In a culture that promotes alternative medicine, natural childbirth, and sometimes-bizarre dietary supplements, it seems strange that natural infertility treatments are not well-known. A natural infertility treatment is not necessarily alternative medicine, but rather a conventional-medicine approach that seeks to cure the underlying cause of infertility, allowing natural conception. It stands in contrast to assisted reproductive technology such as in vitro fertilization (IVF), which is stick a "band-aid" solution that does nothing about the underlying causes of fertility problems.

Why is assisted reproductive technology the current standard of care for infertility? If you type "fertility treatment" into Wikipedia, you are redirected to "assisted reproductive technology." Wikipedia, being written collaboratively by people around the world, reflects the biases and attitudes of those people. Fertility drugs and IVF are what people think of when they think about infertility treatments.

I think the reason IVF is so popular — despite its astronomical cost and mediocre success rate (only 1 in 3 attempts results in a live birth) — is because it is a "magic pill" approach. It is a silver bullet, a straightforward process left in the hands of doctors. Natural fertility treatments are more complicated because they start with diagnostics, rather than jumping immediately into treatment.

Among the diagnostic steps used in natural fertility treatments for women are ultrasound, laparoscopy, and sonohysterosalpingography (SHSG) to look for structural problems in the reproductive organs, as well as hormone level checks. During her menstrual cycle, a woman's estrogen and progesterone levels can change significantly in as little as 24 hours, so daily or every-other-day tests are best. Any underlying disease or structural abnormality that is uncovered is treated to increase the odds of a naturally conceived pregnancy.

How successful is natural infertility treatment compared to assisted reproductive technology? IVF has a maximum success (pregnancy) rate well under 50% (for 27-year-old women), with an average success rate closer to 35%. Statistics for live birth are even worse, with an average of only about 27% of attempts resulting in live births. That means that an average of 8% of attempts result in a miscarriage or stillbirth (or, if the fetus is imperfect, abortion). The poor success rates reflect, in part, the fact that over 50% of embryos conceived in vitro have chromosomal abnormalities, as reported by Rebecca Taylor of Mary Meets Dolly. Natural fertility technology also has treatments for male infertility.

According to the Pope Paul VI institute, a major proponent of natural infertility treatment, so-called "natural reproductive technology" has higher success rates than IVF for various infertility diagnoses. These results are both statistically significant (i.e. not due to chance) and personally significant (i.e. they're a lot higher). For example, for a diagnosis of endometriosis, IVF has a success (pregnancy) rate of about 21%, while natural reproductive treatment has a success rate of about 57%. It reports a 37% success rate for tubal occlusion compared to IVF's 27%. The whopping 82% success rate reported for natural fertility treatment of anovulation (not producing mature eggs) may be due to straightforward treatment of the most obvious cause of anovulation, hormonal insufficiency (although I am speculating here).

I find it amazing that natural treatments for infertility are not better-known, even though they are more effective than current approaches. That's right: for infertile couples, it is more effective to try to conceive a baby the way nature always has than to inject a sperm into an egg under a microscope, with less chance of complications like chromosomal abnormalities and multiple gestation. Who wouldn't choose that first, if they knew it was available?

Image credit: "Test tube baby" by Brendan Dolan-Gavitt. (CC) Some rights reserved.

Why do people think it's selfish to have lots of kids?

Recently there was a bit of a dust-up in the combox at my sister's blog, Mama Says*, in which one commenter in particular charged that only selfish parents have big families. Having lots of kids (eight, in this case) allegedly is harmful to the older children in the family.

This is a mainstream attitude in modern American culture. Big families are viewed with scorn and derision, the parents accused of being selfish because either (a) they are dividing their love and attention among too many kids, (b) they are contributing to overpopulation, (c) they are using more than their share of natural resources, or (d) all of the above.

As a cradle Catholic, I have known a lot of big families. I even grew up in one, as the oldest of a brood of eight. But I have yet to meet a big family with selfish parents who are focused on fulfilling their own desires at the expense of either their family or our larger society.

I think this attitude stems from the discomfort people feel when they see large families. They cannot imagine themselves having a baseball team's worth of children, so they feel subconsciously threatened when they see one. That statement is not intended to be judgmental; it's human nature, and everyone experiences feelings like that when confronted with behavior that falls outside of social norms.

Why it is not selfish to have a big family

Let me present a picture of a typical big family. This fictional family has two parents and a startling number of kids. They have a strong religious faith, perhaps Catholic or Mormon or Evangelical. The parents at times feel overwhelmed by the sheer number of people underfoot. They know they could easily take steps to prevent themselves from having so many children, but they don't, because they have decided to trust God. They see each kid as a gift and have faith that God will provide for the kids he gave them. This is not a decision made lightly. This is radical, and they know it.

All the members of the family make a lot of sacrifices in order to follow this path. Maybe the kids aren't in as many organized activities, sports, and lessons as most of their peers. Maybe they go to restaurants less often, take fewer vacations, and share bedrooms. Maybe the younger kids rarely see a new article of clothing, being clad instead in hand-me-downs.

But they also have a lot of privileges that their peers will never know. They are never lonely. Their house is the neighborhood social hub for the 18-and-under set. They probably have a groupie or two, lonely children with no siblings whose parents work all day. They have a precocious understanding of the important things in life, like love and sharing. The older ones help their parents and learn child-care skills. They all learn practical life skills by doing chores, such as how to do laundry. They see what it is like to really live according to one's ideals and values.

They never have to hear their parents say that children are burdens, or that they are "so glad" they're done having kids.

And above all, they never, ever feel unloved. Big families like to repeat the saying that "love doesn't divide, it multiplies." It's more than a cute saying, it's literally true: the kids all love each other. Each new baby has a live-in fan club. Each older child has a crowd of younger devotees who think he is the coolest person on the planet.

The truth is, every parent of a crowd has no choice but to give of the deepest part of themselves, every single day. They are practically forced to be unselfish.

Selfish parents could not do this job.

* (cough cough) Which I helped design, by the way (ahem) not that I'm boasting or anything, but I have mad skillz don't I? Nevermind that I didn't do most of the work.

The youngest Leave the lights on blogger, my 14-month-old son, got three shots last week. He and his brother have had every vaccination recommended by pediatricians. I understand that a lot of parents are hesitant about vaccinations because of fears of their safety. Those parents should fear for the safety of their children if they don't vaccinate.

Vaccines are safe

Most of the fears about vaccinations center on the purported link between the mercury-based preservative thimerosal and autism. But study after study — most recently, one conducted in Italy — have shown that thimerosal does not cause autism. In fact, the original study that suggested the thimerosal-autism link was faked. And even if this evidence is not convincing, thimerosal is no longer used in most vaccinations.

Not vaccinating can be deadly

Last month in Minnesota, a seven-month-old baby died of Hib, or Haemophilus influenzae type b. Hib infections are vanishingly rare in the U.S. because of the routine use of the Hib vaccine, which is given at 2, 4, 6, and 12 months (this is one of the shots my son received last month). The child who died, and two of four other kids who were sickened by the Hib outbreak, were unvaccinated "because of their parents' decisions." In other words, the parents decided not to protect their children against deadly infections.

Of the other two children, one was only five months old and so had not completed the primary 3-shot series. The other had an immune deficiency. When vaccination rates are above a certain "threshold," people like these two children are protected by "herd immunity" (a term that originated in animal husbandry). The disease cannot spread because there are not enough vulnerable individuals in the population. When people choose not to be vaccinated, or not to have their children vaccinated, herd immunity suffers, and people like these two babies can be sickened.

The refusal to vaccinate one's children is a source of frustration for health officials. I cannot understand a parent's reluctance to protect their children against deadly diseases that should only be a memory in the twenty-first century.

On the site ObamiconMe, one can create images in the style of the famous "CHANGE" poster for Obama. (See my profile.) A change feared by many Americans is the passage of the Freedom of Choice Act (FOCA), which would undoubtedly increase the rate of abortion and, according to some reports, require hospitals and clinics to provide elective abortions even if the management opposes the procedure.

These "Obamicons" feature the juniormost Leave the lights on blogger, my 13-month-old son. They're under a Creative Commons license, so feel free to share them. If you put one or both on your blog, you can add a link on the Mr. Linky widget below. Please note that if you do not post one of these posters, your link will be deleted.





Edit: Added new versions with improved backgrounds. For the original images, see Choose Life and Fight FOCA.

The new Vatican document on reproductive technologies, Dignitas Personae, makes only a brief, passing reference to one particular practice of assisted reproduction: surrogate motherhood. In this practice, a woman is commissioned or hired to gestate a baby whom she agrees to surrender to another family at birth. The genetic parents of the baby may include the gestating mother or one or both members of the couple who commissioned her, or one or both of the genetic parents may be third party egg or sperm donors.

Surrogate motherhood is always ethically and morally wrong. To put it more bluntly, surrogate motherhood is evil. In surrogacy, a child is commissioned (often purchased outright) as if he is a sculpture or a book rather than a human being.

According to the Catechism of the Catholic Church, all reproductive technologies that involve outside donors, including practices from artificial insemination to surrogacy, "infringe the child's right to be born of a father and mother known to him and bound to each other by marriage" (CCC 2376). That paragraph bears a closer look, as it asserts a human right that many in the secular world have never even thought of:

All children have a right to be born to parents who are known to him.

This is a right written in the hearts of all babies. An infant knows his mother's voice before he is born. Newborns may not seem very aware of their surroundings — indeed, I have heard some atheists odiously describe them as not even being "sentient" — but they are, in fact, very aware of their surroundings, at least in the aspects that matter to them, and the item of foremost importance to a newborn is who his mother is.

Later in life, all human children are interested in their roots. They want to know who their biological mother and father are. If they are raised by others, this curiosity stays with them, sometimes turning into a burning search for their first parents.

According to another document from the Congregation for the Doctrine of the Faith, Donum Vitae,

Surrogate motherhood represents an objective failure to meet the obligations of maternal love, of conjugal fidelity and of responsible motherhood; it offends the dignity and the right of the child to be conceived, carried in the womb, brought into the world and brought up by his own parents; it sets up, to the detriment of families, a division between the physical, psychological and moral elements which constitute those families.

Though this statement comes from a Catholic document, it makes no appeal to strictly theological principles. It asserts that the wrongness of surrogacy can be understood according to the principles of natural law.

Surrogate motherhood and adoption share some similarities. In both situations, a child is raised by people other than the mother who bore him. As an adoptive mother myself, I am keenly aware of the inalienable fact that all adoptions begin with a tragedy: the separation of a child from his first mother. In her book of the same title, Nancy Verrier calls this event "the primal wound," a permanent blow to the heart of every child relinquished for adoption, even those adopted as newborns.

In adoption, the primal wound is unavoidable, a cross to bear, a part of what makes this world (to quote the prayer) a "valley of tears." Adoption by loving parents is a step in healing this wound in a child who otherwise would have no parents at all.

In surrogacy, however, the primal wound is not a tragic circumstance, but a premeditated act. The adult parties plan in advance to tear the newborn from the mother he knows, the one who carried him. Even for non-Christians, surrogate motherhood should be viewed as universally wrong and a violation of human rights.

Last month I was blessed to give birth to my son. While filling out some of the scads of hospital paperwork, I ran across this question:

Was this pregnancy planned?

I was at a loss over how to answer. How do you plan to receive a gift?

My attitude on family planning -- wait. "Attitude" is the wrong word. This is something much more inherent. "Perspective" is a better word, with the understanding that it's the perspective from a place I am firmly anchored with a deep taproot. So I'll start over.

My perspective on family planning -- wait again. "Planning" is the wrong word. Let's say "building". I'll start over once more.

My perspective on family building is that the building blocks come from God. He is the Architect, and we construction workers -- my husband and I -- can only build the building he means us to build if we follow his blueprint. That means trusting him.

For the first seven years of our marriage, there were no pregnancies, though we were not doing anything to prevent them. Out of this came our first son, whom we adopted. I think the reason God gave us no pregnancies was just so Big Brother could join our family.

And then I did get pregnant and gave birth to our second son. I had accepted infertility, so I was confused but thrilled.

Was Little Brother planned? To me, that's like asking if I planned for the sun to shine today.

He wasn't planned in that we weren't actively trying for pregnancy. That is, we were not watching the ovulation clock. He wasn't not planned in that we were not attempting to frustrate God from giving him to us. That is, we were not using any contraception.

Confused by the question on the hospital form, I wrote "sure". I should have written "not applicable".