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. 2022 May 20;89(4):404–419. doi: 10.1177/00243639221101839

The Unitive Meaning of the Conjugal Act in Evaluating Assisted Reproductive Technologies

Wendy Laurento 1,✉
Editor: Peter J Colosi
PMCID: PMC9743037  PMID: 36518714

Abstract

Humanae Vitae taught that sexual relations must respect both the procreative and unitive meanings of the marital act. Most Catholic ethical analysis of assisted reproductive technologies (ART) has focused on whether the procedure assists or replaces the conjugal act. This paper proposes that such an approach is missing an essential element—namely, whether the procedure respects the unitive meaning of the conjugal act. Pope John Paul II’s “theology of the body” provides principles for understanding the unitive meaning. In this light the conjugal act, which is a union of persons, is characterized by respect for the personalist norm, total mutual self-gift, the freedom of the gift, spousal exclusivity, and the spousal communio personarum. In addition to considering the procreative meaning, the moral evaluation of ART should also consider whether the unitive meaning of the conjugal act is respected. When viewed within this framework, certain kinds of ART that are considered morally licit by some ethicists may be impermissible because, or to the extent that, they violate the unitive meaning of the conjugal act.

Keywords: Artificial insemination, IVF, Test tube baby, TOB in vitro fertilization, Purposes of sex, Procreative, Unitive

Introduction

Moral reflection on assisted reproductive technologies (ART) is younger than I am. I remember the headlines when Louise Brown, the first “test-tube baby,” was born in the United Kingdom on July 25, 1978. At that time, there was no defined body of magisterial teaching to provide direct answers to the ethical questions raised by ART. This paper arose from my interest in helping ethicists develop an adequate framework for evaluating ethical issues in this burgeoning field.

Ten years before Louise Brown was conceived in vitro, Pope Paul VI’s encyclical Humanae vitae addressed the problem of contraception and taught that the marital act has unitive and procreative meanings, which must be preserved in order for an act of sexual intercourse to be a truly conjugal act capable of fostering mutual love and generating new human life (1968, para. 12). Contraception is wrong because it rejects both the procreative and unitive dimensions of the marital act (Burke 1988). Nineteen years later, while John Paul II was pope, the Congregation for the Doctrine of the Faith under Joseph Ratzinger (later Pope Benedict XVI) issued the instruction Donum vitae to address the problem of assisted reproductive technologies wherein the unitive dimension of the marital act is violated. Donum vitae insisted that “the procreation of a new person, whereby the man and the woman collaborate with the power of the Creator, must be the fruit and the sign of the mutual self-giving of the spouses, of their love, and of their fidelity” (1987, II.A.1). It then set forth the normative rule for assessing the morality of ART which has become the primary test applied by Catholic ethicists since then: “If the technical means facilitates the conjugal act or helps it to reach its natural objectives, it can be morally acceptable. If, on the other hand, the procedure were to replace the conjugal act, it is morally illicit” (Donum vitae 1987, II.B.6).

Twenty-one years after Donum vitae, the Congregation for the Doctrine of the Faith issued Dignitas personae to respond further to new reproductive technologies. Dignitas personae lists a variety of fertility treatments that do not replace the conjugal act and are morally acceptable—for example, hormonal treatments, surgery for endometriosis, and surgically repairing fallopian tubes (2008, 13). 1 The list of licit procedures is not exhaustive, but it is noteworthy that it does not include techniques that require sperm to be withheld from an act of sexual intercourse or the intervention of a technician after an act of intercourse.

The Church’s magisterium has not issued any subsequent teaching regarding ART in the 14 years since Dignitas personae. Meanwhile, the technologies continue to change and the kinds of patients using these technologies have also changed. Now we have same-sex couples employing ART, gestation in a transplanted uterus of children conceived through in vitro fertilization, and human embryos being created with genetic material from three parents. The technology is developing at an explosive pace, but Catholic ethicists have continued to analyze the ethics of these technologies using exclusively the traditional moral toolbox inherited from the Scholastic tradition. Their focus has been on whether a procedure assists the marital act (in which case it is licit) or replaces the marital act (in which case it is not morally permissible). Within this analytical framework they have been unable to reach consensus on a number of the new technologies such as Gamete Intra-Fallopian Transfer (GIFT), Tubal Ovum Transfer with Sperm (TOTS), Intrauterine Insemination (IUI), and at-home cervical cap insemination kits. (These procedures are described in detail later in this paper.)

One thing these assisted reproductive technologies have in common is that they affect human persons at the deepest level of their being. They invoke the creative power exclusive to God, and they touch the most intimate, personal core of the couple’s identity as individuals and as spouses. Something is lacking in an ethical analysis that fails to address the effect of these technologies at that deeply personal level. Most moral analysis is focused on the objective aspects of the technologies (does x procedure assist or replace the conjugal act?) and pays no heed to the interpersonal aspects (does x procedure strengthen or harm the couple’s conjugal life?). Ethicists closely evaluate the causal links between a technological intervention and fertilization to determine whether conception is the result of the marital act and whether the act retains its procreative meaning. While that is a necessary component of the moral analysis, it is not sufficient. The Church does not teach that a procedure is morally acceptable if it facilitates the conjugal act or helps it reach its natural objectives, but only that it “can be morally acceptable” (De Marco 1991, 207–208, quoting Donum vitae). Humanae vitae holds that both the unitive and the procreative dimensions must be respected in generating new human life and fostering true spousal love. So, in judging the morality of ART this paper urges ethicists to assess whether a procedure respects the unitive meaning of the conjugal act, not only the procreative meaning.

The Unitive Meaning of the Conjugal Act

What exactly is the “unitive meaning” of the conjugal act? Humanae vitae does not say. In God’s providential timing, as soon as scientists first achieved success with human in vitro fertilization Pope John Paul II began presenting a groundbreaking series of weekly catecheses that, among other things, fleshes out the spartan doctrinal statements of Humanae vitae and sheds light on what is meant by the “unitive meaning” of the marital act. This rich body of teaching given between 1979 and 1984 is known as the “Theology of the Body” (TOB). The TOB was the fruit of Father Karol Wojtyla’s decades of theological and philosophical reflection before he was elected bishop of Rome on October 16, 1978. It is an extended reflection on what it means to be a human person, both body and soul, made in the image and likeness of God and called to an eternal destiny in God. Its method is a synthesis of reflection on Sacred Scripture, the Scholastic tradition (marked by its search for truth via objective analysis) and personalist philosophy (marked by its search for truth via analysis of the subjectivity of persons). John Paul II’s insights in the TOB and elsewhere develop what is implied in Humanae vitae’s unadorned references to the “unitive meaning” of the marital act.

Well before offering his TOB catecheses as pope, Karol Wojytla wrote about the threat to the unitive dimension of the marital act when the act is pursued as a means to the end of procreation. In Love and Responsibility, he strongly criticized the rigorist and puritanical view of marital intercourse as being good only because it serves the end of procreation (Wojtyla 1981, 58). This view exalts procreation at the expense of personal union, endorsing a form of utilitarianism that is influenced by the ancient Manichean rejection of marriage as something carnal and therefore evil (Wojtyla 1981, 58–59). John F. Crosby, a personalist philosopher and student of Wojtyla’s thought, makes this observation:

For if [the spouses] put their sexual union in a mere instrumental relation to offspring, so that in their sexual intimacy they are using each other for getting a child, then their action is personalistically indefensible. The excellence of the end does not abolish the disorder that results when persons achieve the end by using each other. Though Wojtyla makes much of the necessity of remaining open to offspring (as in his rejection of contraception …), he is aware that there is a way of practicing this openness that involves the violation of the spouses as persons (2004, 250).

Before assuming the Chair of St. Peter, Wojtyla was a philosopher in the tradition of Christian personalism, which is characterized by its employment of a philosophical and/or theological model of “person” as the point of departure for further analysis of a subject matter such as moral action or bioethics (Dern 2004, 9). In the personalist approach of Wojtyla, the greatest personal experience is the I-Thou encounter of one person with another (Dern 2004, 10).

One principle that pervades Wojtyla/John Paul II’s teachings about procreation and sexual relations is that the act which transmits life and unites the spouses is a personal act. 2 This principle is only hinted at in magisterial teaching prior to John Paul II’s papacy. 3 For John Paul II, the unitive meaning of the marital act refers first and foremost to its being a union not primarily of bodies but of persons (Crosby 1993, 215). In the TOB, John Paul II taught that precisely in the field of conjugal relations, “which is so deeply and essentially human and personal, one must before all else look toward the human being as a person, toward the subject who decides about himself or herself, and not toward the ‘means’ that turn him into an ‘object’ (of manipulations) and ‘depersonalize’ him…. The whole problematic of the encyclical Humanae vitae is not simply reducible to the biological dimension of human fertility … but goes back to the very subjectivity of the human person, to that personal ‘I’ through which the person is man or woman” (TOB 129:3, emphasis in original). 4

With John Paul II as guide, I will attempt now to identify the characteristics of the unitive meaning of the conjugal act and their significance to reproductive technologies. 5

The Personalist Norm

A key to John Paul II’s understanding of what it means to be a human person made by a loving God in His image and likeness is found in Gaudium et spes 24: “[M]an, though he is the only creature on earth which God willed for its own sake, cannot fully find himself except through a sincere gift of himself” (Second Vatican Council 1965). The first statement in this paradox is, according to John Paul II, a restatement of the personalist norm expressed by Kant in the words, “each person is an end in himself and is never to be treated, whether by himself or by another, as an instrumental means for realizing some result” (Crosby 1993, 206). For John Paul II this “personalist principle” is the first principle of morality (Crosby 1993, 206). It is never permissible to use a person as a means towards an end (Wojtyla 1981, 27). Wojtyla always measures relations between man and woman in reference to this norm, asking whether either person is using the other or whether they are mutually using each other (Crosby 2004, 249).

Shame, according to John Paul II, is the feeling that arises in one who feels that he or she is being treated as an object in the sexual realm (TOB 19:1, 30:6, 31:1). This shame is not a sense of moral fault on the part of the person who feels it, but is a sign that points to a threat to the value of the person and at the same time preserves that value in an interior way (TOB 28:6). Crosby describes this as a sort of “noble sexual shame that is a kind of ‘personalist instinct’” that protects against violation of the personalist norm (2004, 256). Shame serves as a warning sign when a spouse feels that he or she is being used in the marital act as a means to an end. This can be experienced by husbands as well as wives. More commonly one thinks of a wife sometimes feeling used for sensual pleasure, but a husband can also feel used as a means to conceiving a child.

Freedom of the Gift

The second part of the quote from Gaudium et spes 24 (“man … cannot fully find himself except through a sincere gift of himself”) forms the germ of John Paul II’s “theology of the gift,” which he elucidated in the TOB. The entire argument of the TOB may be expressed in these words of Pascal Ide: “Gift expresses the essential truth of the human body” (Waldstein 2006, 124).

What John Paul II means in speaking of the body as gift is that “the human body, with its sex—its masculinity and femininity … contains ‘from the beginning’ the ‘spousal’ attribute, that is, the power to express love: precisely that love in which the human person becomes a gift and—through this gift—fulfills the very meaning of his being and existence” (TOB 15:1). Donum vitae places this concept of self-gift firmly within the Church’s historical tradition in this quote from Pius XII: “In its natural structure, the conjugal act is a personal union, a simultaneous and immediate cooperation on the part of the husband and wife … which is the expression of the mutual gift which, according to the words of Scripture, brings about union ‘in one flesh’” (Donum vitae 1987, II.B.6, quoting Pius XII, Italian Catholic Union of Midwives, AAS 43 (1951): 850).

The spousal meaning of the body is linked exactly to the interior freedom of the gift—the freedom to make a complete gift of oneself to another (TOB 15:1). In order to make a gift of self, the person must be the master of oneself—in other words, must be free (TOB 15:2). In the TOB John Paul II focuses at length on how concupiscence entails the loss of the interior freedom of the gift, particularly when it leads to the use of intercourse for one’s own pleasure and denies the procreative meaning of the act (TOB 32:4–6, 33:1–5). But there are other factors besides concupiscence that can impair interior freedom and thereby threaten the freedom of the gift. Psychological coercion presents a threat to interior freedom that is highly relevant to our discussion of the unitive dimension of the marital act.

Where coercion is present, a person feels pressured to act a certain way by an external force that threatens something harmful or undesired if not obeyed. As Part II of this paper will argue, ART protocols are coercive because they prescribe exactly how and when spouses must supply sperm and ova, or else the procedure will not be successful. This is true even for those ART procedures that are not clearly immoral based on the procreative analysis. A protocol that demands spouses have sexual intercourse within a narrowly defined window of time that is synchronized with a technical intervention is inherently coercive. When spouses engage in the marital act in compliance with such a protocol, the freedom of the gift is impaired.

Exclusivity of the Spousal Relationship

Another essential characteristic of marital love and, by extension, the conjugal act, is that it is exclusive (Humanae vitae 1968, 9). No person other than the husband and the wife may participate in the acts that are proper to the spouses alone.

Protected by the bond of exclusivity, husband and wife form an intimate communion of persons. Only in the intimacy of their exclusive union can the spouses find the conditions necessary safely to entrust their person to the other in confidence, to know each other in the fullest sense “with all the peace of the interior gaze” (TOB 13:1, 61:2). 6

The Child as the Fruit of the Communio Personarum of the Spouses

Undergirding Donum vitae’s insistence that the procreation of a new person must be the “fruit” and the “sign” of the “specific act” of mutual self-giving of the spouses (Dignitas personae 2008, 12; Donum vitae 1987, II.B.4) is the concept of the communion of persons (communio personarum) formed by the spouses. For John Paul II, the intimate communion of persons formed by the spouses within their exclusive marital bond is an icon of the divine communio personarum (TOB 9:2–3, 10:3; Mulieris dignitatem 1988, 6–7). The expression of love in which two human persons make themselves a complete gift to the other, with the potential life-giving that entails, is the primordial sacrament and sign by which we come to know and participate in the life of the Trinity (Donum vitae 1988, 3; TOB 21:4–7, 95b:6–7, 96:1–7). In both the sacramental sign and in the divine reality to which it points, we see that communions of persons have unitive and procreative dimensions.

The communio personarum is not, as it were, merely the loving environment in which it is permissible for the spouses to become parents using any sort of reproductive technology that does not otherwise violate a moral norm. Rather, it is the relationship from, in and through which the spouses’ bodily expression of love generates, in cooperation with divine Grace, a third person. In order for the marital communio personarum to be a truthful sign of the divine communion of Persons, the new life that is generated must result from the exchange of spousal love and not from a separate act of the spouses or a technician. 7

Principles for Respecting the Unitive Meaning

The foregoing discussion described the essential qualities of the unitive meaning of the conjugal act. These qualities give rise to the following principles and ethical norms that must be respected if the unitive meaning is to be preserved:

  • → As a union of persons, the unitive meaning of the conjugal act demands complete respect for the personalist norm. Any marital act in which one of the spouses is treated as an object or instrument—such as for procreation—violates the personalist norm.

  • → The unitive meaning of the conjugal act entails a complete and total self-gift of each spouse to the other. Any technical means that utilizes or creates an obstacle to the complete gift of self (such as a condom) violates the exchange of self-gift that is the inherent meaning and dynamic of the marital act.

  • → The unitive meaning of the conjugal act is grounded in the freedom of the gift. In what follows below, I explore the idea that any reproductive technology that requires the spouses to engage in intercourse at a prescribed time or place or in a prescribed manner, creates an element of external compulsion which threatens the freedom of the gift.

  • → The unitive meaning of the conjugal act entails exclusivity between the spouses. I argue that any reproductive technology that involves a third party in the performance of the act or the unfolding of its natural and immediate consequences (including fertilization) violates spousal exclusivity.

  • → Authentic spousal love is an icon of the divine communio Personarum. To be a true sign of the divine communion of Persons, new life that is generated must be the fruit of the exchange of love between the spouses and not the result of a separate act.

Evaluation of Assisted Reproductive Technologies in Light of the Unitive Meaning of the Conjugal Act

What can we conclude about the morality of ART viewed from the perspective of whether they respect the unitive meaning of the conjugal act? In this paper I consider solely those procedures that have not been ruled out by the magisterium. 8 My goal is to bring to evidence that considerations from the unitive perspective have not been taken account of in the moral analysis, and when taken into account give rise to a set of serious concerns which I think may render these procedures immoral, or at the very least morally problematic from a personalist perspective that has been overlooked. I will limit myself to tentative responses in the hope that professional theologians and bioethicists will consider the thoughts I have offered and propose their own conclusions. But even to do only that much, it is necessary to have some understanding of the reproductive technologies under consideration. 9

Technologies Under Consideration

Gamete Intra-Fallopian Transfer 10

The ovaries are stimulated by ovulatory drugs, and three to five (sometimes more) eggs are removed just prior to ovulation by laparoscopy then kept in an incubator. Sperm are collected 2–1/2 h prior to the procedure, through masturbation or from a silastic sheath used during intercourse, “washed” to remove antibodies and prostaglandins, and concentrated. The eggs and treated sperm are placed in a catheter, separated by an air space to avoid fertilization occurring in vitro, then inserted via incision high in a Fallopian tube where fertilization hopefully occurs (Haas 1993, 1–2).

Low Tubal Ovum Transfer

In this technique, designed for women with damaged or blocked Fallopian tubes, drugs are used to stimulate ovulation. The couple engages in normal intercourse just prior to expected ovulation. Immediately thereafter, a doctor retrieves ova via laparoscopy and, within 2 h, repositions the eggs in the lower portion of the fallopian tubes or uterus. The couple shortly thereafter engages in normal intercourse again, and fertilization hopefully occurs. The clinical success rate of LTOT appears to be minimal (De Marco 1991, 212–214).

Tubal Ovum Transfer with Sperm

According to De Marco, this procedure was initially referred to by the acronym TOT (Tubal Ovum Transfer), and ethicists mistook it as a variation of LTOT but with the ovum transferred higher in the fallopian tube. This resulted in some Catholic ethicists approving it, whereas in fact it is essentially identical to GIFT (De Marco 1991, 214–217).

Gamete Intra-Fallopian Transfer, Tubal Ovum Transfer with Sperm and Low Tubal Ovum Transfer: A Note About Oocyte Retrieval

When an ART procedure calls for oocyte retrieval, it is performed about 34–36 h after drugs that stimulate oocyte maturation have been administered. An anesthesiologist administers intravenous sedatives and pain relievers to minimize discomfort. A transvaginal ultrasound probe is inserted to visualize the ovaries and follicles. A long needle is guided into each follicle and the oocytes and other contents aspirated. After the procedure, patients are observed while they recover from anesthesia. Vaginal spotting and lower abdominal discomfort for several days following this procedure are not uncommon (Society for Assisted Reproductive Technology 2022). According to the American Society for Reproductive Medicine, “There are risks related to the egg retrieval procedure…. Removing eggs through an aspirating needle entails a slight risk of bleeding, infection, and damage to the bowel, bladder, or a blood vessel. This is true whether the physician uses laparoscopy or ultrasound to guide the needle…. In rare cases, infection may occur from the retrieval or embryo transfer” (2018, 16).

Intrauterine Insemination 11

This procedure is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. Insemination is performed at the time of ovulation. Sperm are collected, then “washed” to remove potentially toxic chemicals which may cause adverse reactions in the uterus, and “separated” to concentrate the motile sperm into a small volume. The doctor inserts a speculum into the vagina to the uterus where a catheter deposits the semen at the time of ovulation, usually within 24–36 h after the LH surge is detected, or after the “trigger” injection of hCG is administered (National Infertility Association 2022).

At-Home Cervical Cap Insemination 12

The Stork® OTC claims to be the only FDA cleared over-the-counter conception device for use at home. The Conceivex Conception KitTM was a similar product in the past which appears to no longer be available. According to The Stork’s instructions for use (Product Leaflet 2021), the couple uses an ovulation predictor kit to identify the best day to conceive, then has intercourse using a condom-like sheath with a cervical cap resting within the sheath (the Conceptacle®). Alternatively, donor sperm can be used. The Conceptacle collects the semen containing sperm. The cervical cap is then removed and placed into the applicator. The applicator cradles the cervical cap and guides it through the vagina to the cervix. This delivers the sperm next to the cervix. The cervical cap is then removed after 4–6 h using a tampon-like pull string.

Evaluation of Assisted Reproductive Technologies in Light of the Unitive Meaning of the Conjugal Act

Does the Procedure Respect the Personalist Norm?

Reproductive procedures that require sperm to be captured by a condom (even a perforated one) for later reinsertion into the wife by a separate and distinct act may violate the personalist norm by treating the husband, and the marital act, as means to obtain gametes that are used by a technician in a subsequent act that leads to conception (Doerfler 2000, 56–57). These procedures include GIFT/TOTS and IUI. 13 The same result could be achieved through masturbation, and in fact with more clinically positive results. 14 That the husband is being used primarily as a source of sperm is starkly evident the more time elapses between sexual intercourse and fertilization, as when sperm are collected and frozen for use years later.

The violation of the personalist norm occurs whether or not the spouses have the emotional experience of feeling “used,” as it takes place at the level of objective fact. In persons with a developed sensibility, treating the act of intercourse as a means to obtain sperm should result in a healthy sense of shame (in the sense used by John Paul II) whose limit can be crossed only with difficulty and over inner resistance (TOB 61:3). The experience of shame and embarrassment by the husband who is required to wear a condom for sperm collection is a warning sign that his dignity as a person is being threatened.

Spouses sense when the personalist norm is being violated, even if they do not have a name for their distress. One pastoral minister has observed this from his experience with couples undergoing fertility treatments:

Throughout the process of trying to conceive a child, sexual intercourse may be less an act of love and self-giving and more a clinical act. When the time of sexual expression becomes ‘baby making’ and not ‘lovemaking,’ it can cause harm to them as a man or as a woman. When they experience a shift of attitude from love and beloved to function and performance, the unifying significance of the marital act is lost and disunity may follow (Bozza 2003, 43). 15

Another pastoral worker comments that men, in particular, may feel they are being treated as a “reproductive machine,” especially when the wife only seems open to intercourse when conception is possible (Quesnell 1988, 161).

It is true that spouses may violate the personalist norm in seeking to conceive a child even when no “artificial” reproductive technology is involved. This can occur even in the most “natural” reproductive methods such as timing intercourse for fertile periods. Thus, even reproductive methods that do not inherently treat one or both spouses as means to an end nevertheless risk violating the personalist norm when the spouses do not carefully and conscientiously respect their own and each other’s intrinsic dignity and worth as persons. Because of man’s concupiscence this is a risk in every conjugal act (TOB 32:1–6, 33:4, 58:5–6). The correct response to this risk is for the spouses to pursue purity of heart and examine their consciences to avoid their marital acts being more often than not clinical acts (Bozza 2003, 43).

Is there a Total, Mutual Gift of Self?

In a secular (non-Catholic) clinical setting, masturbation is the preferred means of obtaining sperm from the husband. To avoid the moral evil of masturbation, some Catholic ethicists require sperm to be collected from an act of marital intercourse using a SilasticTM sheath (a type of condom). Instead of being deposited in the woman’s body, all or some of the sperm are retained within the sheath and then subsequently relocated into the woman’s body in order to achieve fertilization. GIFT/TOTS, IUI and home insemination kits are the putatively acceptable technologies that rely upon this “catch and release” method of obtaining sperm.

Catholic ethicists who justify the use of a Silastic sheath reason that it is not done for a contraceptive reason. 16 Others require that the sheath be perforated in order for some of the sperm to get through, so that the act does not positively exclude the possibility of new life being generated. 17 Whichever type of sheath is used, the sperm that are used to fertilize the ovum or ova are deliberately withheld from the marital act in the sheath and relocated by a technician after several intervening steps. The ethicists who endorse these methods claim to preserve the procreative meaning of the conjugal act but, in my opinion, fail to give adequate consideration to the unitive meaning. They acknowledge that even a perforated condom “compromises sexual union” (DeMarco 1991, 229–233) and the marital act is principally the means to gather sperm (Haas 1993, 2). Nevertheless, they uphold the use of a perforated condom as moral.

Let us grant for the sake of argument that using a perforated condom does not actually negate the procreative meaning of the conjugal act—even though any sperm that escape are not the ones that are expected to fertilize the ovum. The sexual act is not a true conjugal act unless the unitive meaning is also preserved. Whether perforated or not, I contend that using any type of condom to collect sperm for an ART procedure violates the unitive meaning of the conjugal act because it prevents the man from offering his complete gift of self. When a Silastic sheath is used to prevent sperm from entering the woman’s body so they may be collected and injected elsewhere into the woman’s body, the sexual act becomes a means for collecting sperm and the condom divides the husband’s gift from the woman’s body, so that the woman does not receive her husband in a total sense (Watt 2005, 35). Instead of the child being the fruit of the sexual act “normally performed,” the child is the result of a withholding sperm from the couple’s union, followed by the withdrawal and reinsertion of the sperm by a technician (Watt 2005, 35). The marital act achieves, at most, only a partial uniting and violates the self-giving that is part of a truly conjugal act (Watt 2005, 35–36). This may be especially problematic for the father, who bears the greatest risk of dissociation from a proper sense of responsibility for the child when the link between his gift of himself to his wife and the donation of his sperm is not protected (Watt 2005, 36).

The use of any kind of condom violates the total gift of self in another way. During natural intercourse the spouses exchange and assimilate hormones and prostaglandins through their mucous membranes, which assist in the bonding process at a biochemical and emotional level (De Marco 1991, 228–29). While intercourse with a perforated condom may signify the marital act, the sign is incomplete because full, mutual self-giving does not take place.

Reproductive technologies that rely on an act subsequent and supplemental to the conjugal act threaten the self-giving characteristic of the unitive dimension in a subtler way as well. They do not attack a spouse’s gift of self, but rather the receiving of the gift by the other spouse. If a technical procedure that is supplemental to the conjugal act is required in order for conception to occur, there is a sense that the spouses’ mutual gifts of self are inadequate. Take as an example a husband who suffers from oligospermia or decreased sperm motility. He makes a complete gift of himself in the conjugal act, yet it is “not good enough.” Instead of accepting this gift with gratitude even with its physiological limitations, his wife requires something more, in the form of a technological intervention to achieve conception. This is experienced by the husband at the conscious or subconscious level as a rejection of his self-gift as inadequate.

Do the Spouses Act with the Freedom of the Gift?

Reproductive technologies that require the spouses to engage in sexual relations during a narrow window of time, in a particular setting (such as a clinic), or in a prescribed manner or position (one that perhaps does not bring satisfaction to the woman), have the potential to impair the freedom of the gift by creating an atmosphere of coercion. How troubled the spouses are by these external pressures will depend in large part on their unique personalities and psychological make-up. It is therefore not possible either to exclude a particular procedure as always illicit, or include a particular procedure as always licit, based on this criterion. The protocols associated with some reproductive technologies do, however, tend to increase the likelihood that one or both spouses feel duress to engage in intercourse. In LTOT, for example, intercourse must take place within a few hours before the scheduled technical intervention in which the doctor retrieves the ova laparoscopically and repositions them within the fallopian tubes or uterus, and again within a few hours after the intervention. At that point the couple has paid a great deal of money, and the woman has undergone a great deal of chemical and surgical interventions, discomfort and risks, so the pressure to have intercourse is strong. Similar pressures exist with GIFT/TOTS and IUI.

Coercion is a factor that must be considered on a case-by-case basis by the spouses as they seek to make a moral judgment concerning whether they should pursue a given reproductive technology or method. They must always seek to avoid putting improper pressure on each other so that their gift of self in the conjugal act is freely given.

Are the Exclusivity and Intimacy of the Marital Act Respected?

Certain kinds of ART require the involvement of a trained clinician in close temporal connection with the marital act. GIFT, TOTS, and IUI involve technical intervention during the time of peak fertility for the woman and within hours before and/or after intercourse. It is true that no clinician is present when the spouses engage in the marital act, yet the clinician’s involvement with the “product” of the marital act (namely, sperm) is uncomfortably intimate. This is particularly the case when sperm are obtained directly from the woman’s vagina following intercourse (which is reportedly not common in clinical practice) and (in the case of IUI) later reinserted through the vagina. Such an intrusion into the intimacy of the marital act engenders a sense of shame in a sensitive person. The shame serves as a sign that the person (in this case the woman) is being treated as a receptacle from which to collect and deposit sperm, in violation of her dignity as a person.

Is the Child the Fruit and Sign of the Spousal Communio Personarum?

Doerfler (2000, 56–57) and Tonti-Filippini (1990, 72–73) have examined GIFT, TOTS, and IUI and concluded that the technician performs an act (or acts) that initiates a new causal process, so that the act of the technician is the principal cause of fertilization. If this is correct, then the child is not the fruit and sign of the spouses’ communion of persons.

In addition to that flaw, an aspect of GIFT/TOTS that fails to receive sufficient consideration by ethicists is the fact that the sperm and ova are introduced into the woman’s body through incisions in her abdomen. This is a far cry from fertilization occurring as a result of the marital act; fertilization occurs (if at all) as a result of a doctor penetrating the woman’s abdomen with surgical instruments and depositing both sperm and eggs into her fallopian tubes through a catheter. The marital act (which is incidental in any event, as most secular clinicians obtain sperm from masturbation rather than a Silastic sheath used during intercourse) has no sign value of the divine communio Personarum and the child is not the fruit of the marital act but of the doctor’s interventions.

According to Doerfler, home insemination kits are also problematic because the marital act is not the principal cause of fertilization (2010, 3–4). The causal processes initiated by the marital act are stopped when the sperm are captured in the Silastic sheath, then poured into the cervical cap which is then placed over the woman’s cervix. Placing the cervical cap is in fact the principal cause of fertilization, amounting to an act of artificial insemination (Doerfler 2010, 4). It is a separate physical act that involves a separate act of the will, one that is in the complete control of the wife who could, after all, decide not to place the semen-filled cervical cap over her cervix. Although no technician is involved, the child conceived through the use of an insemination kit is neither the fruit nor the sign of the specific marital act of the spouses.

As for LTOT, both Doerfler (2000, 55–56) and Tonti-Filippini (1990, 77) 18 judge that the technician’s act of relocating the ovum laparoscopically prior to intercourse does not interfere with the natural causal processes following sexual intercourse, so that the spouses’ specific marital act is the cause of fertilization. While the spousal communio personarum is respected, as explained previously LTOT threatens the freedom of the gift by requiring timed intercourse both before and after the procedure.

Other Signs of Something Amiss at the Unitive Level

There are many signs that something is amiss at the subjective, interpersonal level when couples employ modern reproductive technologies. The popular media abounds with anecdotal evidence that couples seeking to conceive a child experience stress and disorder in their sexual relations. An article commenting on a study from Stanford University about infertility and female sexual dysfunction is illustrative:

When sex is so fraught with failure, it quickly becomes a casualty. When it does occur, it may be the on-demand variety that feels like a chore for both men and women. “When the woman calls her husband at work and says ‘I’m ovulating. Come home. We’ve got to do it now,’ it ruins people’s ideas of romantic conception,” says Diamond. There’s little room for foreplay, and men may have trouble performing under so much pressure. Alice Domar, a psychologist who developed a popular mind-body program for infertility patients . . . advises patients to protect the pleasure of sex by designating one bed for baby-making sex and another for fun sex (Richards 2010).

The article reports that medical interventions can cause intense duress, and that people often experience a disconnect between the unitive and procreative meanings of the marital act when they employ reproductive technologies to conceive:

Although medical intervention can be an added source of stress for couples—fueling arguments over how much money to spend for treatments and whether to use donor eggs or sperm—one [reader] says it helped her sex life by relieving her of her baby-making duty. “The doctor is essentially barging in the reproductive cockpit and taking over,” writes “Shayla” (also not her real name), a 30-year-old artist from San Diego, who has tried unsuccessfully to become pregnant for more than two years. “Since sex no longer serves a practical purpose, i.e., getting the woman pregnant (that’s handled in the lab), it is all of a sudden just for pleasure again. That can be really, really nice after months of pressure-filled and timed intercourse” (Richards 2010).

The psychological and relational stresses of reproductive technologies are frankly acknowledged by the medical societies who practice them. The Society for Assisted Reproductive Technology (2021) notes, “Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event, such as the death of a family member or separation or divorce.” Because psychological and relational stress is of particular importance to a moral analysis focusing on the unitive purpose of the marital act, it is worth spelling out the Society’s cautions in greater detail:

The aspects of IVF that are perceived as stressful by patients are multifaceted and affect all parts of their life/lives: marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress may impact the marital relationship, by reducing sexual intimacy. Couples also may find themselves stretched financially, paying for the high cost of IVF treatment with a somewhat limited probability of success. Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, injections, sonograms, future health concerns, and decision making about embryos, their disposition and multiple pregnancies (2021).

Psychotherapists have observed firsthand that reproductive technologies cause short- and long-term damages to women’s psychosomatic health (Peterson 2005, 171–172). Clinicians and ethicists, especial Christian ones concerned with the wellbeing of the whole person and the health of marriages, must give more study and attention to this dimension of ART. Such research would be a valuable aid to ethicists seeking to understand how some technologies impair the unitive meaning of the conjugal act. It would also help couples who are using procedures that are not per se illicit by giving them a better understanding of the threat to the unitive meaning so that they can be alert and protect their love with greater communication and prayer.

Synopsis

The Church calls us not only to avoid separating the two meanings of the conjugal act, but to “reverence” both meanings. This reverence for what is sacred is a gift of the Holy Spirit which, for John Paul II, “seems to initiate man and woman particularly deeply into reverence for the two inseparable meanings of the conjugal act, which the encyclical [Humanae vitae para. 12] speaks about in relation to the sacrament of marriage. Reverence for the two meanings of the conjugal act can fully develop only on the basis of a deep orientation to the personal dignity of what is intrinsic to masculinity and femininity in the human person, and inseparably in reference to the personal dignity of the new life that can spring from the conjugal union of man and woman” (TOB 131:4; emphasis in original).

Considering ART in this light, a morally licit reproductive technology is one in which both the unitive and procreative meanings of the conjugal act are reverenced. Christian ethicists will best serve the people of God by complementing the traditional moral analytical framework which focuses on the objective, procreative dimension with the insights of the Theology of the Body and its emphasis on the personal, unitive dimension. Such an approach can shed light on the morality of technologies where there is not yet a theological consensus and may provide a new perspective on technologies generally considered acceptable but on which the magisterium has not yet spoken definitively. Also, by highlighting the personalist dimension of marital relations and procreation, ethicists can help the Church more effectively explain her moral teaching to couples seeking medical help to conceive children. Finally, couples, pastoral counselors and Christian health care providers should be educated about the threats posed to the unitive dimension of the marital act by technologies that may otherwise be viewed as morally licit solely because they preserve the procreative meaning. This knowledge will help couples make a better judgment about whether, or how, to pursue having a child through assisted reproductive technologies.

Biographical Note

Wendy Laurento, JD, received her BA from the University of Richmond, her JD from Villanova University School of Law, and her MA with a concentration in systematic theology from St Charles Borromeo Seminary/School of Religious Studies. She has taught courses on introductory Catholic theology and the Theology of the Body as an adjunct professor at Immaculata University in Pennsylvania. She has a graduate certificate in Catholic health care ethics from the National Catholic Bioethics Center.

Notes

1.

Dignitas personae also instructs that certain ART is morally unacceptable in all circumstances, including heterologous artificial insemination, in vitro fertilization and intracytoplasmic sperm injection (2008, 12, 14–17).

2.

See Familiaris consortio (John Paul II 1981, no. 11); CDF Donum vitae (CDF 1987, Introduction 3–5 and II.B.4). Although Donum vitae was published by the Congregation for the Doctrine of the Faith (headed at the time by Cardinal Josef Ratzinger), it was approved and ordered to be published by John Paul II.

3.

See Humanae vitae (Paul VI 1968, no. 9). According to papal biographer George Weigel, Wojtyla played an important role in the development of Humanae vitae. Though the Polish government denied him a passport to attend the meeting of the Papal Commission in which the majority position in favor of contraception was discussed, he set up his own local commission as Cardinal Archbishop of Krakow to study the issues being debated. The Krakow commission articulated a framework for the Church’s traditional teaching on contraception grounded in the personalist principles of marital chastity developed in Love and Responsibility (Weigel 1999, 206–210). Although Humanae vitae did not expressly adopt the rich personalist rationale of the Krakow commission’s approach, it reached the same moral conclusion and left the door open to a fuller articulation of the reasons for its conclusion—an invitation which John Paul II took up in the “theology of the body” catecheses he commenced immediately upon becoming pope.

4.

In this paper, citations to Pope John Paul II’s catecheses known as the “Theology of the Body” (1979–1984) are taken from the translation of Michael Waldstein and follow the format (TOB weekly audience number: paragraph number).

5.

For a deeper understanding of Humanae vitae’s “principle of inseparability” and the personalist understanding of the marital act, see Donald Asci, The Conjugal Act. (2002) This compact volume does not directly confront the problem of reproductive technologies, but it provides a valuable study of the doctrinal development reflected in Humanae vitae upon which any ethical analysis of reproductive technologies must be based.

6.

John Paul II means intimacy in the sense of an interior space protected from the outside (Waldstein 2006, 368).

7.

See Dern, “The ‘Rival’ Personalisms,” 275–276.

8.

For example, in considering GIFT and IUI we will assume those conditions are present that Cataldo identifies as being necessary for moral liceity: (1) only the gametes of the husband and wife may be used; (2) masturbation may not be used to collect the husband’s semen; (3) the semen must be collected using a perforated condom as part of a conjugal act; (4) the ovum should be collected on the same day as the conjugal act (he gives no explanation as to why this is morally significant); (5) the sperm must be used within 72 h so that it is not used after its natural viability for fertilization; (6) so that fertilization occurs within the woman’s body, an air bubble must be used to separate the male and female gametes; (7) ovarian stimulants, if used, should be controlled and mild to reduce the risk of multiple embryos being generated (Cataldo 2009, 107).

9.

Any attempt to describe the variety of reproductive technologies that may potentially be morally licit must acknowledge that these procedures are described in different ways, at different times, by different sources. Some of these variations have determinative moral significance, and some are clearly immoral from a Catholic perspective. By way of example, Tonti-Filippini notes the countless variations even among a “single” procedure commonly called GIFT. Sperm may be obtained through masturbation, use of a perforated condom, from the male epidymis, or from the vagina after intercourse; one or more eggs may be obtained, with or without ovarian hyperstimulation, and may or may not be cryopreserved; and the male and female pro-nuclei may already have been formed but the first cell division has not yet occurred (1990, 68–70).

10.

GIFT comprises less than one percent of ART procedures performed in the United States at present (American Society of Reproductive Medicine 2018, 13). It has not been specifically rejected by the Magisterium but serious arguments have been raised against it and a nearly identical procedure, Tubal Ovum Transfer with Sperm (TOTS), by highly regarded ethicists who believe that it replaces the marital act. For judgments against GIFT and TOTS, see De Marco 1991, 223–234; Doerfler 2000, 56. For judgments against GIFT only, see Haas 1993, 1–3 and May 2008, 93; and Tonti-Filippini 1990, 74–77. For judgments in favor of GIFT see Cataldo 1996, 2 and McCarthy 1993, 4.

11.

IUI has been called into question for reasons similar to GIFT and TOTS but nevertheless finds support among some respected ethicists. Doerfler presents a compelling argument against the liceity of IUI in “Assisting or Replacing the Conjugal Act,” 57–58. Cataldo holds that IUI may be licit if certain conditions are met, including in particular the use of a perforated condom to procure sperm (2009, 107; 1996, 1). The National Catholic Bioethics Center’s Catholic Health Care Ethics Manual presents the arguments in favor of GIFT and IUI as equally “strong” and “probable” as those opposed (2009, 107–108).

12.

A lively debate over the Conception Kit appeared in Ethics & Medics between July 2009 and May 2010. See Napier, “Morality and ‘The Conception Kit’” (2009b) and “Defending Conceivex as Assistance” (2009a) (in favor); Mirkes, “The Conceivex Kit Reconsidered” (2009) (opposed); and Doerfler, “The Cause of Fertilization” (2010) (opposed). It appears the Conceivex Conception Kit is no longer available for sale, but similar products are on the market.

13.

LTOT similarly treats the woman as a means to obtain gametes, in violation of the personalist norm. Unconnected to sexual intercourse, ova are removed laparoscopically from the woman’s body after a series of hormonal treatments to stimulate ovulation, then reintroduced into her lower fallopian tubes.

14.

May notes that the initial spurt of ejaculate is the most potent, yet this tends to escape the perforated sheath and the less potent ejaculate is what remains for use in the procedure (1988, 134).

15.

Karol Wojtyla explicitly cautions against this mentality in Love and Responsibility: “Marriage is an institution that exists for the sake of love, not merely for the purpose of biological reproduction. Marital intercourse is in itself an interpersonal act, an act of betrothed love, so that the intentions and the attention of each partner must be fixed upon the other, upon his or her true good. They must not be concentrated on the possible consequences of the act, especially if that would mean a diversion of attention from the partner” (1981, pp. 233–34).

16.

This appears to be Napier’s position, because the Conception Kit he endorses does not use a perforated sheath (July 2009b, 3).

17.

Cataldo 2009, 107; Haas 1993, 2. Note that May and others cited by him oppose the use of any kind of condom to collect sperm for subsequent intervention by a technician (May 2008, 93–94). May follows the traditional analysis of whether the intervention replaces or assists the marital act and does not situate the problem in the context of the unitive meaning

18.

Tonti-Filippini calls this procedure by the acronym TOT (which could be mistaken for TOTS), but what he describes is LTOT.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Wendy Laurento, JD https://orcid.org/0000-0001-6030-8304

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