ST. LOUIS -- "Be fruitful," God instructed Adam and Eve, "and multiply."
They were the first words God spoke to his creation, and his creation has heeded them ever since. But over the years, God's creation has become sophisticated enough to rewrite the original rules of being fruitful, and most of the new rules don't sit well with leaders of the Catholic church.
There is "great confusion among lay Catholics regarding the church's teaching on human reproductive technologies," Philadelphia's Cardinal Justin Rigali said at the U.S. bishops' meeting in Baltimore last November. "There is a need to help Catholics understand specific differences between the Catholic understanding and a secular understanding of human life."
When Rigali was archbishop of St. Louis, he celebrated a Mass for infertile couples, as did the current archbishop, Robert Carlson, on Tuesday (Feb. 16) night.
By celebrating a Mass for infertile Catholics, Carlson walked a pastoral high-wire act that has becoming increasingly familiar to church leaders.
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On one hand, bishops need to educate Catholics about the church's moral teachings. On the other, they face Catholic couples suffering through the heartache of infertility, many of whom believe their church contributes to the pain by erecting roadblocks to medically assisted pregnancy.
That balancing act is summed up in a document on reproductive medical advances called "Life-giving Love in an Age of Technology" that U.S. bishops approved at their fall meeting in Baltimore.
"The church has compassion for couples suffering from infertility and wants to be of real help to them," according to the document. "At the same time, some 'reproductive technologies' are not morally legitimate ways to solve those problems."
Church teaching says technology used to facilitate or support marital conjugation and conception is fine, but any other technology is not.
For instance, church teaching allows tests and treatment for low sperm count or problems with ovulation, but not with artificial insemination by anyone other than the husband. Even using the husband's sperm is forbidden if it is obtained in any way other than normal intercourse.
"Children have a right to be conceived by the act that expresses and embodies their parents' self-giving love," according to the U.S. bishops. "Morally responsible medicine can assist this act but should never substitute for it."
According to a 2002 Centers for Disease Control and Prevention study, 7.4 percent of married women of childbearing age were infertile, though only about 1 percent tried artificial insemination as a means of becoming pregnant -- about a quarter of the number who tried ovulation drugs. According to the American Society for Reproductive Medicine, between 85 and 90 percent of infertility cases are treated with drug therapy or surgical procedures, while fewer than 3 percent required assisted reproductive technologies.
The church itself offers help and support for infertile married couples, such as a monthly "In God's Hands" discussion group at St. John's Mercy Medical Center in St. Louis.
The Catholic church also has formulated a women's health monitoring system, called NaPro (for Natural Procreative Technology) that tries to detect and treat underlying medical causes of infertility; NaPro technicians claim up to an 80 percent success rate, depending on the cause of the infertility.
American Catholics have a reputation of ignoring their church on bedroom matters. Only 4 percent of Catholic married couples use natural family planning -- a modern version of the rhythm method -- according to the bishops' own research.
It follows that few Catholic couples who are desperate for their own biological family will choose church teaching over a chance at pregnancy and children.
"American Catholics are no more going to listen to this than they listen to the church about birth control," said Glenn McGee, a scholar at the Center for Practical Bioethics in Kansas City, Mo.
Barbara Collura, executive director of RESOLVE: The National Infertility Association, a Virginia-based nonprofit group, said the bishops would have a hard time trying to explain to infertile Catholics "that the medical technology is there but not available to them; that their dream of a biological child is gone."
But Catholic bioethicists say the point of the church's position is to protect the dignity of children by honoring the church's conception of natural law.
"If a couple decides they have the right to a child, the child has become a commodity," said Marie Hilliard, director of bioethics and public policy at the National Catholic Bioethics Center in Philadelphia. "And if they haven't been given the gift of a child, it doesn't mean they have the right to a child as commodity."
McGee said Pope Benedict XVI has begun "to play hardball" with American Catholics who flout church teaching on assisted reproductive technologies by issuing a 2008 document called Dignitas Personae, or the Dignity of the Person.
The document reaffirmed church teaching that human dignity should begin at the moment of conception, and that the only morally acceptable method of procreation is "an act which expresses the reciprocal love" between a wife and husband.
McGee said the warning that Benedict wants to convey to American Catholics is that "we are not going to sit by anymore and not hold individual Catholics accountable for their use of ... reproductive technology."
McGee calls it "brining the hammer down" on wayward U.S. Catholics, but E. Christian Brugger, a moral theologian with a specialization in bioethics at St. John Vianney Theological Seminary in Denver, said that was not the intent of either the Vatican or the U.S. bishops.
The bishops "are not trying to impose Vatican restrictions," he said. But "you have many Catholics who hold this view and believe the church is betraying them."
Infertile American Catholics are in "a quandary," Brugger said. "They don't have a frame of reference by which to find intelligible the church's teaching [because] so much of the surrounding culture opposes what the church says."
[Tim Townsend writes for The St. Louis Post-Dispatch in St. Louis, Mo. The story is made available by Religion News Service.]