Introduction
It would seem that assisted reproductive technologies aimed at helping people achieve pregnancy provide an answer to infertility.Footnote 1 The cultural message is that one does not need to be childless if one has the economic means, the emotional stamina, and the work flexibility to pursue pregnancy and childbirth with the help of medical science. However, assisted reproductive technologies are not without controversy; the issues surrounding them are varied and complex.Footnote 2 Rather than focusing on the ethics surrounding specific technologies, I will instead explore what resources the Christian tradition offers toward developing a theology of infertility. Articulating a theology of infertility is important, since Catholic teaching bans the use of most reproductive technologies,Footnote 3 and reproductive technologies are successful approximately 5–42 percent of the time.Footnote 4 As a result, many infertile couples still need to grapple with childlessness and how it is understood in relation to their faith.
While Scripture does not directly speak to the ethics of reproductive technologies, the narratives we read, pray during the Liturgy of the Hours, study, reflect on, and hear proclaimed during worship shape our responses to infertility. Scripture indicates, and tradition reaffirms, that children are a gift from God. However, the laments of Sarah, Rebekah, Rachel, and Hannah highlight the perception that God could withhold that gift. For example, Rachel despairs of having children and rejoices when she eventually bears a son (Gen 30:1–2, 22–24). In the ancient world, a childless man solved his problem by having children with a second wife, or with a surrogate. A childless woman, on the other hand, suffered reproach, shame, and disgrace. Infertility was perceived as a sign that the woman had somehow displeased God. Conception and a child affirmed that God was pleased, and assured the woman's place in the ancient household. Thus the word emerging from Scripture can be experienced as both a blessing and a curse.
On a theoretical level, we might suppose we no longer believe that a woman is incomplete unless married with children. But do we still act from the beliefs that a woman is incomplete unless she can biologically bear a child, and that infertility is a sign of God's displeasure.Footnote 5 Consequently, then, do we implicitly believe there is something wrong with a woman (and, by implication, a couple) who does not have biological children, who does not seek a medical remedy for infertility (either her own or her husband's), and who might not adopt children?
The normative cultural and ecclesial narrative presumes that a woman and man fall in love, marry, and have biological children. For Catholics, receiving the sacrament of marriage requires that the couple be open to children, with the underlying assumption that this openness means biological children. This presumption is exposed when the presider at the marriage ceremony asks a couple beyond childbearing years if they are open to children, often eliciting laughter from the congregation. Yet it seems normal when a younger couple is asked the same question, and infertility as a possibility goes unacknowledged. Couples do not hear the question, “Are you willing to accept the possibility of infertility or the inability to bear biological children?” What happens, then, as the marriage progresses and biological children do not arrive? How is one to understand the inability to become or remain pregnant? Where does the infertile couple fit in the theological picture of love, marriage, and children?Footnote 6 What challenges does infertility pose to our self-understanding, individually, as a couple, and as a community? Is our imagination and tradition supple enough to understand a man or woman as fully human, without being a biological parent, particularly within a marriage? What does the Catholic tradition offer to help the infertile couple understand their place in the Body of Christ?Footnote 7 More specifically, given the limited success of reproductive technologies and the number of infertile couples who do not use them for various reasons, what theological and ecclesial resources exist to begin developing a theology of infertility that can answer these questions?
To begin a consideration of a theology of infertility, I will proceed in the following fashion. In section 1, I will sketch an outline of the dominant cultural assumptions operating in the use and ethical assessment of reproductive technologies. Section 2 offers a brief overview of the Roman Catholic Church's recent moral tradition regarding reproductive technologies and the potential conflict the tradition poses for the infertile, particularly women. In this section I will also explore how the teaching opens space for rethinking infertility. In section 3, I will argue for the potential that Karl Rahner's theology of concupiscence holds for a theology of infertility. Additionally, I will suggest potential pastoral changes the Church can make and other potential theological venues that warrant further study in order to develop a theology of infertility.
1. Dominant Cultural Assumptions Surrounding Assisted Reproductive Technologies
The portrait that follows is a generalization. Yet, sketching the broad contours is necessary and important because reproductive technologies are often presented as good or morally neutral. Laying out operating assumptions regarding their use makes it easier to identify areas that need to be addressed when developing a theology of infertility.
In the United States, at least two presuppositions underlie our twenty-first-century approach to reproduction and infertility. One, the myth of the American Dream—the belief that we will succeed and accomplish anything we wish as long as we work hard enough—encourages us to think we can conquer infertility. Nadine Pence Frantz and Mary Stimming describe the phenomenon in this way: “We have come to expect that we should be able to achieve the particular future of our desiring.” This includes children.Footnote 8 Two, our culture primarily celebrates reproductive technologies while mostly ignoring their detrimental effects. This “celebration” occurs in prime-time news stories about multiple births, feature stories on talk shows like Oprah, reality shows such as (the now-canceled) Jon & Kate Plus 8, and articles or reports describing new advances in medical science.Footnote 9 The reports or feel-good stories rarely if ever offer critical analysis of the technology.Footnote 10 The celebration rightly acknowledges growth in scientific knowledge, the results of human creativity, and the birth of children. Yet this celebration glosses the pain and suffering that often precedes the successful use of assisted reproductive technology or that results from its failure. Furthermore, the celebration of reproductive technologies neglects the fact that technology is not value-neutral. John Staudenmaier, an historian of technology and culture, argues that technological inventions embed and cultivate values. As a result, any technology needs examination that explores the values that are being promoted, protected, or overlooked.Footnote 11 Theologian Richard McCormick, in a different vein, contends that “bioethical thought—and indeed health care planning in general—can be profoundly influenced by certain cultural assumptions, trends, unexamined attitudes, biases—what I shall call ‘value variables.’”Footnote 12 If we take Staudenmaier and McCormick seriously, then we need to ask what cultural assumptions or values need scrutiny in light of assisted reproductive technologies. Assisted reproductive technologies surface cultural assumptions, unexamined attitudes, and questions regarding how we comprehend human freedom, finitude, and embodiment as well as how we understand childlessness and parenthood. Some brief consideration will be given to each “value variable” just named.
Freedom
In a modern context, freedom frequently functions as the ability to have options, to choose among objects, and to exercise one's rights. Furthermore, humans often understand freedom as the ability to control their destiny and the outcome of their endeavors.Footnote 13 This type of freedom, freedom of choice, operates in approaches to reproductive technologies in a variety of ways.Footnote 14 Philosopher Karey Harwood discusses the “consumer” language, mentality, and framework operating in this style of reproductive-choice-as-freedom.Footnote 15 Freedom understood as choice appears, for example, when people shop for the clinic with the best success rates, when they screen embryos to increase the chance of implantation, in advertisements requesting egg donors with specific criteria, or in the screening of sperm donors for desirable characteristics.
There are at least two ironies in thinking about freedom of choice as providing options and reproductive technologies. The first is that one's socioeconomic status can hinder one's ability to avail oneself of certain types of reproductive technologies. Maura Ryan details this reality in The Ethics and Economics of Assisted Reproduction: The Cost of Longing. Footnote 16 The second irony involves both the perception that a couple should or will use reproductive technologies, and the desire for the technology to “fix” infertility. Both actually function to make it hard to say “no” to the technology. For example, Harwood observes that while the nonprofit advocacy organization RESOLVE: The National Infertility Association sees the “decision to remain ‘child-free’” as a response to infertility, “few if any of the people who came to the monthly RESOLVE meetings had not tried or were not considering some form of infertility treatment.”Footnote 17 Thus, saying “no” to reproductive technologies is often saying “no more,” rather than simply “no” at the outset. Connected to the ability to say “no” as one type of free choice is how humans respond to human finitude.Footnote 18
Finitude
Underlying the anguish, sorrow, and despair that one hears in the questions of those wrestling with infertility (such as “If I want a baby, why can't I have one?” or “Why won't my body cooperate?”) is the reality of our inability to transcend the limits of human finitude. Infertility profoundly brings home the reality that we are finite, contingent creatures, who do not control all aspects of our lives. Infertility harshly illuminates the lies that “we can have it all” or “if we only work hard, we can accomplish anything.” Infertility forces people to grapple with these lies when they do not get immediately pregnant, when they are told they are infertile, when various reproductive technologies do not work, or if they chose to follow their church's ban on certain reproductive technologies. This is a painful reality for both men and women in different ways. Miroslav Volf describes this reality as a “poison and a curse” and laments, “One hundred months' worth of hopes, all dashed against the stubborn realities of bodies that just wouldn't produce offspring.”Footnote 19 Ryan writes about the lie in this way: “As the quite normal expectation of growing up, marrying, and raising a family of one's own begins to appear out of reach, so the assumption that the course of one's life is predictable and subject to the powers of reason and will becomes a lie.”Footnote 20 These particular experiences of finitude arise from the body not doing what is normally expected. As a result, the body receives attention in a different manner.
Embodiment
Our bodies matter. Women experience bodily changes every month from puberty to menopause. At some point, for most women, this monthly bodily fluctuation becomes an event requiring little attention or reflection. However, for the woman trying to get pregnant, the monthly hormonal changes and resulting flow of blood are reminders that her body is “misaligned” with her heart and its desires. This can feel like death and subsequently causes suffering.Footnote 21
In addition to the dissonance between body and heart, women bear the greater physical burden of infertility. They are tested more frequently than their spouses. Some women's reproductive systems are found to be fine, and the infertility occurs because of an issue with the male's biology. Male infertility, though, often means that the woman still needs treatment. Women thus withstand the worst of medical interventions when attempting pregnancy. In light of cases such as these, Judith Lorber has raised the question of the value of women's altruism in shouldering the burden of infertility, even when their husband is infertile.Footnote 22
The question of whether women should subject otherwise healthy bodies to medically invasive procedures raises the additional question of how to classify infertility. Medically speaking, humans subject their bodies to many painful procedures in the hope of future health, defined as a restoration of proper bodily functioning. Understood in this context, classifying infertility as a disease draws attention to the need to determine underlying causes for infertility, increasing the potential for restoring reproductive functioning.Footnote 23 On the one hand, this is a positive outcome. On the other hand, the “technological cure” is not always equivalent to “healing” more broadly defined.Footnote 24 “Healing” more broadly construed applies to different dimensions of human existence, such as the bodily, emotional, and spiritual dimensions. Ryan highlights this when she asks “whether individuals now being offered treatment for infertility . . . are in general being healed by the experience.”Footnote 25 Attending to the question of health and how to classify infertility is important because the quest to become pregnant and to “heal” the body by means of technology can lead to spiritual disease and ill health. For example, Mary T. Stimming writes that, for her, the pursuit of pregnancy eventually functioned as a form of idolatry. Using Paul Tillich's notion of “ultimate concern,” she reflects on how pregnancy, not God, became the “center of her life.”Footnote 26
Given the amount of time women spend infertile during puberty, perimenopause, menopause, and even most days during their supposedly fertile years, perhaps we should also perceive of infertility, no matter when it occurs, as an ordinary dimension of being human. Noticing infertility as part of the rhythm of our bodies might open a space for saying “no” to certain medical treatments and help counter the lure of what Harwood has called “the infertility treadmill.” This “no” then creates a space to consider saying “yes” to something else. However doing so means considering how the body's infertility causes one to confront cultural assumptions about childlessness.
Childlessness
Celebrating reproductive technologies leaves unchallenged the unspoken, unexamined societal assumption that we are somehow incomplete as human beings without children.Footnote 27 Evidence of this presumption exists, for example, in the question “Do you have children?” If one answers “no,” often the next question is, “When are you planning to have children?” Many people do not realize that someone might be infertile. Mercy Amba Oduyoye, a Methodist theologian from Ghana and founder of the Circle of Concerned African Women Theologians, writes that people have said to her, “Don't say ‘no’, say ‘not yet.’”Footnote 28
Oftentimes, silence greets a response of “No, I do not have children.” This silence extends beyond societal convention to silence by the Christian church on the role of the married childless members of the Body of Christ. Oduyoye directly challenges the Christian church's silence.
The “child factor” in Africa (and perhaps elsewhere) is complex, and its public faces are daunting; but nothing is more oppressive than the ordinary meanings imposed on the absence of children in a marriage. The silence that shrouds the issue compounds its potential for the disempowering of women. Shall we continue to be silent, or shall we shape a theology that is life-giving in a situation that is otherwise a context of death? The one who sits on the throne says, “See, I am making all things new” (Rev. 21:5). Shall we not seek new life for the childless?Footnote 29
This is a difficult challenge given that the Judeo-Christian tradition emphasizes the importance of children within marriage.Footnote 30 The ability to talk about childlessness resulting from infertility also means examining the implicit “norms” that govern the practice of parenthood.
Parenthood
Using or considering the use of reproductive technologies can indicate a profound desire to have a biological child as the fruit and grace of a shared love, commitment, and life together. Wanting to share a genetic connection with one's child cannot be overlooked or minimized. However, the desire to “have a child of my own” can also belie a sense of ownership, undercutting the very sense that children are a gift from God, a gift held in trust.Footnote 31 Scripture underlines this sense of gift. For example, Hannah's response to God hearing her plea for a child shows she recognizes her custodianship; she dedicates the child to God (1 Sam 1:20–28). Moreover, thinking about infertility within a limited focus on biological parenthood risks denigrating the familial relationships between children and the nonbiological adults in their lives, such as adoptive parents, foster parents, or other child-raising scenarios.Footnote 32
From a theological perspective, focusing on biological parenthood potentially ignores the Christian claim that we are all brothers and sisters in Christ, responsible for each other, and that relationships based on discipleship are not subordinate to biologically familial relationships. This theological tenet opens up possibilities for understanding adoption not just as a second choice when reproductive technologies fail, but instead as a Christian response to care for God's children. This is not to suggest that adoption is a simple answer, since adoption itself has ethical implications.Footnote 33 Rather, I want to suggest we have to hold in tension the importance of biological connections with the Christian belief that life-giving love transcends biological connection.
Thus, the American landscape around reproductive technologies contains some implicit assumptions that require consideration when developing a theology of infertility. These assumptions include the ideas that freedom equals the ability to choose among available options, that technology can compensate for human finitude, that we need to subject our bodies to all types of medical interventions, that women and men need children to be complete, and that adoptive parenthood is inferior to biological parenthood.
Before exploring resources for developing a theology of infertility, I want to examine the Roman Catholic Church's teaching on reproductive technologies. This examination will further illuminate why a theology of infertility is necessary.
2. Infertility and Recent Roman Catholic Teaching on Reproductive Technologies: Donum Vitae
The Catholic Church's primary statement regarding the use of reproductive technologies is the Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation (Donum Vitae), promulgated by the Congregation for the Doctrine of the Faith (CDF) on February 22, 1987.Footnote 34 In December 2008, the CDF released the Instruction on Certain Bioethical Questions (Dignitas Personae), which affirmed Donum Vitae and addressed questions that had arisen since Donum Vitae's publication. Donum Vitae will be the focus here, since it provides the foundational arguments against most forms of reproductive technologies.
Donum Vitae begins by describing the proper use of technology in relation to the beginnings of human life. It states that the proper use of technology is to aid procreation and to serve humanity, in contrast to a misuse of technology, which dominates and controls procreation, impinging on the values and rights of the human person. Sadly, the instruction does not more fully develop its assessment of technology's positive and negative features. If the CDF instruction had included a more robust theological discussion about technology, it would have provided an additional moral framework for considering various reproductive technologies.
Instead, the CDF focuses its examination on the status of the embryo and protecting the value of procreation within marriage in order to evaluate the licitness of various reproductive technologies. Many have examined the CDF's arguments against various types of reproductive technologies found in section 2 of Donum Vitae. Footnote 35 What is missing, however, is an analysis of Donum Vitae's presumption that procreation means having biological children, an assumption that does not hold in light of barrenness, which poses a challenge for understanding the procreative aspect of marriage found in Donum Vitae. Yet the instruction also affirms the intrinsic value, dignity, and worth of the infertile couple and their marriage. How do I arrive at these conclusions?
In section 2 of Donum Vitae, the CDF delineates its position on assisted reproductive technologies, ultimately concluding that both homologous (using the wife's eggs and the husband's sperm) and heterologous (using some combination of donor eggs or sperm) techniques are morally illicit. The techniques prohibited include artificial insemination and in vitro fertilization. Prior to the publication of Donum Vitae, Kevin Kelly examined the question “How far is the Roman Catholic position on contraception a determining factor in its assessing the morality of IVF?” He analyzed various statements by the Catholic bishops in Britain, addresses by Pope Pius XII, and theological analysis by Richard McCormick, SJ. He noted that since the position in Pope Paul VI's 1968 encyclical Humane Vitae regarding contraception is a conclusion drawn from the more fundamental premise that the unitive and procreative aspects of sexual activity must be held together, this fundamental premise would be important when looking at in vitro fertilization (IVF). Humanae Vitae's concern is to maintain the union of the unitive and procreative in the conjugal act, while IVF separates the unitive and procreative “outside the sexual act.”Footnote 36
The CDF in Donum Vitae did end up arguing that the unitive and procreative goods of marriage and their connection with sexuality needed to be upheld. The CDF states, “Indeed, by its intimate structure, the conjugal act, while most closely uniting husband and wife, makes them capable of the generation of new lives, according to laws inscribed in the very being of man and of woman.” In other words, conjugal activity by design is both unitive and procreative. After noting that this structure has implications for responsible parenthood, the CDF cites Humanae Vitae: “By safeguarding both these essential aspects, the unitive and the procreative, the conjugal act preserves in its fullness the sense of true mutual love and its ordination toward man's exalted vocation to parenthood.”Footnote 37 The CDF concludes that there is a connection here regarding the use of contraception and what occurs in homologous artificial fertilization, so that neither is permissible because of the underlying premise that the conjugal act is both unitive and procreative. Contraception and artificial insemination, albeit in different ways, sever the link between the unitive and procreative aspects of the conjugal act, and undermine the connection between the unitive and procreative goods of marriage. What holds true for artificial insemination also holds true for in vitro fertilization. Therefore, the CDF argues that by seeking procreation outside of the conjugal act by using artificial insemination or IVF, a couple incorrectly permits a separation of the goods of marriage and undermines the link between the goods of marriage and the conjugal act.
While the CDF argues that many reproductive technologies are illicit, they sanction technologies that correct underlying medical conditions and as a result permit procreation to happen through the conjugal act.Footnote 38 For example, hormonal treatments to correct for low or high levels that contribute to infertility, surgery for endometriosis, clearing blocked fallopian tubes, and treating varicocele are acceptable.Footnote 39 However, for many couples, the solution might not be so simple, particularly if permitted treatments do not change their infertile status. If couples choose to follow the Roman Catholic Church's instruction and not avail themselves of the prohibited reproductive technologies, how are they to understand the inseparability of the unitive and procreative aspects of their married life and their conjugal activity, especially when procreation is understood as bringing forth biological children?
For many who suffer from infertility, the Roman Catholic Church's instruction prohibits a method for fulfilling the mandate or blessing emanating from Genesis 1:28 to “be fruitful and multiply.” Alongside the presuppositions that one will be able to have children, the Roman Catholic emphasis on the contributions of married couples as parents,Footnote 40 and the belief that children are a “gift” and “blessing” from God, put the couple in a bind. Ryan describes this bind as a “paradoxical and ultimately untenable position.” This position results from the emphasis on the fullness of marriage culminating in parenthood and not having the “right to expect that they will be able to participate in this ‘expected’ role.” The CDF in Donum Vitae then says that certain methods the couple might use for moving out of this bind and fulfilling their “expected” role as Christian parents are off-limits.Footnote 41
Complicating this reality for women is the Roman Catholic Church's discussions about women as wives, mothers, and virgins, and their societal roles. With roots in Scripture, the tradition's dominant stream maintains that a woman's primary role is motherhood, fulfilled by becoming a wife and bearing children, or in the case of religious women, spiritual motherhood. This sensibility is slowly changing because of work by Ann O'Hara Graff, Donna Teevan, Elizabeth Johnson and others, even as the virgin/mother myth remains deeply embedded in our theological imaginations and some ecclesial writings.Footnote 42 A woman's vocation as mother comes to the fore when Pope John Paul II exhorts women to model Mary, in whom “The Church sees … the highest expression of the ‘feminine genius’ … . Through obedience to the word of God she accepted her lofty yet not easy vocation as wife and mother in the family of Nazareth.”Footnote 43 Evidence of the virgin/mother construction materializes in the Apostolic Letter Mulieris Dignitatem, where John Paul II says of Mary that “virginity and motherhood co-exist in her: they do not mutually exclude each other or place limits on each other. Indeed, the person of [Mary] helps everyone—especially women—to see how these two dimensions, these two paths in the vocation of women as persons, explain and complete each other.”Footnote 44 However, the infertile married woman is neither a perpetual virgin like Mary nor usually a biological mother. Therefore, the CDF instruction places some women in a quandary, because it creates a tension between the Roman Catholic teaching on the nature and vocation of women as primarily virgins or mothers and its reproductive teaching, which closes a biological motherhood option for infertile women.Footnote 45
One reason this predicament exists can be found in the statement from Donum Vitae cited earlier. To drive home the point, I cite it in a fuller form:
The Church's teaching on marriage and human procreation affirms the “inseparable connection, willed by God and unable to be broken by man on his own initiative, between the two meanings of the conjugal act: the unitive meaning and the procreative meaning. Indeed, by its intimate structure, the conjugal act, while more closely uniting husband and wife, makes them capable of the generation of new lives, according to laws inscribed in the very being of man and of woman. . . .” “By safeguarding both these essential aspects, the unitive and procreative, the conjugal act preserves in its fullness the sense of true mutual love and its ordination toward man's exalted vocation to parenthood.”Footnote 46
This statement says to the married couple, particularly to the woman, that the Church teaches that children are a blessing of marriage and they are the generative end of the conjugal act. This declaration also implies that men are by vocation called to be fathers. Furthermore, John Paul II's teaching that fathers take a more active parenting role is necessary and valid.Footnote 47 However, I have not found any teaching that restricts men's vocation to fatherhood. Indeed, men are assumed to have other vocations besides fatherhood. Therefore, given the Roman Catholic Church's teaching regarding the nature of women and the role of men in the family, I would argue that the CDF in Donum Vitae also does not assume that males are tied to their vocation of fatherhood, but does claim that women's primary vocation is motherhood.
Yet if a woman or her husband is infertile, Roman Catholic teaching denies a woman a means of reaching her (or their) generative function and vocation in marriage. Hence, using the same underlying premise for excluding contraception and for banning certain types of reproductive technologies is somewhat problematic, since in Humanae Vitae “procreative” is understood as biological procreation. The desire to preserve and protect the inseparability of the unitive and procreative goods of marriage, manifested in the conjugal act is valuable, but the inseparability collapses in light of infertility. A married couple's infertility demonstrates the fallacy of always insisting on conjoining the unitive and procreative goods of marriage and dimensions of conjugal activity when one understands procreation only as biological procreation. This raises the question of how we understand procreativity as a good of marriage if biological procreation is not possible.
The CDF in Donum Vitae offers a potential way forward when it implicitly argues that nature does not dictate a woman's vocation to be mothers. It does so when it writes, “The fidelity of the spouses in the unity of marriage involves reciprocal respect of their right to become a father and a mother only through each other.”Footnote 48 While this statement could reference the embodied aspect of cocreating a child, an alternative reading is possible, one that highlights the reality that men and women become parents in relationship to each other. Female nature does not make a woman a mother any more than male nature makes a man a father. The CDF makes a nod in the direction of acknowledging that parenthood is more about decision, commitment, and relationality than simply a biological connection. It is the sacrifice for and care of a vulnerable dependent human child together that forge the identity of a mother or father.
Furthermore, Donum Vitae states that “marriage does not confer upon the spouse the right to have a child.”Footnote 49 While contributing to the bind of married couples noted earlier, this statement could be interpreted as saying that biological procreation is not necessary for a valid and fruitful marriage. Thus the CDF, on its own terms, challenges the belief that a person, particularly a woman, is incomplete without a biological child. If this is so, then to maintain the inseparability of the unitive and procreative goods of marriage, procreation needs to be more broadly construed as generativity.Footnote 50 Generativity can encompass biological procreation yet also provides a framework for perceiving “fruitfulness” more broadly. In fact, section 3 of Donum Vitae hints at how the infertile couple might understand procreation in a more expansive way. Here, the couple is encouraged to examine other gifts they might have to offer, with which they might serve the community of believers. There is a responsibility to God and the community to develop those gifts and use them. Infertility, while dashing hopes, also invites the couple to examine in a new way what their role is, or should be, in the larger community. Likewise, the CDF states that the full ecclesial community must consider how they will welcome and incorporate the infertile or childless into their midst. Unfortunately, this responsibility on the part of the couple and the community is not explained well.Footnote 51
Despite the fact that I find Donum Vitae's reasoning in support of the prohibition on reproductive technologies lacking, I do acknowledge that the CDF recognizes that reproductive technologies are not morally neutral. The CDF also provides support for another option that those who are infertile may have, namely, the option to say “no” to reproductive technologies and the “infertility treadmill.” However, given the CDF proscription on the use of most reproductive technologies, the Church needs to grapple with the theological implications of this teaching for the lived experience of the faithful, its theological anthropology, and the understanding of marriage as inseparably unitive and procreative. One way to do this would be to develop a theology of infertility that helps women and men not feel like failures, that counters the sense that they have somehow found disfavor with God or that they are incomplete members of the Body of Christ. Any formulation of a theology of infertility would require honoring the suffering caused by infertility and would need to uphold the dignity, worth, gifts, and contributions of infertile women and men, and the infertile couple. Furthermore, a theology of infertility would break the silence of the Church on this matter and permit a more thoughtful, compassionate embracing of all members of the Body of Christ. I propose we move forward and begin to formulate a theology of infertility. The next section offers steps for starting that work.
3. Toward Crafting a Theology of Infertility
Given that people experience infertility, it is important that practical steps to address this reality be taken as a theology of infertility is developed. My suggestions fall into three general categories: societal, ecclesial, and theological. The first two are more praxis-oriented.
Societal
These suggested changes involve our daily encounters with people. We should be deliberate with the type of questions we ask. Let others take the lead in speaking about their children or lack thereof. We need to resist the urge to resort to platitudes when encountering the suffering of those who are infertile. We should be willing to have non-child- centered conversations. And we should be courageous in thinking and discussing both the good that can come from reproductive technologies and the negative consequences of the technology, while always being mindful to honor the stories and experiences of those who have suffered the pain of infertility.
Ecclesial
The ecclesial proposals might appear more pastoral than theological. However, changed ecclesial practices, in addition to meeting needs among the faithful, could foster an awareness for a theology of infertility. By implementing changes, ecclesial communities rise to Mercy Amba Oduyoye's challenge to address the pain and suffering of infertility, breaking the Christian church's silence. This is important because, as Ryan highlights, infertility is not only a “medical or social crisis” but also a “spiritual crisis, a deep confrontation of meaning and belief.” Acknowledging the spiritual dimension of infertility allows one to engage resources within the tradition to help people grapple with loss and self-transformation, to hold onto hope, to heal, to forgo the pursuit of a technological solution, and to arrive at a new sense of self.Footnote 52 The Church must accompany its people in their spiritual distress.
Consequently, attending to homilies, bulletin inserts, and church events around particular holy days while recognizing that such feasts can be a test of faith or a source of great sorrow for infertile couples can help to break the silence. For example, Christmas, which focuses on the birth of a baby, Emmanuel, poses particular challenges for those longing for a child. Celebrations and blessings of mothers and fathers in church on Mother's Day or Father's Day can be alienating, since they often overlook those who are infertile. These celebrations can be more inclusive if they seek ways to recognize “the pain of longing for parenthood” and incorporate this recognition “liturgically alongside the joy and struggles of its [parenthood] realization.”Footnote 53 On the other hand, Pentecost provides a great resource to preach on the power of the Holy Spirit and the gifts provided to the Church on that day. How can this feast help us think beyond the usual gifts from God that include but are not limited to children? How can we name, recognize, and honor these other gifts of the members of the Body of Christ on a more deliberate, consistent basis?
Changing and adapting the marriage rite to include the possibility that children might not arrive needs consideration. When the couple is asked to commit to each other “in good times and in bad, in sickness and in health, for richer or poorer,” “with or without biological children” could be added. We acknowledge that health might decline, material circumstances will change—why not acknowledge that biological children may or may not arrive? One resource within the marriage rite already makes this acknowledgment. The prayers highlight the rich dimensions of marriage and express the community's hopes that the marriage will facilitate service to the world, foster growth in holiness, increase trust between spouses, shape a shared life together, function as sign of the union between Christ and his Church, serve as a witness to the world of divine love, function as an image of the covenant between God and God's people, and be blessed with children.Footnote 54 These are wide-ranging hopes for the marriage, whereby children are one hope among many. We need to admit, and discover how to communicate, that prayers that make reference to children actually request that God may grant or bless the couple with children. Liturgically, the prayers and blessings admit the reality that biological children might not arrive.Footnote 55 Frank discussions regarding this reality could also help break the silence surrounding infertility and begin facilitating discussions about the gifts of the childless within the community, as well as broader understandings of procreativity as a good of marriage.
However, changed practices are not enough. The cultural assumptions surrounding reproductive technologies discussed in section 1 still need more developed theological responses.
Theological
Theological resources exist within the tradition to counter the cultural notions of freedom and finitude operative in the celebration of reproductive technologies, specifically Karl Rahner's notion of theological concupiscence.Footnote 56 For Rahner, theological concupiscence is the category with which to discuss the relationship and essential tension between human finitude (nature) and human freedom (person).Footnote 57 This tension between nature (finitude) and person (freedom) exists as an existential of human existence.
Nature, according to Rahner, is “that which is pre-established for free personal control and which serves as the norm of [a] decision.”Footnote 58 Nature serves as the norm of any decision, because it is what the Creator created, our essence—the clay of the potter, so to speak. Person, on the other hand, is “what this being in freedom makes of itself and as how it wants to understand itself.”Footnote 59 It is how the human wants to shape and form her being and life through the choices made and actions undertaken. However, freedom does not arise from nothing; it requires that which is embodied, prior to expression, in our nature. Nature forms the a priori basis for any decision or action in freedom. In other words, nature sets the preconditions for any action. However, these preconditions are transcended through freedom and subsequent actions.Footnote 60
All actions engage varying depths of our being, and thus embody our values and beliefs. Rahner states, “Seen from a Christian point of view, the idea of responsible freedom changes greatly and becomes immensely deeper when it is seen that man can determine and decide himself as a whole by his freedom . . . and that he therefore posits acts which must not merely be qualified morally and then pass away again.”Footnote 61 In other words, acts are not just momentary blips in our lives. Acts have effects that influence not only present but also future actions, our way of being in the world, and our relationships. If Rahner is correct that we determine our identity and shape the direction of our lives by our actions, then the possibility exists that struggles with infertility and reactions to reproductive technologies indicate that infertile couples are engaging their freedom more deeply than freedom-of-choice language implies.
Given the reality that reproductive technologies do not always succeed, theological concupiscence provides a theological foundation for understanding the uncertainty in any response to infertility. Theological concupiscence accentuates the lack of certainty and the elusiveness of many moral decisions and actions. There remains something irresolute in the relationship between our finitude and our freedom, something that questions the decision made or the action taken, or elements to be considered that we simply do not yet recognize; there is a remainder of sorts. This means that every decision or action undertaken entails risk. The risk is that we will be more wrong or more wonderfully right than we ever imagined.
Moreover, any response to infertility will require grappling with some form of suffering, since nature (finitude) can never be fully overcome by freedom. Rahner describes how the tension between our finitude and our freedom manifests itself in the experiences of human Passion.Footnote 62 Passion as humans experience it is not the Passion of Christ, but the aspect of human existence “characterized by what we normally call pain, suffering, anxiety, fear, death,” and so forth.Footnote 63 This is experienced as any “diminution of a natural condition of existence or activity”—stated differently, as an experience of finitude.
When discussing human Passion, Rahner makes a crucial distinction between the natural and personal aspects of this human experience. The natural is related to what we experience biologically or that which other creatures would also experience. The personal refers to what occurs “within the natural sphere” as experienced by a human being. In other words, the personal indicates a degree of freedom in thinking, acting, and deciding about one's “reality,” “own being,” and “life.” The personal transcends simple empirical analysis of the natural experience. The natural and personal experiential aspects of Passion help explain why infertility is not simply a matter of biology. The biological effects of infertility manifest themselves in personal ways, raising questions about identity, purpose, and a person's life narrative. Rahner recognizes that suffering is part of every decision engaging the depth of human freedom. Suffering occurs because every decision involves renunciation; deciding in favor of some possibilities means closing off other possibilities. Freedom seen as truth-to-self will necessitate “suffering” or the closing of certain possibilities. For example, for those who are infertile, this actuality reveals itself when they let go of hopes for biological children. Thus, infertility is one particular expression of the existential reality that, for all human beings, freedom never completely transcends finitude. However, while Rahner's concept of theological concupiscence can help us think about the tension between freedom and finitude in the context of infertility, on its own it is insufficient for a theology of infertility.
A robust theology of infertility also means theologically contesting the cultural and religious notions regarding childlessness noted earlier. A starting point could be perceiving Genesis' call to be fruitful and to multiply as a call not just for individuals but also for the human race. If humanity is to be fruitful and multiplying, can we consider how procreation might not be a necessity for all human couples? This would require a conversation about the identity and place of childless couples in the community and the Body of Christ. What is their role? Would a better understanding of the celibate's role in the community help us think about the role of the childless within the community?Footnote 64 Giving a satisfactory answer to the questions regarding childless couples' contributions to the Body of Christ means we must attend to several underlying foundational issues.
First, can we more explicitly articulate a belief that childless marriages are valid vocations?Footnote 65 This is a difficult question to answer. Given the operative norm that the fruit of marriage is children, our ability to answer in the affirmative depends on our ability to give theological support for an expanded notion of procreation. The theological move from the goods of marriage being unitive and procreative to being unitive and generative, where “generative” includes biological procreativity, is central to a theology of infertility. This would help create space for infertile couples to think about their marriages as not empty and barren, but rather as fruitful. Among others, Bonnie Miller-McLemore and Christine Gudorf have already done some work in the area of generativity, but more needs to be done.Footnote 66 Mercy Amba Oduyoye indicates the value of seeing procreativity differently, where the infertile could claim that their lives were lived as a doxology to God, and their creative command became “increase in humanity. Multiply the likeness to God for which you have the potential. Multiply the fullness of humanity that is found in Christ. Fill the earth with the glory of God. Increase in creativity. Bring into being that which God can look upon and pronounce ‘good,’ even ‘very good.’”Footnote 67
The second foundational issue that needs further work in developing a theology of infertility concerns Mary. Analysis of how a theological anthropology that prioritizes Mary's virginity and motherhood as a central image that shapes views about women's vocation must continue. Mary is important, but what understanding of women and vision of women's vocations would arise if other scriptural images of women were also integrated into our theological heritage? Is it possible to shatter the duality of the virgin/mother construct for women so that roles other than vowed life or motherhood are appreciated and supported as a valid response to God's call? Studying the role of other women in Scripture, such as Miriam, Deborah, and Phoebe would help develop a more robust theological anthropology and understanding of vocation for women. Doing so would provide alternative visions for identity formation when biological motherhood is not an option.
4. Conclusion
The operating premise of this article is that a theology of infertility needs to be developed as a response to questions raised by infertility. Section 1 indicated some challenges facing human self-understanding in light of infertility and our cultural response to reproductive technologies. These challenges include how our comprehension of freedom, finitude, and embodiment, responses to childlessness, and views of parenthood are shaped by cultural presuppositions. A theology of infertility would need to offer alternative constructions for understanding freedom, finitude, embodiment, childlessness, and parenthood. Section 2 examined the Roman Catholic Church's teaching on reproductive technologies and raised additional challenges in two areas: theological anthropology and the understanding of the inseparability of the unitive and procreative goods of marriage. The analysis of Donum Vitae also yielded insights toward maintaining the inseparability of the unitive and procreative goods of marriage in light of childlessness and discerning gifts to be offered to the community. Additionally, Donum Vitae with its prohibition of many types of reproductive technologies provides an alternative to the “infertility treadmill.” However, saying “no” to the technology needs to be placed within the context of a more robust theological vision of women's vocations, a richer understanding of procreativity, and sensitivity to and pastoral responses attentive to the implications of the teaching in the lives of the faithful.
As a result, suggestions were made in section 3 for implementing societal and ecclesial practices that would foster awareness of infertility and sensitivity to the infertile in our communities. Karl Rahner's notion of theological concupiscence was used to show an alternative way of considering freedom and finitude. Finally, additional places within the tradition and Scripture that might yield fruit for crafting a theology of infertility were suggested. Doing the further work needed to craft a theology of infertility would continue the process of raising awareness and breaking the silence surrounding infertility in communities and would provide an alternative to the cultural vision celebrating reproductive technologies while ignoring their costs.Footnote 68
