Treatment of Unexplained Subfertility in Catholic Health Care

Though in vitro fertilization (IVF) has become common treatment for unexplained subfertility,1 concerns about the practice linger. The risks to women posed by all-too-common IVF-associated multiple pregnancies, and the heightened risks of prematurity and congenital disabilities for IVF-conceived babies, are troublesome to those of all moral sensibilities. Furthermore, spare embryos and the practice of fetal reduction are disconcerting to those even outside of antiabortion circles. Finally, the costs of IVF treatment raise serious questions of justice and access. Surprisingly, a Cochrane review finds that the assumed efficacy of IVF for unexplained subfertility relative to other more natural treatments is not sustained by empirical evidence. Given these ethical concerns, and the unproven relative efficacy of IVF, I argue that standard care for unexplained subfertility should favor more natural options, including expectant management. I also consider the promising preliminary evidence for Natural Procreative Technology (NaProTechnology), an infertility treatment approach that seeks to identify and address the underlying cause of a couple’s infertility. Though I acknowledge the need for further empirical studies on NaProTechnology’s effectiveness, I argue that couples seeking treatment for unexplained subfertility should at least be informed of NaProTechnology’s methods. Moreover, Catholic health care can and should take a lead role informing patients of and treating patients using NaProTechnology’s methods.