so Ms. Arnold expected a pregnancy would happen eventually. But by the time she was 43, the couple still had not conceived, and so she found herself sitting by that window in San Francisco.
“For some reason, I didn’t get the memo about trying to conceive at a younger age,” Ms. Arnold quipped in an interview with America. “Like, that’s how women’s bodies are made.”
The World Health Organization estimates that, worldwide, one in six couples of reproductive age at some point struggle with infertility, which they define as “the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse.” Studies show that infertility cases are increasingly common, and many factors involving both men’s and women’s bodies, as well as environmental issues, can contribute to the problem.
According to couples with whom I spoke, doctors often recommend in vitro fertilization, or I.V.F., a well-known treatment for infertility. I.V.F. enjoys bipartisan support, and earlier this year, President Trump signed an executive order seeking recommendations for ways to make the treatment more affordable. Still, many Americans, including Catholics, do not fully understand the process.
The Catholic Church does not approve of I.V.F. because it involves the creation of human embryos outside of the womb, in a laboratory setting. There are church-approved fertility treatments, as well as support groups for couples struggling with infertility, but they are relatively unknown, which leaves many Catholic couples feeling lost and alone as they consider their options.
Ms. Arnold was raised Catholic but stopped practicing. She certainly didn’t know about I.V.F. alternatives or support groups and did not fully understand the church’s teaching when she and her husband were experiencing infertility. What she and her husband did know was that they wanted a baby more than anything.
“Trying to conceive at an older age can be a very lonely, solitary thing,” she said. “I didn’t want to let anyone else in. Everyone has their opinions. I didn’t want that to crowd my mind.”
Their doctor recommended I.V.F. and said they had to move quickly, given Ms. Arnold’s age, so they began the process.
How I.V.F. Works
In 1978, Louise Brown became the first “test-tube baby”—that is, the first person born using I.V.F. Her mother, Lesley, had been unable to conceive because of fallopian tube blockage. The media widely covered Ms. Brown’s birth in England, which made the cover of Time magazine.
It took nearly a decade of research and experimenting for that to happen. Over those years, doctors attempted to implant embryos in 282 women. While five had become pregnant, none had given birth to a living baby before Ms. Brown. In 1981, Elizabeth Carr became the first I.V.F. baby born in the United States.
Today, the success rate for I.V.F. varies considerably, depending on the mother’s age. According to the Society for Assisted Reproductive Technology, an egg retrieved from a woman under 35 has about a 45 percent chance of leading to a live birth. If the woman is over 42, the success rate drops to below 3 percent.
During I.V.F. treatment, a process in which conception occurs in a laboratory, women are injected with medication that first shuts down their reproductive systems. Next, they take drugs that stimulate the ovaries to produce many follicles, where the eggs are housed. Doctors then retrieve the eggs through the woman’s abdomen using a needle.
To provide the sperm, the man must masturbate (which the church considers immoral). An embryologist in the lab combines the egg and the sperm. The resulting embryos are left to culture for five days, at which point doctors judge which embryos—called blastocysts at this stage—have a higher likelihood of surviving implantation.
“The idea behind the I.V.F. approach is that if we get enough eggs collected, fertilize all of them, then we can select the embryos that are most viable,” according to Craig Turczynski, who used to run an I.V.F. laboratory and is trained as a reproductive physiologist. His experience in this dates back to the 1990s.
The number of eggs retrieved from a woman’s ovaries varies, he said, but it often surpases the number of eggs generated in a year of ovulation. The average number of eggs retrieved is around 10. Of those, about eight will become embryos. In the early 2000s, doctors would routinely transfer three to five embryos for implantation, Dr. Turczynski said, but now the practice is to attempt one or two at a time. The remaining embryos are frozen in cryopreservation for possible future use. Anywhere from 20 to 50 percent of embryos do not survive cryopreservation.
In Ms. Arnold’s case, doctors created five embryos after egg retrieval. After culturing, the clinic deemed only one viable for implantation. The doctors suggested freezing it while Ms. Arnold took measures to physically prepare to receive it. But a month later, the clinic called to inform the couple the embryo was no longer viable. They were devastated.
Katie McMahon was 33 when she and her husband began the I.V.F. process after seven years of marriage. They had adopted their daughter three years into the marriage but still desired to conceive a child. They first sought treatment for her husband’s low sperm count, and their doctor recommended better sleep and a change in diet.
When that treatment did not work, they began I.V.F. Ms. McMahon had worked for years as a nurse, so she was familiar with the process. The doctors created 12 embryos, seven of whom they deemed viable after they were cultured. The couple transferred one, and the others went into cryopreservation. They joyfully welcomed another daughter to the family nine months later.
Still, Ms. McMahon kept thinking about the six remaining embryos. Month after month, the family paid the fee for cryopreservation, and this reminded the couple of their embryos. “Part of the reason for thinking about them was just the financial piece,” Ms. McMahon said.
She started to pray more, including for the embryos, and the couple considered the church’s position against cryogenic preservation.
“As I began praying for them, I realized, ‘Oh my gosh, these are in fact children that God wants us to take care of, and we can’t take care of them in the freezer,” Ms. McMahon said.
It is impossible to know how many embryos are in cryopreservation, according to Dr. Turczynski. While some estimate the number at 1.5 million, he believes it is more likely between five million and 10 million. That number takes into account that 800,000 embryos are created each year, of which 100,000 are transferred. Half of the remaining embryos, or 350,000, are frozen. Labs began freezing embryos in 1985, 40 years ago.
In the McMahons’ case, the couple decided to transfer and try to give birth to their remaining embryos. “We really did feel like we were pursuing the I.V.F. transfer as a way to save them,” she said. “Either they would be born or they would die in the process, and kind of return to God.”
They miscarried two, and two did not survive the thawing process. After mourning the miscarriages, they tried again. Their third daughter was born nine months later.
“I live with both the joy that I.V.F. can bring and the sorrow,” Ms. McMahon said, adding that she and her husband will not pursue I.V.F. in the future. “A piece of me regrets that I didn’t choose something that God would have wanted for me to see how [God] would show up. He showed up amazingly in spite of the crooked lines that I wrote.”
The church has expressed great concern for couples struggling with infertility in the Catechism of the Catholic Church as well as in “Donum Vitae” and “Dignitas Personae,” two Vatican teaching documents on bioethics.
“The community of believers is called to shed light upon and support the suffering of those who are unable to fulfill their legitimate aspiration to motherhood and fatherhood,” according to “Dignitas Personae.” At the same time, the church is clearly opposed both to artificial means of conception and to practices such as “selective reduction,” in which multiple embryos are transferred simultaneously to increase the chance of achieving pregnancy, with some later being aborted to maximize the chance for safe delivery of those that remain.
Ms. McMahon has come to accept that teaching, but she added that she and her husband did not find much support in the church for people dealing with infertility.
“We were so desperate, my husband and I would have probably done anything,” she said. “No one walked us through the idea of redemptive suffering. And a lot of times, that’s the way we get closer to God. Like we really should be reaching out to God first.”
Eventually, she did find someone who would accompany her.
Ministries of Accompaniment
In Texas, a lack of resources for those struggling with infertility drove Lauren Allen to start her own community of support. Her journey began even before she was married, when she started charting her menstrual cycle. Through charting, Ms. Allen discovered she might have polycystic ovarian syndrome.
Ms. Allen and her husband tried to conceive immediately after their marriage because they understood it would be difficult. They have been married for five years and still have not had a pregnancy.
“The Catholic Church does, in my opinion, a very poor job on focusing on what the vocation of being a wife and mother is,” she told me. “Even in our marriage prep, there was never a conversation on infertility. It was, ‘You’re going to be open to life and multiply.’ So as a Catholic woman, there’s that pressure and the idea, ‘This is what I’m supposed to do to glorify God: give my husband a child.’”
Ms. Allen found some blogs from women sharing their infertility stories, but the blog would end if its author conceived a child. She searched for resources online but found few. Eventually, she pitched the idea of starting a website to a support group on Facebook.
Within a week, it all came together, and Ms. Allen launched The Fruitful Hollow, a Catholic resource and a community for those who struggle with infertility. Ms. McMahon discovered the collaborative group after her experience with I.V.F.
“Our goal is to help women carry the cross of infertility with grace,” Ms. Allen said. “There’s no judgment with us. There’s a lot of love and respect for human life.”
Over the last few years, Ms. Allen has connected with countless Catholic women who report feeling judged when they go to church because they do not have children. She said she met one woman who had 15 miscarriages.
“They need accompaniment,” she said. “Infertility leaves big wounds. People don’t think about it. It comes with fear and anxiety. We never want to make people feel like they’re not welcome or like we’re condemning what’s happening. The important thing is love and compassion for what everyone is going through.”
Eventually, Ms. Allen and her husband adopted two boys.
Like the Allen family, Ann M. Koshute and her husband started trying to have children right away. She was in her early 40s when they married.
“I’m the youngest of two and he’s the youngest of 16,” she said. They knew it might be more difficult given their age but believed they would eventually welcome a new life into their home. “We come from loving, faithful Catholic families,” Ms. Koshute recalled thinking. “Even if it takes a little bit longer, that’s OK. God is going to bless us with children.”
But month after month and then year after year, it didn’t happen.
Ms. Koshute, who has been married for 14 years, described the tendency of some fellow Catholics to measure the holiness of a couple by their family size. When couples do not have children, she said, some in parish communities assume they are using contraception or are more focused on their careers.
“We get into murky waters when we make those kinds of judgments about other people without knowing their story,” she said. “For the most part, couples who are carrying this cross are not going to reveal that or talk about it openly.”
Many Catholic couples with infertility feel ashamed, she said.
Before she was married, Ms. Koshute earned a graduate degree from the Pontifical John Paul II Institute for Studies on Marriage and Family. She said she understands and believes in the church teaching on I.V.F., but also understands why couples consider it.
“There were moments in the deepest part of my sadness and despair and confusion about the whole thing when I thought, ‘Why can’t we just do this? Why can’t the church make this accommodation for a desire and a suffering that is so great?’” she said. The thought was fleeting, but Ms. Koshute stressed the importance “for the church, for our pastors, for people in our families, for those who are going through this struggle, to be able to acknowledge the deep desire, pain, sadness—so many complex emotions that go with this particular cross.”
Ms. Koshute did not find the pastoral support she needed from the church, and neither did Kimberly Henkel, her classmate from the institute. Ms. Koshute lives in Pennsylvania and Ms. Henkel lives in Ohio, but the two co-founded Springs in the Desert in 2019. The Catholic infertility ministry has grown into a national effort with a seven-person core team that works alongside volunteers and contributors.
“We like to say our focus is on Christ and not conception. We’re here to walk with people, wherever they are on the path of infertility or loss,” Ms. Koshute said. “Infertility is a circumstance. It’s not our identity, and it doesn’t define a marriage. Every single marriage is good and is called to be fruitful in so many ways, often ways that are unexpected.”
Both Ms. Allen and Ms. Koshute said the church can do more. To begin with, priests and people in the pews should be aware of the prevalence of infertility and be sensitive to the complex emotions that come along with it, Ms. Koshute said.
“To be aware that the miracles that happen—and they certainly do—don’t necessarily happen for every couple in every situation,” she said. “We place such a value on children, and rightly so. Marriage is ordered toward children. But it isn’t only ordered toward children.”
Fruitfulness, in other words, is not limited to birthing children.
“All Christians are called to give life in the world,” Ms. Koshute said. “We’re called to conceive Christ in our hearts and to birth him through so many different ways that we interact in our families and in the world.”
If one in six couples struggle with infertility, Ms. Allen said, it does not make sense to focus only on the “big Catholic family.”
Being Catholic in a Pro-I.V.F. World
Molly McBride lives with her husband and four children in Rochester, N.Y. She had a miscarriage early in her marriage and had a pregnancy with twins who were stillborn.
“Seven total—four who are currently trashing my house,” she told America. “I knew at the very beginning that I cared about my Catholic faith and about sticking with what I thought was morally right. And in hindsight, it’s easier for me to say that because it all worked out for me. I ended up with what I wanted.”
Like Ms. Allen, Ms. McBride has polycystic ovarian syndrome.
“The first doctor I went to was like, ‘You can do nothing or you can do I.V.F.,’” she said. “It’s like they’re not even addressing what is wrong with my personal body. They’re just pushing me down this conveyor belt of I.V.F.”
Ms. McBride described walking into I.V.F. clinics and finding beautiful baby pictures everywhere.
“It’s like, ‘You want to have a baby. We want you to have a baby. Let’s have a baby by Christmas!’” she said. “It’s all so positive, you could very easily get sucked into it.”
In her case, Ms. McBride had to advocate for herself. The Catholic doctor in town did not take her insurance. But she found a doctor who, despite not sharing her moral reservations about I.V.F., still listened to her opinion.
“And actually the issue that I have can sometimes be controlled by losing weight or controlling your diet or reducing stress—or taking more vitamins,” she said of her experience in the clinic. “Not everything that happens in a fertility clinic is terrible. Not every person who steps foot in there is doing something morally wrong.”
Ms. McBride hopes other women in her situation will find a doctor who will respect their values. The church might also consider helping with the cost of adoptions, she said, which in the United States can range from $20,000 to $45,000, according to a report from the U.S. Department of Health and Human Services’ Child Welfare Information Gateway.
Ms. McBride also hopes couples who have conceived using I.V.F. do not feel judged by the church. “It’s just such a core desire for people that I can understand why people are like, ‘I will do anything that’s possible to have a baby,’” she said, though she added that, morally, this could become “a slippery slope.” She also said, “[But] I hope that people don’t look at their child and say, ‘I should never have had this child because I did I.V.F.’ I assume most people are thrilled. If a baby was born through some unideal means…you would never look at that baby differently.”
Still, like Ms. McBride and her husband, Catholic couples struggling with infertility have a number of church-approved options they can pursue instead of I.V.F.
“Infertility is not a disease,” according to Marguerite Duane, executive director of Facts About Fertility. “It’s actually a symptom of other underlying diseases. And to effectively treat infertility, you really need to treat the underlying root causes to restore the reproductive system the way it’s designed to function.”
Dr. Duane named three modern approaches to restorative medicine treating fertility: natural procreative technology, or NaPro; fertility education and medical management, or FEMM; and NeoFertility.
These treatments fall under the umbrella of restorative reproductive medicine, or R.R.M., a medical discipline that seeks to heal the causes of infertility and conceive naturally. Ongoing research suggests that R.R.M. can be as effective or sometimes even more effective than I.V.F.
Studies have reported a range of success, from 29 percent to 66 percent of couples using R.R.M. having a live birth. Researchers in Ireland, for example, found R.R.M. to be as effective as artificial reproductive technology, like I.V.F. One recent study, though not yet peer reviewed, found R.R.M. to be 40 percent effective, compared with 24 percent for couples using I.V.F.
“I.V.F. promises that they’re going to make a baby. And they may be able to make an embryo in a test tube. But the reality is that the embryo has to be transferred into a woman’s body where it can be able to grow,” Dr. Duane said.
Women who cannot conceive naturally often suffer from underlying hormonal, autoimmune or inflammatory conditions that prevent them from getting pregnant, she said. Left untreated, those conditions may also prevent an I.V.F. pregnancy from continuing.
“To try to treat infertility by creating embryos is to fail to actually do what women deserve, and that is to actually get a diagnosis and treatment for those underlying causes,” Dr. Duane said. She specifically noted endometriosis (which is often characterized by painful periods) and polycystic ovarian syndrome, or P.C.O.S. (which is often characterized by irregular periods), as leading causes of female infertility that can go untreated for over a decade.
Still, R.R.M. has not been as thoroughly studied as artificial reproductive technology. The R.R.M. process can be a heavy lift, and it generally takes longer than I.V.F. Ms. Allen worked with a NaPro doctor, but it took two years to get her complete diagnosis. Ms. Koshute and her husband also tried NaPro, watched their diets and began a specific approach to menstrual cycle charting, called the Creighton Model FertilityCare System. They went through surgeries, took tests and tried supplements.
“It’s wonderful that science is going in that direction, toward ways of healing our bodies and attending to our natural bodily rhythms rather than frustrating or kind of manipulating them in ways that some of these artificial technologies do,” Ms. Koshute said. “But there was another side to all of that: the physical toll that these treatments take, the emotional and spiritual toll on our marriage because you’re having to plan out your intimacy.”
Still, according to the people I interviewed, R.R.M. offers a better path forward. Dr. Turczynski, who is Catholic and based in Texas, left the fertility industry after being involved for years, citing the harm he believes it causes patients as the reason for his decision.
“In the I.V.F. industry, that whole diagnosis of what’s causing infertility is becoming less and less defined,” he said. “It doesn’t matter if you have blocked tubes, or [there is a] male factor or endometriosis or uterine factor, or you’re older and you’re not ovulating. All of those will still be treated the same way”—that is, with I.V.F.
I.V.F. can cost from $15,000 to $150,000. The cost fluctuates depending on how many rounds of egg retrieval couples attempt, and on whether the process involves egg donation or surrogacy. In a few states, Medicaid helps pay for I.V.F. Some health insurance providers also cover it.
In addition to Springs in the Desert and Fruitful Hollow, Red Bird Ministries, which helps address couples mourning miscarriage and the loss of an infant, may also be helpful. Ms. McMahon got involved with Shiloh, a post-I.V.F. healing resource, after her experience.
“We have two living children that were conceived by I.V.F. now,” Ms. McMahon said. “But we have 10 others that died in the process of I.V.F.”
Diedre Wilson, a Catholic doctor who specializes in NaPro, expressed concern for the potential long-term impact on women who take strong drugs before undergoing egg retrieval. In some cases, women suffer from ovarian hyperstimulation syndrome, a painful swelling of the ovaries, as a side effect of the process.
“We need a new evangelization in health care,” she said. “I.V.F. took us backward because it has made it so that you don’t have to look at and solve these underlying medical conditions. We can just bypass them, and that’s darkened our medicine.”
Dr. Wilson estimates that couples who try NaPro have a 50 percent chance of, as she put it, “bringing home a baby.” I met one of them.
‘A Lot That Is Not Told’
The Zorita family live in a single-story home with gravel, agave and a variety of cacti in the front yard. The desert plants take time to grow, but even in the brutal Arizona climate, they eventually bloom.
The temperature reached nearly 100 degrees outside when I met with the family. Their small dog, Daisy, greeted me at the door and accompanied me throughout the visit. Millán opened the door and offered me a cool glass of water.
Millán, a firefighter, has a firm handshake and a penchant for the classics. You will find Fyodor Dostoevsky, Leo Tolstoy and Evelyn Waugh on his bookshelf. He also writes about Francisco Suárez, S.J., a 16th-century Spanish Jesuit theologian and philosopher whose thought profoundly influenced Western society. Millán presents papers on Suárez in English and Spanish, both in the United States and overseas.
I did not know any of this when I visited Millán and his wife, Lisa, in their Phoenix-area home. I met them in passing decades ago at All Saints Catholic Newman Center on Arizona State University’s Tempe campus. We sometimes attended the same Mass.
I knew Lisa as a co-founder of Maggie’s Place, a Phoenix-based organization that provides safe housing and a supportive community for homeless pregnant women. Lisa is involved in community development and has worked within the prison system. She and Millán are also respite foster parents and have welcomed a mother and baby into their home to support them in a challenging moment.
Lisa and Millán married in their mid-30s and struggled with fertility for a decade, including three miscarriages.
“There’s a physicality to the miscarriage, and the connection,” Lisa said, describing the bond between mother and unborn child. “It is difficult. It’s a cross.”
Lisa told me she and Millán “would have wanted a bushel of kids.” But like others I spoke with, they never considered I.V.F. because of their beliefs.
“There’s no judgment for folks who have chosen that route,” Lisa told me, “except that there’s just a lot that is not told. Heartache, medical challenges, ethical decisions of what you do with all of these embryos that are created.”
While visiting the Zorita home, I also met Catalina. Lisa and Millán were not sure they would ever meet her. She is their 12-year-old daughter, who was born in part thanks to Dr. Wilson’s help and treatments that sustained the pregnancy. The two lay Dominicans named their daughter after St. Catherine of Siena.
“I think what St. Catherine said is true, that if you do what you’re meant to do you will set the world on fire,” Lisa said. “And Catalina is a firecracker, that’s for sure…. Faith does not mean everything works out as we planned. Faith is a light that lights up the way that ultimately opens a larger plan.”
