Writing about IVF is a minefield. As a mother of four children, I am acutely conscious that someone as blessed as I am could rightly be accused of being insensitive to the plight of those who are infertile and who wish to make use of IVF, writes Breda O'Brien.
Yet, unlikely as it may seem, I understand the hunger for a child very well. Early on in our marriage it looked as if I would never get pregnant. I remember the longing which hammered within me for a child. When I did become pregnant, I was ill all the time, and yet it seemed a minor price to pay. My second pregnancy miscarried and left a wound which has never entirely healed. For a significant time it seemed as if we would have only one child, and I discovered that the longing for a second child can be every bit as deep as for the first.
If ever anything looks as if the end justifies the means, it must be IVF. When you consider the pain which infertility brings, the stress which it can put on marriages, and the joy which a successful IVF intervention brings, it seems horribly lacking in compassion to raise any questions about the whole process. Yet some questions have to be asked.
IVF is an enormously stressful process, both physically and mentally, as hopes are raised and dashed time after time, due to failed implantations or the trauma of a miscarriage following a successful implantation.
Those who work in this area naturally resent deeply the suggestion that what they do is somehow anti-life. Yet the degree of dedication involved in pursuing this work may mean that they are not the best judges of the consequences of their work.
The death rate of embryos in IVF is extraordinarily high. When you freeze embryos, four out of 10 will not survive the process. The normal number implanted at any one time in Ireland is three, and most will not survive. The most optimistic success rates, that is, the birth of a baby, are 25 per cent to 30 per cent, and these fall to 5 per cent for women over 40.
If it is conceded that the embryo is a separate human being, worthy of the same respect as any individual, this kind of work becomes problematic, and perhaps even impossible. It is not religion but science which tells us that a fertilised egg is a genetically complete human organism, a new individual.
Those who work in the field of IVF are adamant that, as embryologist Dr Aonghus Nolan put it on Morning Ireland recently , "an embryo is not a baby". It is indisputable that an embryo is not a baby, no more than a baby is not a teenager. However, one would be looked at oddly for suggesting that the baby and teenager are not the same individual, although very different in appearance, independence and capabilities. Yet it seems to be all right to suggest some kind of radical discontinuity between the embryo and the baby.
What is added to the embryo, other than time and nurture, which makes it genetically different from the future teenager and old-age pensioner? Some embryologists would favour implantation as the moment when human life begins. Nonetheless, implantation, too, is just one stage in human development, which cannot be singled out as the moment which makes us human, no more than puberty makes us fully adult.
Of course, Dr Nolan was not necessarily speaking philosophically when he said an embryo is not a baby, but highlighting the fact that even in natural conception there is an extraordinarily high death rate among embryos.
However, it is not comparing like with like to compare natural conception with IVF. In one, the death rate is a consequence of our biology, and the other an inevitable consequence of certain processes involved in IVF. We are bringing into existence human individuals who will take part in a form of Russian roulette, except the chances of death are much higher than the chances of life. Medical science is always attempting to improve on nature.
It is difficult to imagine what other medical procedure would be justified with the argument that medicine is doing the same as, much less worse than, nature. If heart operations led to more deaths than untreated heart disease, it would be extraordinary.
In theory, it should be possible to fertilise three eggs, implant them immediately and, as a result, have no unnecessary deaths of embryos. This is strongly resisted by IVF specialists, because the failure rate, already high, would become catastrophic. In effect this is an admission that embryo death is an absolutely central part of the process, whether it happens through freezing or other ways.
If this is the death of human material or tissue, it is not too significant. If it is the death of someone who with the right conditions would become a little boy with his father's eyes and his grandmother's wicked sense of humour, then it is serious indeed.
This is before we contemplate at all what we do with embryos where the couple separate, or a partner dies. Not to mention the question of where IVF involves donor egg or sperm, what responsibility the donor has to the ensuing child, or what rights the child has to know about the family and medical history of her biological parents.
Does the medical profession make it clear in counselling infertile couples that there has been significant progress using non-invasive means, in the treatment of common reasons for infertility? Redressing hormonal imbalances has helped some women to conceive for whom IVF has failed, using NaPro technology, currently available in Ireland through Dr Phil Boyle in Galway.
Meanwhile, how do we treat those who are infertile? Churches have only recently come out of the dark ages with regard to stillbirth and miscarriage, by providing religious rituals to mark the passing of our smallest ones.
The care of couples who are infertile would seem an obvious ministry for a church. It should also be made abundantly clear that children are children, unique and loved no matter how they are conceived.
No one who just wants to hold and love a baby should ever be made to feel a pariah. Living without children is already hard enough.