SACRAMENTO, Calif. - Catholic teaching has called in-vitro fertilization techniques immoral for decades. But most Catholics still haven't heard the news. California attorneys Anthony and Stephanie Epolite found out the hard way that in-vitro fertilization wasn't all it's cracked up to be. After years of marriage, and facing her 39th birthday still without a baby, Stephanie turned to a fertility clinic. Two years and $25,000 later, the couple had nothing but frustration and embarrassment to show for the time spent on in-vitro fertilization.

"We were emotionally, financially and spiritually spent," Stephanie Epolite said. "The clinic did no diagnostic tests. They loaded me up with fertility medication and determined the right time for retrieval of my eggs." But, after the retrieval and the mixing of the eggs with Anthony's sperm in the laboratory, still no embryo developed. "In the end, they told me I just had old eggs," Stephanie said. She wishes she had known at the beginning what she has since learned: The Catholic Church forbids fertility techniques that try to make babies outside of marital intercourse. "There is no education out there about the alternatives," she said, "so Catholics are flocking to the fertility clinics."

According to the American Society for Reproductive Medicine, infertility affects more than 6 million American women and their spouses, or about 10% of the reproductive-age population. About 5% of infertile couples use in-vitro fertilization. As to how many Catholic couples are among them, figures are hard to come by. But many Catholics seem unaware of the immorality of the procedure.

"Anecdotally, from our consultation experience here. Catholics using reproductive technologies are generally unaware of the Church's moral teaching in this area," said Dr. Peter Cataldo, director of research with the Boston-based National Catholic Bioethics Center. "They're not hearing it from the pulpit or elsewhere." In her teaching on human reproduction, the Church seeks to safeguard human dignity. God wants life "to be the result of an act of love by those committed to loving each other," philosophy professor Janet Smith has written. Anything that assists the conjugal act achieve its purpose of procreation is licit; anything that substitutes for it is not.

In No. 2377, the Catechism explains why the Church opposes methods that separate marital love-making from baby-making.

They dissociate the sexual act from the procreative act. The act which brings the child into existence is no longer an act by which two persons give themselves to one another, but one that entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children. Under the moral aspect procreation is deprived of its proper perfection when it is not willed as the fruit of the conjugal act, that is to say, of the specific act of the spouses' union.

In successful in-vitro fertilization, a human life comes into existence outside the conjugal act and outside the womb. Conception is the result of a technician's manipulation of "reproductive materials." The process for the collection of sperm often necessitates masturbation, which is itself immoral.

Father Tadeusz PachoIczyk, director of education at the National Catholic Bioethics Center in Philadelphia, explained that the Church teaches that the procedure is immoral for several reasons. "It undermines the meaning of sex. It violates the exclusivity of the couple's marriage covenant," Father Pacholczyk said. "It says that it is okay to manufacture life in a laboratory as if it were a commodity, when it should be the result of human love."

"There's also the ancillary evil of freezing embryonic humans that are later abandoned or poured down the sink if they are not useful," he added. In addition, Father Pacholczyk noted that babies created through in-vitro fertilization have an elevated risk of birth defects. "Studies have shown a six fold elevated risk for in-vitro fertilization children contracting an eye disease called retinal blastoma versus normally conceived babies," he said. "In-vitro fertilization is very unnatural. You're extracting ova from the woman, culturing them and inspecting the developing embryo in a laboratory setting. They are in a completely unnatural environment for a very long time before they are put back into the womb.

"Commercial interests offer in-vitro fertilization as standard practice," Father Pacholczyk said. "The Catholic Church is the only voice opposed to it." But there are morally acceptable alternatives to in-vitro fertilization, and Dr. Thomas Hilgers is trying to let more Catholic couples know that.

In response to Humanae Vitae, Pope Paul VI’s encyclical reaffirming the Church’s opposition to contraception, Hilgers devoted his life to the study of human reproduction, developing the Creighton Model System of Natural Family Planning and eventually opening the Pope Paul VI Institute for the Study of Human Reproduction.

In 1991, Hilgers coined the term NaPro Technology (Natural Procreative Technology), a reproductive and gynecologic medical science that seeks to evaluate and treat a host of women's health problems without the use of contraception, sterilization, abortion or artificial reproductive technologies, thereby making it consistent with Church teachings.

NaPro Technology first identifies the causes of infertility and then seeks to treat them. That's not always the case at fertility clinics. "The aim of most fertility clinics is to skip over the abnormality to try to get women pregnant," Hilgers said. "Yet when you skip over the causes, you end up dealing with them one way or another.

"It's ludicrous to promote in-vitro fertilization as the help for the vast majority of 6.62 million with impaired fertility," he said. "When you listen to the national news and morning television shows, you think that in-vitro fertilization is the only thing available to infertile couples, yet less than 0.5% of infertile couples in the U.S. are helped by in-vitro fertilization each year."

Catholic theologians and ethicists would agree that NaPro Technology is morally acceptable Cataldo said. Cataldo pointed out that "certain drug therapies and egg-stimulating medications at doses that don't have disproportionate risks for the children engendered or for the mother" also are acceptable. But other technologies, such as intrauterine insemination (IUI) and gamete intrafallopian transfer (GIFT) fall into a gray area. "Some moral theologians and ethicists see these techniques as assisting the conjugal act. Others see it as replacing it," he said. "Until such time as the Vatican speaks, Catholics contemplating the use of IUI or GIFT should inform themselves of both sides of the moral and theological argument and then make a decision in good conscience."

Regardless of the artificial method chosen, the cost of such techniques remains high and the success rates low. According to the 2001 Assisted Reproductive Technology Success Rates report compiled by the U.S. Department of Health and Human Services, a survey of 384 fertility clinics showed a clinical pregnancy success rate of 32%.

In a 1990 article published in Social Justice Review, then-associate director of the U.S. Catholic bishops' Pro-Life Secretariat Richard Doerflinger noted that a survey of in-vitro fertilization clinics discovered that half of the clinics had never had a live birth after being in business at least three years, collectively treating more than 600 women and collecting $2.5 million for their services.

"Those with the extraordinary emotions that engulf infertile couples are extremely vulnerable," Hilgers said. "They are easy prey." Not only do natural and morally acceptable alternatives such as NaPro Technology cost far less, but they also are more successful. The Pope Paul VI Institute boasts success rates ranging from 38% to 80%, depending upon the condition being treated.

Following the Epolites' experience with in-vitro fertilization, Stephanie learned about the Pope Paul VI Institute from a Natural Family Planning counselor. In the fall of 2000, the couple applied to the institute, gathered charts they had kept that outlined vital signs related to fertility, and underwent diagnostic testing. As it turned out, both had reproductive issues that their previous fertility clinic had never diagnosed. Anthony's sperm count was low, and Stephanie suffered from endometriosis and blocked fallopian tubes.

Six months later, following treatment of their conditions at the Pope Paul VI Institute and at the age of 42, Stephanie conceived naturally. Their daughter, Claire Marie, was born Oct. 3, 2002.

"At the Pope Paul VI Institute, we saw compassion, concern, help and love," Stephanie said. "They provided individualized treatment, versus the empty feeling that we felt from the fertility clinic. Whereas the fertility clinic bypasses all the laws of nature, the Pope Paul VI Institute works with the laws of nature."

The Paul VI Institute collected these statistics about the NaPro fertility approach:

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Tim Drake writes from St. Cloud, Minnesota