GAMETE INTRAFALLOPIAN TRANSFER (GIFT)

GAMETE
INTRAFALLOPIAN TRANSFER (GIFT)


Explanation of Terms and Procedures


The assisted reproductive technology of Gamete
Intrafallopian Transfer (GIFT
)
involves three steps.
The first step is ovarian stimulation and monitoring. Medications are
used to stimulate the woman to produce more than one follicle and ovum, and to
aid in stimulating the follicles to release the ova.
During this time the woman’s response to the medication and the
development of her ova are watched and assessed. The second stage begins with
a laparoscopy performed under general anesthesia to retrieve the ova.
The ova are then examined under a microscope to determine maturity.
Semen is obtained and processed in a centrifuge, where it is washed and then
placed in a test tube so that the active sperm can swim to the top. The third
step consists in transfer of  the
ova and sperm into the woman’s body.  Ova
and sperm are placed in a catheter, and the catheter is inserted directly into
the woman’s fallopian tube through a surgical procedure using a laparoscope.
The ova and sperm are then injected into the fallopian tube, with the
intent of fertilization occurring in its normal environment within the
woman’s body.  If fertilization
does occur, the developing embryo(s) will remain in the fallopian tube and
then move to the uterus for implantation. (1)

Policy

     The
use of Gamete Intrafallopian Transfer (GIFT) by marital spouses is not
excluded, provided that the following restrictions are observed:

     1)
the retrieval of ova and sperm must follow a natural act of sexual
intercourse;

     2)
sperm must be collected from that act of intercourse by morally acceptable
means;

     3)
the procedure must be carried out in  such
a  way
as  to  avoid
the  possibility
of
extracorporeal conception;

     4)
any ova collected but not transferred back into the woman’s body must not
be fertilized             in
vitro, with the resulting embryos
frozen for later implantation.

     Should
a multifetal pregnancy result through the use of the GIFT procedure, pregnancy
reduction, that is, the abortion of some of the fetuses, is not
permissible.

Sources of Policy


The Instruction on Respect for
Human Life in its Origin and On the Dignity of Procreation
from the
Vatican Congregation for the Doctrine of the Faith (1987) did not explicitly
pass judgment on  the GIFT
procedure. (2)  Cardinal Joseph
Ratzinger, prefect of the Congregation for the Doctrine of the Faith at the
time the Instruction was issued,
gave the following instructions on techniques whose use had been left open:
‘When the discussion is still open and there is not yet a decision by the
magisterium,  the doctor is
required to stay informed, according to classic theological principles and
concrete circumstances’ and to ‘make a decision based on his informed
conscience.’ (3)


The following directives from the Ethical
and Religious Directives for Catholic Health Care Services,
based on the
Vatican Instruction, are relevant to assessing the moral permissibility of
the GIFT procedure:

 

When
the marital act of sexual intercourse is not able to attain its procreative
purpose, assistance that does not separate the unitive and procreative ends of
the act, and does not substitute for the marital act itself, may be used to help
married couples conceive. (no. 38)

41.
Homologous artificial fertilization (that is, any technique used to
achieve conception using the gametes  of
the two spouses joined in marriage) is prohibited when it separates procreation
from the marital act  in its unitive
significance (e.g., any technique used to achieve extra-corporeal conception).
(no. 41)  (4)


The restriction concerning the method of collecting sperm is derived from
the Church’s long-standing teaching on the immorality of masturbation.
This teaching was reaffirmed in 1975 by the Sacred Congregation for the
Doctrine of the Faith in the  Declaration on Certain Problems in Sexual Ethics:

…both
the magisterium of the Church, in the course of a constant tradition, and the
moral sense of the faithful have been in no doubt and have firmly maintained
that masturbation is an intrinsically and gravely disordered action.
The principal argument in support of this truth is that the deliberate
use of the sexual faculty, for whatever reason, outside of marriage is
essentially contrary to its purposes.  For
it lacks that sexual relationship demanded by the moral order and in which
‘the total meaning of mutual self-giving and human procreation in the context
of true love’ is achieved.  All
deliberate sexual activity must therefore be referred to the married state. (5)


Regarding the third restriction, see the handbook entries on In
Vitro Fertilization (IVF)
and Cryopreservation
(Freezing) of Embryos.


The prohibition against selective reduction is part of the Church’s
unqualified opposition to direct abortion; see the Congregation for the Doctrine
of the Faith, Declaration on Procured
Abortion
(1974).  (6)


1. Fertilitext, Gamete Intrafallopian Transfer (GIFT), http://www.fertilitext.org/gift.html;
FertilityRX.com,  Assisted
Reproductive Technology
, Section IV: Gamete Intrafallopian Transfer (GIFT),
http://iop.com/ ~poetsrx/art/gift.html; Reproductive Medicine Group, Tampa, FL, Gamete
Intrafallopian Transfer (GIFT),
http://www.vbtivf.com/GIFT.htm;
Lycos Health by WedMD, Gamete Intrafallopian Transfer (GIFT), and Zygote Intrafallopian
Transfer (ZIFT),
http://webmd.lycos.com/content/dmk/dmk_article_5461649;
Am-I- Pregnant.com, Gamete/Zygote
Intrafallopian Transfer
, GIFT, http://www.am-i-pregnant.com/giftinv.shtml.


2. Congregation for the Doctrine of the Faith, Instruction
on Respect for Human Life in its Origin and On the Dignity of Procreation
(Donum Vitae) (Washington, DC: United States Catholic Conference,
1987).


3.  Origins
16/40 (March 19, 1987): 697, 699-11 at 699, marginal notes.


4. National Conference of Catholic Bishops, Ethical
and Religious Directives for Catholic Health Care Services
(1994)
(Washington, DC: United States Catholic Conference, 1995).


5. Sacred Congregation for the Doctrine of the Faith, Declaration
on Certain Problems of Sexual Ethics
(Dec. 29, 1975), no. 9, reprinted in
Kevin D. O’Rourke , OP and Philip Boyle, OP, Medical
Ethics Sources of Catholic Teachings
(St. Louis: Catholic Health
Association, 1989).


6. Reprinted in Austin Flannery, O.P. (ed.), Vatican
Council II: More Post Conciliar Documents
, vol. 2 (Northport, NY: Costello
Publishing Company, 1982). 

 

COMMENTARY

GAMETE INTRAFALLOPIAN TRANSFER (GIFT)

Medical Facts about GIFT

 
The GIFT procedure was developed in 1984 by Dr. Ricardo Asch and his
associates at the University of Texas Health Science Center in San Antonio. (1)
The procedure is ‘most often recommended for couples with unexplained  infertility
with the female partner having at least one open fallopian tube.’ (2) It can
also be recommended ‘for patients whose infertility is due to cervical or
immunological factors, mild endometriosis, or selected cases of male
infertility.’ (3)


GIFT is considered a variation of in vitro fertilization (IVF), with one
significant difference. With the GIFT procedure, it is intended that
fertilization occur naturally within the woman’s body instead of in a
laboratory. (4) For this reason, GIFT is sometimes described as ‘an
alternative for patients whose religious beliefs prohibit conception outside the
body.’ (5)


Reports of the success rate of GIFT in comparison with IVF vary.
Some reports indicate a higher  successs
rate for GIFT in achieving a pregnacy. (6)
Other reports indicate similar success rates for GIFT and IVF (7), with
IVF supplanting GIFT at some fertility clinics. (8)


A procedure called Tubal Ovum Transfer (TOT), or alternately, Tubal Ovum Transfer with Sperm  (TOTS)
is very similar to GIFT and has been superseded by it. (9)

Theological Opinion about GIFT


The Pope John Center, in consultation with Msgr. Carlo Caffarra, head of
the Pope John Paul II Institute for the Family in Rome, approved the GIFT
procedure in 1985, with the restriction that
sperm are collected during an act of sexual intercourse. (10) However,
the legitimacy of the GIFT procedure was not accepted by all theologians, and
the controversy continued through the decade of the 1990’s.
(11)  Nevertheless, the GIFT
procedure has not, to date, been explicitly rejected by the magisterium. (12)
Because of the lack of agreement among reputable theologians, and
concomitantly, because of the lack of an explicit pronouncement of approval by
the magisterium, the handbook’s policy statement is stated cautiously, namely,
that the use of GIFT by marital spouses is not
excluded.
(13)  

Defense of the Permissibility of the GIFT
Procedure


Rev. Donald McCarthy of the Pope John Center has defended the GIFT
procedure on the following grounds:

The
conjugal act in the described procedure remains the essential step in getting
the ovum and sperm to meet.  This
step is followed by the repositioning of the ovum and sperm in a manner which
markedly increases the likelihood of fertilization.
Hence, GIFT…can be seen as a medical procedure which assists, rather than replaces, the conjugal act…

In
conclusion, while the GIFT technique uses technology to assist
fertilization, it simply re- positions the sperm and ova to enhance the desired
outcome of fertilization.  The link
between the marital act and procreation is realized by technical assistance.
(14)


It should be noted that there is theological precedent for regarding the repositioning
of ova or sperm after an act of sexual intercourse as morally permissible; see
the entry Theological Opinion on
Permissible Assisted Reproductive Technologies (ARTs)
.
GIFT likewise involves the temporary exteriorization of ova and the
temporary exteriorization and processing of sperm after an act of sexual
intercourse.  Again, there is
theological precedent for regarding these procedures are morally permissible;
see the entry Theological Opinion on
Permissible Assisted Reproductive Technologies (ARTs).


Further, Peter Cataldo has attempted to spell out more exactly what it
means for a technological procedure to replace
the conjugal act or to assist it:

A
procedure replaces the conjugal act if it determines, of itself, those
conditions which immediately secure the success of fertilization; a procedure
assists the conjugal act if it does not determine, of itself, those conditions
which immediately secure the success of fertilization, but rather allows
fertilization to take place under immediate conditions which are natural. (15)

Using
this criterion, Cataldo argues that GIFT is a morally legitimate procedure:

…I
believe that GIFT with a conjugal act assists that act because the immediate
conditions of fertilization are not determined or created by the procedure
itself.  Unlike IVF and the other
procedures which replace the conjugal act, fertilization itself takes place in
GIFT within natural conditions which are essentially the same as those in which
a pathology is not present. (16)

Central Objection to the GIFT Procedure


The central objection voiced against the GIFT procedure is that it does
not really assist an act of sexual
intercourse, but rather, illegitimately substitutes for the conjugal act between spouses in achieving
conception.  This objection has been
developed in several ways.


William May contends that this procedure makes the conjugal act
incidental to the achievement of pregnancy in that an act of sexual intercourse
is needed only to obtain sperm in a morally acceptable way:

…I
think it must be said that in the GIFT procedure the conjugal act is in truth
incidental and not essential to the achievement of pregnancy.  The bond between the marital act and the GIFT procedure is
not essential.  This is quite
obvious from the fact that this procedure as such does not require the marital
act.  There is a complete
dissociation between the marital act and the technical method which leads to
conception.  The only
reason to engage in the marital act is to obtain the husband’s sperm in a
non-masturbatory way.  But this is
only incidental to the GIFT procedure as such. …GIFT, therefore, substitutes
for the marital act as far as the conception of the child is concerned and
does not facilitate it or help it to achieve its natural objectives. (17)

Donald
DeMarco also contends that these procedures make ‘the conjugal
act…incidental to the achievement of pregnancy’ because ‘the technical
method could be employed in the complete absence of the sex act, or even of love
and marriage.’ (18) Indeed, some fertility clinics make explicit that sperm
for the procedure is usually obtained through masturbation. (19)


Those approving of the GIFT procedure have pointed out that, when the
procedure is employed  together with the collection of sperm in a perforated condom
during an act of sexual intercourse, some sperm does enter the body of the
woman, and hence that the possibility does exist that actual fertilization
occurs from that sperm. (20) This possibility is used to counter the charge that
GIFT makes the conjugal act purely incidental to the achievement of pregnancy.


Another version of the objection that the GIFT procedure substitutes for
the act of sexual intercourse between spouses is developed by John Hass:

With all the procedures which intervene
between intercourse and conception in GIFT an integral link between the marital
act and procreation is lost.  In
other words, there is no longer  an
inherent, necessary and intelligible link between the marriage act and
procreation. (21; italics added)

However,
it is not simply the passage of time between coitus and the injection of the
gametes  which would seem to render
GIFT immoral but the fact that the intrinsic link between coitus and new life is
broken by the intervening human acts.  It
would seem that the new life is more the result of the actions of technicians
and medical personnel rather than the act of love between a husband and a wife.
…What is morally relevant is that the interventions of the technicians and
substitution of a host of procedures
come to replace the marital act. (22; italics added)

In
sum, ‘opposition to the moral acceptability of GIFT is based on the reason
that the number of interventions
breaks the intrinsic link between marital coitus and new life.’ (23; italics
added)


Peter Cataldo has offered the following reply to this line of argument:

The
same procedures considered individually and apart from GIFT are found morally
wrong within GIFT.  The following
interventions taken singly (and in conjunction with the conjugal act) are
considered licit as means to overcome infertility: collecting semen with a
perforated Silastic sheath; placing it in a syringe, injecting semen into the
uterus, treating the sperm, the use of ovulatory drugs, laparoscopic retrieval
of eggs, and injection of eggs into the fallopian tubes at an atypical site.
Thus, what are considered individually licit interventions become illicit
in GIFT because there are too many of them.
It is the number as such, the total number of interventions, which is
found objectionable.  Further proof of this is seen from the fact that the very
thing which makes each intervention licit individually is that each does not
violate the intrinsic link between conjugal act and procreation.
If the very thing needing to be preserved
is preserved individually by each, then the reason for the rejection of
those same procedures  must be the size of their number taken in combination.

Hence,
there must be some threshold number which makes the moral difference between
assistance and replacement for those who disapprove of GIFT.
But what is that number, and how is it to be determined?
In fact, there cannot be such a threshold because it cannot be
objectively determined.  Moreover, Donum Vitae does not place an inherent, quantitative limit to the
concept of assistance.  The number
of steps in between conjugal act and fertilization is not morally decisive for
the difference between assistance and replacement… (24)


In further defense of the union between the couple’s act of sexual
intercourse and conception it might be recalled that fertilization is not
simultaneous with the act of intercourse, but is a process that can take up to
thirty hours. (25)  Indeed, there
are cases where fertilization does not begin until two or three days after
intercourse because the woman has not yet ovulated and because the sperm still
have sufficient viability to bring about fertilization. (26)


Yet a third version of the objection has been presented by Benedict
Ashley and Kevin O’Rourke:

We
agree, however, with DeMarco that even if fertilization is not extracorporeal,
the ethical defect of GIFT is that fertilization is not directly the result of
the marital act, since the semen  used
is not deposited by that act in the vagina, but by a technician’s manipulation
which substitutes for the marital act…  Hence,
‘the immediate condition by which fertilization takes place’ it seems to us
is not the marital act but the technician’s manipulations.
Nor is it relevant to cite as a precedent the traditional statement of
the moral manuals, for which also Pius XII made allowances, that it would be
permissible (if it were shown to be effective, which seems not to be the fact)
for the husband to use some device to move semen higher into the
vagina or uterus to enhance the possibility of conception.
In that case it was supposed that the semen was deposited in the vagina
of the woman by normal intercourse and remained within her. (27)


Those approving of the GIFT procedure might again point out that, when
the procedure is employed  together with the collection of sperm in a perforated condom
during an act of sexual intercourse, some sperm does enter the body of the
woman, and hence that the possibility does exist that actual fertilization
occurs from that sperm. (28)

Extracorporeal Conception and the GIFT
Procedure


When the GIFT procedure was initially developed, the protocol included
air spaces between the sperm and ova when they were placed in the catheter for
insertion into the woman’s body. This was done in order to keep them separated
and to prevent fertilization outside the body. (29) This respected the Catholic
view that extracorporeal conception is not morally permissible. (30)


While some fertility clinics have retained this protocol (31), a number
of descriptions of the GIFT procedure now speak of the sperm and ova being
‘placed together’ or ‘mixed’ during the step of transferring them into
the woman’s fallopian tube. (32) At the same time, it is affirmed that
fertilization takes place in the normal, natural way within the woman’s body
in her fallopian tube. (33) Indeed, GIFT is described as ‘an alternative for
patients whose religious beliefs prohibit conception outside the body.’ (34)


Once sperm and ova are in contact, how can it be claimed unequivocally
that fertilization takes place within the woman’s body?
Here it might be replied  that
‘fertilization is a series of processes rather than a single event.’ (35)
Specifically, fertilization involves penetration of the corona radiata,
attachment to and penetration of the zona pellucida, fusion of sperm and egg,
prevention of polyspermy, metabolic activation of the egg, decondensation of the
sperm nucleus, completion of meiosis in the egg, and the development and fusion
of male and female pronuclei. (36) The short time in which ova and sperm are
mixed extracorporeally while being transferred into the woman’s body during
the GIFT procedure, combined with the temporal series of events needed for
fertilization, may well undergird the claim that fertilization takes place in
the natural way in the woman’s fallopian tube in this procedure.


Nevertheless, as a mattter of moral caution, Catholic couples seeking to
use the GIFT procedure are encouraged to inquire how it is being performed at
that particular fertility clinic and to request the original protocol in which
air spaces are included between the sperm and ova when they are placed in the
catheter for insertion into the woman’s body.
The original protocol is a simple one, and it should not be a burden on
the clinic to carry out the procedure in this way.

Use of the Procedures In
Vitro Fertilization (IVF
) and the Cryopreservation
(Freezing) of Embryos

in conjunction with GIFT


In its Revised minimum standards
for in vitro fertilization, gamete intrafallopian transfer, and related
procedures
the American Society for Reproductive Medicine makes the
following recommendation:

Because
technical considerations at the time of oocyte recovery may prevent tubal
transfer and/or oocytes in excess of those recommended for tubal transfer may be
obtained, it is recommended that GIFT only be performed in a facility that is
prepared to carry out IVF, as an alternative or in addition, in the event that
the GIFT procedure turns out not to be feasible and/or excess oocytes are
recovered.  Accordingly, a GIFT
program must have an embryo laboratory and personnel capable of performing IVF.
In addition the program should be capable of fertilizing nontransferred
oocytes and freezing the resulting embryos if they are of good quality.
(37)


Because in vitro fertilization (IVF) and the freezing of embryos are
considered to be morally impermissible practices by the Catholic Church, it is
never permissible to use the GIFT procedure in conjunction with them.
See the entries In Vitro
Fertilization (IVF)
and Cyropreservation
(Freezing) of Embryos.

Multifetal Pregnancy Reduction


Because a number of ova are used in the GIFT procedure in order to
enhance the chances of  achieving a pregnancy, the possibility exists of this
procedure resulting in a multifetal pregnancy, that is, in a pregnancy in which
two or more fetuses are present in the womb. (38) The following is
one set of statistics on multi-fetal pregnancy rates for the GIFT
procedure:


Single Baby      
Australia: 74%; US: 65%.

            
Twins                          Australia: 23%; US: 26%.

            
Triplets             
Australia:  3%;
US:  7%.


Quadruplets or higher   
Australia:   0%; US:  1%.
(39)

 
Multifetal pregnancies carry risks for both the fetus and the mother.
Risks to the fetus include  ‘an
increased chance of miscarriage, birth defects, premature birth, and the mental
and/or physical  problems that can
result from a premature delivery.’ (40)  Maternal
risks include ‘premature labor, premature delivery, pregnancy-induced high
blood pressure or pre-eclampsia (toxemia), diabetes, and vaginal/uterine
hemorrhage.’ (41) 


Multifetal pregnancy reduction consists in removing one or more of the
fetuses in a multifetal pregnancy ‘in an effort to increase the likelihood
that the pregnancy will continue’ (42), and concomitantly, to reduce the risks
to the mother and remaining fetuses. (43).
Pregnancy reduction is more likely to be performed when four or more
fetuses are present, although it may be considered under special circumstances
in the case of triplets or twins.  (44)


Multifetal pregnancy reduction, as an instance of abortion, is never
permissible.


1.  IVF.com, Introducing
the GIFT Procedure,
http://www.ivf.com/gift.html.


2. Fertilitext, Gamete Intrafallopian Transfer (GIFT), http://www.fertilitext.org/gift.html.
See also FertilityRX.com, Assisted
Reproductive Technology
, Section IV: Gamete Intrafallopian Transfer (GIFT),
http://iop.com/~poetsrx/art/gift.html; Infertility, Gynecology, & Obstetrics
Medical Group of San Diego, The Assisted
Reproductive Technologies Procedures at IGO Medical Group,
Gamete
Intrafallopian Transfer, http://www.igomed.com/fertilityserv.htm; Lycos Health
by WedMD, Gamete Intrafallopian Transfer
(GIFT), and Zygote Intrafallopian Transfer (ZIFT),
GIFT, http://webmd.lycos.com/content/dmk/dmk_article_5461649;
Am-I-Pregnant.com, Gamete/Zygote Intrafallopian Transfer, Gift, http://www.am-i-pregnant.com/
giftinv.shtml.


3. Fertilitext, Gamete
Intrafallopian Transfer (GIFT),
http://www.fertilitext.org/gift.html.
See also FertilityRX.com, Assisted
Reproductive Technology
, Section IV: Gamete Intrafallopian Transfer (GIFT),
http://iop.com/~poetsrx/art/gift.html; Infertility, Gynecology, & Obstetrics
Medical Group of San Diego, The Assisted
Reproductive Technologies Procedures at IGO Medical Group,
Gamete
Intrafallopian Transfer, http://www.igomed.com/fertilityserv.htm; Lycos Health
by WedMD, Gamete Intrafallopian Transfer
(GIFT), and Zygote Intrafallopian Transfer (ZIFT),
GIFT, http://webmd.lycos.com/content/dmk/dmk_article_5461649.


4. See, for example, Fertilitext, Gamete
Intrafallopian Transfer (GIFT)
, http://www.fertilitext.org/gift.html;

FertilityRX.com,
Assisted Reproductive Technology,
Section IV: Gamete Intrafallopian Transfer, http://iop.com/~poetsrx/art/gift.html;
Infertility, Gynecology, & Obstetrics Medical Group of San Diego, The
Assisted Reproductive Technologies Procedures at IGO Medical Group,
Gamete
Intrafallopian Transfer, http://www.igomed.com/fertilityserv.htm; IVF.com, Introducing
the GIFT Procedure
, http://www.ivf.com/ gift.html.


5. FertilityRX.com, Assisted Reproductive Technology, Section IV: Gamete Intrafallopian
Transfer, http://iop.com/~poetsrx/art/gift.html.  See also Fertilitext, Gamete
Intrafallopian Transfer (GIFT)
, http://www.fertilitext.org/gift.html;
Infertility, Gynecology & Obstetrics Medical Group of San Diego, The
Assisted Reproductive Technologies Procedures at IGO Medical Group,
Gamete
Intrafallopian Transfer, http://www.igomed.com/fertilityserv.htm; Reproductive
Medicine Group, Tampa, FL, Gamete
Intrafallopian Transfer (GIFT)
, http://www.vbtivf.com/GIFT.htm.


6. See, for example, Fertilitext, Gamete
Intrafallopian Transfer (GIFT)
, http://www.fertilitext.org/gift.html;

FertilityRX.com,
Assisted Reproductive Technology,
Section IV: Gamete Intrafallopian Transfer, http://iop.com/~poetsrx/art/gift.html;
Lycos Health by WedMD, Gamete
Intrafallopian Transfer (GIFT), and Zygote Intrafallopian Transfer (ZIFT),

GIFT, http://webmd.lycos.com/content/dmk/dmk_article_5461649; Am-I-Pregnant.com,
Gamete/Zygote Intrafallopian
Transfer
,  GIFT,
http://www.am-i-pregnant.com/ giftinv.shtml;
Women’s Health Interactive, Treatments
for Infertility Assisted Reproductive Technologies (ART),
Gamete
Intrafallopian Transfer (GIFT), http://www.womens-health.com/ inf_ctr/inf_trt_art.html.


7. See, for example, Infertility, Gynecology & Obstetrics Medical
Group of San Diego, The Assisted Reproductive Technologies Procedures at IGO Medical Group, Gamete
Intrafallopian Transfer, http://www.igomed.com/fertilityserv.htm


8. See, for example, Institute for Reproductive Health, Cincinnati, Ohio,
In Vitro Fertilization, http://www.cincinnatifertility.com/ivf.htm.
See also Sherif Awadalla, M.D., In
Vitro Fertilization
, http://www.FERTILITYNETWORK.COM/articles/articles~ivf.htm.


9. Benedict M. Ashley, O.P. and Kevin D. O’Rourke, O.P., Health
Care Ethics  A Theological Analysis
,
3rd ed. (St. Louis: Catholic Health Association, 1989), p. 285; Donald T.
DeMarco, ‘Catholic Moral Teaching  and
TOT/GIFT’ in Donald G. McCarthy (ed.), Reproductive
Technologies, Marriage and the Church
(Braintree, MA: Pope John Center,
1988), p. 127.  One no longer finds
references to the TOT/TOTS procedure in the literature on assisted reproductive
technologies.


10. Rev. E. Bayer, Letter to Rev. William Gallagher with translation from
Msgr. Carlo Caffarra regarding  GIFT.
Pope John Center, July 9, 1985.


11. See, for example,  DeMarco,
‘Catholic Moral Teaching  and
TOT/GIFT’; William May, ‘Catholic Teaching on the Laboratory Generation of
Human Life’ in  Marilyn Wallace,
R.S.M.  and Thomas W. Hilgers
(eds.), The Gift of Life The Proceedings
of a National Conference on the Vatican Instruction on Reproductive Ethics and
Technology
(Omaha, NB: Pope Paul VI Institute Press, 1990);
John M. Hass, ‘GIFT? No!’ Ethics
& Medics
18/9 (Sept. 1993): 1-2; Benedict M. Ashley, O.P. and Kevin
D. O’Rourke, O.P., Health Care
Ethics  A Theological Analysis
,
4th  ed. (Washington, DC: Georgetown
University Press, 1997), p. 247


12. Ashley and O’Rourke, Health
Care Ethics  A Theological Analysis
, 4th
ed., p. 247.


13. Compare the assessment of Thomas J. O’Donnell, S.J., on the
question of Catholic couples using the GIFT procedure: ‘Moral
Conclusion Regarding LTOT and GIFT:
It is of some significance that although
the Vatican Congregation for the Doctrine of the Faith studied these procedures
there was no comment on them in the instruction of February 22, 1987.
This would seem to signal an intention to leave the matter open for
further study.  Thus while reliable
and responsible Catholic theologians view the procedures as at least probably
acceptable, they may be adopted in practice barring any statements by the Holy
See.’ Medicine and Christian Morality,
2nd rev. ed. (New York: Alba House, 1991), pp.239-40.


14. Donald McCarthy, ‘GIFT? Yes!’ Ethics
& Medics
18/9 (Sept. 1993): 3-4 at 4.


15. Peter J. Cataldo, ‘Reproductive Technologies,’ Ethics
& Medics
21/1 (Jan. 1996): 1-3 at 2.


16. Ibid.


17. May, ‘Catholic Teaching on the Laboratory Generation of Human
Life,’ p. 88.  The same point is
made by Hass, ‘GIFT? No!’ p. 2.


18. DeMarco, ‘Catholic Moral Teaching
and TOT/GIFT,’ p. 133.


19. See, for example, the Reproductive Medicine Group, Tampa, Florida,
http://www.vbtivf.com/ GIFT.htm.


20. Donald G. McCarthy, ‘Catholic Moral Teaching and TOT/GIFT:
Response’ in McCarthy (ed.), Reproductive Technologies, Marriage and the Church, p. 144; Donald
G. McCarthy, ‘Infertility Bypassed,’  Ethics
and Medics
11/3 (March 1986): 3-4.


21. Hass, ‘GIFT? No!’ p. 2.


22. Ibid., p. 3.


23. Cataldo, ‘Reproductive Technologies,’
p. 2.


24. Ibid., pp. 2-3.
See also the entry Theological
Opinion on Permissible Assisted Reproductive Technologies (ARTs).


25. McCarthy, ‘Catholic Moral Teaching and TOT/GIFT: Response,’ p.
141.


26. Ibid.


27. Ashley and O’Rourke, Health
Care Ethics  A Theological Analysis
, 4th
ed., p. 247.


28. See note 19 above.


29. See, for example, Hass, ‘GIFT? No!’ p. 1. This point was
confirmed in a letter of May 16,  2000 from Craig H. Syrop, M.D., Director of the IVF/GIFT
Program, The Iowa Women’s Health Center, Advanced Reproductive Care,
University of Iowa Hospitals and Clinics.


30. National Conference of Catholic Bishops, Ethical
and Religious Directives for Catholic Health Care Services
, no. 41 (1994)  (Washington, DC: United States Catholic Conference, 1995).


31.  See, for example, the
GIFT program at the Iowa Women’s Health Center, Advanced Reproductive Care,
University of Iowa Hospitals and Clinics; protocol for GIFT transfer,
6/10/99.


32. See, for example, Fertilitext,
Gamete Intrafallopian Transfer (GIFT)
, http://www.fertilitext.org/ gift.html;
FertilityRX.com, Assisted Reproductive Technology, Section IV: Gamete Intrafallopian
Transfer, http://iop.com/~poetsrx/art/gift.html; Infertility and IVF Center, St.
Louis, MO, ZIFT and GIFT, http://www.ivfctrstl.org/ht-ziftgift.htm;
Infertility, Gynecology & Obstetrics Medical Group of San Diego, The
Assisted Reproductive Technologies Procedures at IGO Medical Group,
Gamete
Intrafallopian Transfer, http://www.igomed.com/fertilityserv.htm; Lycos Health
by WedMD, Gamete Intrafallopian Transfer
(GIFT), and Zygote Intrafallopian Transfer (ZIFT),
GIFT, http://webmd.lycos.com/content/dmk/dmk_article_5461649;

Am-I-Pregnant.com,
Gamete/Zygote Intrafallopian Transfer,
GIFT, http://www.am-i-pregnant.com/ giftinv.shtml;  Women’s Health Interactive, Treatments
for Infertility Assisted Reproductive Technologies (ART),
Gamete
Intrafallopian Transfer (GIFT), http://www.womens-health.com/ inf_ctr/inf_trt_art.html.


33. See, for example, Fertilitext,
Gamete Intrafallopian Transfer (GIFT)
, http://www.fertilitext.org/ gift.html;
FertilityRX.com, Assisted Reproductive Technology, Section IV: Gamete Intrafallopian
Transfer, http://iop.com/~poetsrx/art/gift.html; Infertility and IVF Center, St.
Louis, MO, ZIFT and GIFT, http://www.ivfctrstl.org/ht-ziftgift.htm;
Infertility, Gynecology & Obstetrics Medical Group of San Diego, The
Assisted Reproductive Technologies Procedures at IGO Medical Group,
Gamete
Intrafallopian Transfer, http://www.igomed.com/fertilityserv.htm; Women’s
Health Interactive, Treatments for
Infertility Assisted Reproductive Technologies (ART),
Gamete Intrafallopian
Transfer (GIFT), http://www.womens-health.com/ inf_ctr/inf_trt_art.html.


34. FertilityRX.com, Assisted Reproductive Technology, Section IV: Gamete Intrafallopian
Transfer, http://iop.com/~poetsrx/art/gift.html.  See also Fertilitext, Gamete
Intrafallopian Transfer (GIFT)
, http://www.fertilitext.org/gift.html;
Infertility, Gynecology & Obstetrics Medical Group of San Diego, The
Assisted Reproductive Technologies Procedures at IGO Medical Group,
Gamete
Intrafallopian Transfer, http://www.igomed.com/fertilityserv.htm.


35. Bruce M. Carlson, Human Embryology and Developmental Biology (St. Louis: Mosby, 1994),
p. 27.


36. Ibid., p. 31.


37. American Society for Reproductive Medicine, Revised
minimum standards for in vitro fertilization, gamete intrafallopian transfer,
and related procedures
, http://www.asrm.org/Media/Practice/revised.html.


38. American Society for Reproductive Medicine, FACT
SHEET: Multiple Gestation and Multifetal Pregnancy Reduction,
http://www.asrm.org/Patients/FactSheets/multiple.html.


39.  About.com, Facts
about Multiples
, http://infertility.about.com/…/aa111399.htm?iam=dp&terms=
infertility+%22multiple+births%2.  These
statistics are taken from Overcoming
Infertility
by Dr. Robert Jansen and date from the year 1993.


40. American Society for Reproductive Medicine, FACT
SHEET: Multiple Gestation and Multifetal Pregnancy Reduction,
http://www.asrm.org/Patients/FactSheets/multiple.html.


41. Ibid


42. Ibid.
See also Mayo Clinic Health Oasis, Fertility
Drugs
, http://www.mayohealth.org/mayo/9902/htm/ fertility.htm.


43. American Society for Reproductive Medicine, FACT
SHEET: Multiple Gestation and Multifetal Pregnancy Reduction,
http://www.asrm.org/Patients/FactSheets/multiple.html.


44. Ibid.