Is Intrauterine Insemination Ethically Acceptable?

In the past, some people believed in what they believed to be ethical or moral concepts of parenthood. These included:

  1. Parents should be a male and female who are married to each other
  2. Children should be conceived only with the sperm and eggs of the husband and wife
  3. The wife should carry the pregnancy and deliver the baby

Now of course, these concepts are considered by many moral and ethical people to be of historical interest only. Why? For example, children may be adopted into a family and still be considered a moral family. A widower may remarry and start a family with his or her new partner. The majority of people would still consider these to be “moral” families”. In addition, of course, we have to ability for ethical and moral couples to build families in ways that may be necessary to overcome their infertility disease process. Men whose testicles do not produce sperm and their partners can still become pregnant, delivery a baby and raise a family together. Women, who were born without a uterus or in whom a pregnancy would damage her health can enlist the help of another woman to carry a pregnancy for her. This list goes on and on.

What is an IUI?

Intrauterine insemination (IUI) is a commonly used treatment in infertility. With IUI, the male collects a semen sample into a sterile cup. The semen is prepared in the laboratory to separate the sperm from the seminal fluid. The sperm is concentrated into a small volume and loaded into a tiny plastic catheter. The catheter is inserted into the uterus of the woman and the sperm are injected inside the uterus.

At first glance, this would seem to be a morally sound practice since it meets all the criteria for moral parenthood that we discussed above. However, some people still have ethical issues with the use of IUI. The three main “complaints” regarding insemination with your husband’s sperm are:

  1. Masturbation for sperm collection
  2. The separation of sex and procreation
  3. The commodification of reproduction

Masturbation for sperm collection

The majority of the time, semen is collected by the male through masturbation. Some people object to the use of masturbation for various reasons. These people will state that masturbation is often accompanied by lust which is often cited as being morally wrong. They believe that lust is morally wrong because it is an expression of original sin. Most people today, however, do not hold these views.

If a couple does have an ethical problem with masturbation, sperm can also be collected at times with a special non-toxic condom that is used during intercourse. In my religious faith, this is considered an acceptable way to collect sperm for ANY type of fertility treatment.

The separation of sex and procreation

The Catholic View

The current Catholic view is that anything other that “conjugal union” is a violation of the natural order. This has been the Churchseperation_of_intercourse_from_procreation.jpg view since 1968 when, under Pope Paul VI, the Vatican produced a document called “Humanae Vitae”. In this document, it is stated that “ it is never permitted to separate these different aspects to such a degree to either exclude the procreative intention or the conjugal relation.”

This view argues that sex is an act of love and procreation at the same time and that the separation of the sexual (unitive) act and the procreative act is immoral. Since intrauterine insemination separates the sex from the procreation, it is therefore considered immoral.

This has not always been the view of the Catholic church. For 1500 years, Christian theology accepted the views of St. Augustine.

In St. Augustine’s view, the sex act was evil, literally a sin. He wrote that even the desire for sex was evil since “Original Sin” expressed itself through lust.

In his view, St Augustine further argued that marriage is the only context in which sex is allowed and then only for the purpose of having children. Once a marriage had produced children, the license was revoked and sex was no longer allowed.

A contradiction?

There is an interesting contradiction here. Before 1968, the view was that sex was evil and should be avoided at all costs. Since 1968, the view is that a treatment such as intrauterine insemination is wrong because no sex is involved.

The Jewish View

The Torah views everything in the world as essentially good – including sexual activity. After creating human beings, God blesses them and tells them, “Be fertile and increase, fill the earth…” (Gen. 1:28). Thus sexual activity is a basic part of God’s creation; as such it must be good.  It is good when used to attempt pregnancy and it is good when enjoyed by a couple who are not trying to produce a pregnancy. Man was made in God’s image and therefore God has sexual organs. There is nothing, therefore shameful or wrong about having or using sexual organs.

The Commodification of Reproduction

Commodification is literally, the making of something into a commodity that can be bought and sold. Prostitution is considered by some to be immoral since it makes the sex act into a commodity that can be bought and sold.

Some ethicists fear that if sex and procreation are able to be separated by the use of even a simple technique such as intrauterine insemination, then this will lead to the commodification of reproduction. The individual components of reproduction: sperm, eggs and a uterus will become individual commodities to be bought and sold.

Some will ask, What is the harm in selling eggs or sperm?” The answer that some ethicists give is that if promotes the evaluationcommidification.png of the end product “the child” as a commodity also. Of course, if children are “bought” and “sold” it is then akin to slavery which is morally wrong. The process will promote the “dehumanization” of some people whose sperm or eggs do not have desirable characteristics as “products”. Stated simply, the buyers of products are going to assign more worth and pay more money for products that meet certain standards.

However, this is an over simplification. Currently, men are compensated for donating sperm to sperm banks. Women are likewise compensated for donating their eggs and surrogates are compensated for the use of their uterus to gestate a baby for another couple. This is not the same as selling eggs or sperm.

In order for a woman to donate her eggs, she must complete a medical history questionnaire, undergo a physical exam, submit to numerous blood tests, inject herself with fertility medications daily for approximately two weeks, return to the doctors office several times for blood tests and ultrasounds to be monitored during those two weeks, and then undergo a surgical procedure to remove the eggs from her ovaries. Since this is an uncomfortable procedure, it is done under anesthesia. If the egg donor has a job, she will have to miss work on that day. Is she therefore not entitled to receive compensation for her efforts? Most reasonable people would say that she is entitled to that compensation and that this is not the selling of eggs.

Conclusion

There are some groups who believe that even simple assisted reproduction technologies such as intrauterine insemination with the sperm of a woman’s husband can be ethically wrong from either a religious perspective or a societal perspective. Other deeply religious and moral groups see no problem with this practice. It is up to each individual to decide what he or she is comfortable with providing (the physicians and nurses) and receiving (the patients who are suffering from infertility).

At IVF1, we view the treatment of infertility, including IUI, as a religious, ethical and moral obligation to help “repair the world”. However, we respect every individual patient’s beliefs. We will educate patients about IUI, what it is for and how it can improve their chance for pregnancy. However, each patient may make their own choice as to whether they use this treatment.