ARTICLES

This Is Natural Law, This Is Not Church Law

DOCTORS HELP UNDO SIN OF STERILIZATION

By James McCoy

A small but growing number of Catholic couples are seeking to make reparation for the sin of sterilization. And a small number of pro-life California physicians are ready to help them repair -- literally -- what they've done.

"The message is getting out there that it [sterilization] is against the natural law," said Father Louis Solcia, an associate at Our Lady of the Rosary in downtown's Little Italy. Father Solcia describes the natural law as "moral DNA...that is really urging our conscience to do the right thing according to nature."

Father Solcia, who said that he tries to refer to the evils of sterilization and breaking the natural law "in every sermon," believes contraception and sterilization cause many divorces. If a couple comes to him for counseling on the matter, Father Solcia tells them that "it's against the natural law. You know very well that sex is for procreation and you are frustrating the natural law that God has given to us."

Yet so far, Father Solcia has known only two couples who have gotten their sterilization reversed. He thinks that if couples can, they should.

About 500,000 American men have vasectomies every year; it is estimated that only one percent will seek to reverse their sterilization. Of that one percent, a smaller fraction still are people who came to the religious conviction that it was morally wrong.

But that number, albeit small, seems to be growing. Dr. Arthur Stehly is an obstetrician and gynecologist in Escondido who has been reversing tubal ligations for more than 30 years. It used to be two to five a year; in recent years, it's been three to six. "I've been doing tubal reversals on people who are good Catholics but...something got them screwed up in the modern world," Stehly said.

About half of those requesting reversals are women who have remarried and want more children, but the other half are acting in accord with their conscience.

Dr. Stehly says that more people would be healthy physically if they had a healthy respect for the natural law. "If people would be natural," Stehly said, "docs would be in trouble." Stehly cites medical expenses which can burden women after tubal ligation, such as dilatation and cutterage to try to relieve their "more than normal pain," hysterectomies, and sometimes even psychiatric treatment.

Stehly said that sterilization "just eliminates that chance for new life, and essentially destroys one of the main reasons you're married for. And I see too many problems in women who have had their tubes tied."

In many cases, women will come to him complaining of "horrendous pelvic pain." They think it's due to a tubal ligation. "But I find nothing," Stehly said. His conclusion? "Most of it is psychological." But that's not to minimize the very real hurt which sterilization does to a person.

"Deep down a woman is not made to have her government-issue two kids and then shut it off," Stehly said. "The Lord's going to shut it off naturally at 48 to 52. And when you shut it off 20 years before that, you're going to have problems.

"Each cell of the fallopian tube has these hairs [called "cilia"] which move the egg towards the proximal end of the tube which would be the uterus," Stehly said. Fertilization occurs at the distant end of the fallopian tube, "the distal part of the tube," Stehly said, which is "most removed from the uterus."

That's because "most of the time the woman's going to need the full tube because there [are] certain hormones that influence the sperm as it comes through the uterus into the fallopian tube....If you have a shortened tube or almost no tube, et cetera, you could have an infertility problem," he said.

As Father Solcia said, "When you take away the natural way of doing things ...nature rebels." Solcia, whose Barnabite order specializes in high school education, quoted a Latin proverb: "Natura odit vacuum" -- "nature hates emptiness," he translated.

But one major obstacle in reversing sterilization is the cost. While vasectomy and tubal ligation are covered by almost all health insurance plans, their reversal is not. The total cost for a tubal ligation reversal by Dr. Stehly is $6300 ($7700 on the installment plan). Vasectomy reversals generally range from $5000 to $15,000.

Yet that's a small price to pay for the possibility of one more soul, according to Steve Koob, a retired Air Force engineer who founded an apostolate in Dayton, Ohio called just that: "One More Soul."

"We believe that anything we can do to help a couple to be open to another child -- or another soul -- is incredibly awesome," said Koob.

The Catechism of the Catholic Church teaches that every human soul "is created immediately by God -- it is not 'produced' by the parents -- and also that it is immortal...."

Since the universe as we know it will pass away but the human soul will abide forever, Koob thinks that when parents cooperate with God in conceiving a new human life, "that's more incredible than His creating the universe."

Koob is married and has 14 children, 5 of whom are adopted. One More Soul is most famous for the cassette tape it offers, "Contraception -- Why Not?" by Janet Smith, Ph.D., a professor at the University of Dallas. More than 200,000 copies of it have been circulated.

But One More Soul has also come out with an "NFP-Only Physicians Directory." NFP stands for natural family planning, which uses a woman's natural monthly cycle to avoid pregnancy -- or achieve it. The latest edition of the directory contains 213 physicians, 19 of whom are in California. (Of those, three do tubal ligations reversals, including Dr. Stehly.) Koob got the idea for the "NFP-Only Physicians Directory" after reading about an obstetrician and gynecologist back east who refused to prescribe contraceptives or perform sterilizations or abortions, but whose practice flourished.

Dr. Stehly's story is similar. "I never tied tubes," said Stehly. But he did prescribe birth control pills to married women -- until Pope John Paul II came to visit the United States in September 1987.

"I knew what I had to do at home," said Dr. Stehly, who is married and has 10 children. "But I didn't think I should be God in the office. But once the pope came to town..." Stehly got to thinking.

"You're playing with nature," he said. "It's not that you're playing with the Catholic Church -- this is natural law, this is not a Church law. Plus, I knew this was driving ladies nuts.

"I talked this over with an Opus Dei priest. 'Father, I got a problem. I'm doing something that's not right ... I'll introduce them to NFP and get them off the Pill [gradually].'"

But the priest told him, as Stehly recalled, "If you were stealing to support your family, and you finally realize you can't steal anymore, would you say: 'I'll slowly decrease stealing for six months until I revamp my life?'" So the following Monday, in November 1988, "Bam, I shut it off completely," Dr. Stehly said. "No birth control, so I got a lot of doors slammed."

He devoted himself to delivering babies to pick up the slack. By March 1989, "Instead of 45 to 50 a month, I was delivering 70 a month. In other words, stopping that kind of practice [prescribing contraception] did not affect my practice," Stehly said.

In Stehly's experience, the success rate for tubal reversal is "at least 80 percent," though "it's hard to keep track of people," he said, especially since "a lot of times they're doing this procedure because of a new marriage" and move elsewhere as part of moving on in their life.

At least one physician in California does vasectomy reversals, and at a reduced rate: Dr. Gregory Polito, a urologist in Whittier.

"I sense a spiritual reawakening in our community," said Dr. Polito. Some married couples have let him know that their consciences are "very bothered" by contraception, which "unleashes selfish inattention to the body's natural harmonies and rhythms."

The "vas" in vasectomy refers to the vas deferens which Dr. Polito described as a "drainage conduit" for sperm cells. Sperm are stored in the epididymis, a C-shaped tubular structure stuck onto the side of the testis. Sperm exit the epididymis near the bottom of the testis and proceed into the vas, a muscular tube that propels the sperm up into the body cavity and into the prostate. There they mix with prostate and seminal vesicle fluids during ejaculation. In a vasectomy, the surgeon cuts through the vas and places a clip or suture around the cut ends.

"Vasectomy is quite traumatic to this delicate system," said Polito. "It takes a while for the testis to get the message that something is awry, so it keeps producing sperm. This naturally increases pressure within the system and produces one or two consequences. "First," Polito went on, "the testis does progressively slow its sperm production. Second, the increased pressure may result in a 'blowout' or rupture within the delicate epididymal tubule." Since the sperm conduit has been shut off, pressure builds up in the epididymis, which can make it rupture. And the more years since the vasectomy, the more likely the blowout.

But that's not all. "The sperm have nowhere to go and are broken down in the testis as they age," Polito said, "releasing materials into the body that it is not used to seeing." As a result, the body develops antibodies against the sperm. Ninety-seven percent of the men with vasectomies have such antibodies.

Said Dr. Polito, "I hated to see couples, who had prayerfully come to the conclusion that they had erred by being sterilized, not [being] able to restore their anatomy because of the cost." So for several years he offered his services without charge, "asking couples to simply donate a small sum to the local pregnancy counseling center, and pay for the anesthesiologist and surgery center."

But people abused the offer. "Couples who could care less about the spiritual dimension of my intent and were simply shopping price," Polito said. "So my office staff sat me down one day and said, 'No more!' Our current all-inclusive cost is $3000." Nationwide, vasectomy costs generally range from $5000 to $15,000, according to "The Patient's Guide to Vasectomy Reversal."

The more simple reversal, vasovasostomy, "is performed as an outpatient and takes two to three hours," Polito said. Local or general anesthesia may be used.

"At surgery," Polito said, "fluid can be removed from the testicular end of the vas and examined under a diagnostic microscope once the scar has been cut away. If sperm or even sperm parts are present the surgeon knows that the system is at least intact, and that a blow-out in the epididymis has not occurred. "If no sperm are present," he went on, "particularly if it has been 10 years or more since the vasectomy, a disruption has probably occurred and an even more delicate, technically demanding procedure may have to be attempted."

In that procedure, called vasoepididymostomy, the surgeon skips trying to put the vas back together again and instead reconnects the vas directly to the epididymis. But, Polito said, "This has a fairly low success rate."

After the operation, "I ask my patients to stay home for four to five days if they have relatively sedentary occupations, or seven to 10 days if they are very physically active," he said. "Prudence also suggests refraining from vigorous exercise for three to four weeks."

Dr. Polito knows of no health insurance plan that covers vasectomy reversals. "It's always cash out of pocket," he said, "that's why it's problematic."

Unlike vasectomy reversal, where the man's vas deferens is so small that it necessitates microsurgery, repair of the much larger fallopian tubes can be done by the naked eye.

It takes Dr. Stehly "an hour and a half at most. I just essentially remove the bad part...where it's been clamped or whatever.

"I try to fix both tubes," he went on. The sutures used are absorbable; Steely removes the plastic splints within the tubes "in about three months."

There can be complications, especially when so many American women are suffering from sexually transmitted diseases. "When I open up the tubes that have been destroyed by infection," Stehly said, "the [resulting] pregnancy rate is 10 to 20 percent.

"You take a slightly greater chance of a tubal pregnancy with an infected tube," he said. "The fertilized egg has to go through a maze to get there." If the new life never makes the uterus, "it has to implant somewhere....And after about four to six weeks it gets too big and it ruptures" the fallopian tube. But Dr. Stehly has only seen that two or three times in 25 years.

Stehly agreed with Father Solcia that if sterilized couples "have the economics and are willing to go through major surgery, then they should do [the reversal]." But if the couple wants to use NFP -- just as any fertile couple would have to -- "I don't think it should be needed that they go to surgery."

The use of NFP as an outward sign of the couple's spiritual conversion has been suggested by John Kippley, Ph.D., founder of the Couple to Couple League, which promotes NFP. In his book Sex and the Marriage Covenant, Kippley writes that the attitude of "if we had to do it all over again, we wouldn't get sterilized" can be expressed and reinforced by practicing NFP. "In this way," Kippley writes, "they will not be taking advantage of their sterilized state, enjoying the fruits of their sin."

In Kippley's opinion, there is a "general moral obligation" to have reversal surgery, "but I would be hesitant to call it a serious obligation, i.e., the grave matter of mortal sin."

Said Stehly, who was converted to being an NFP-only physician by a parable about stealing: "You could steal something, and then go to Confession. [But] then you've got to give it back. You can get the damage done to yourself [sterilization] and go to Confession, and it's going to be fine. But I think you've got to do something."

Dr. Stehly's number is 760-747-6910. Dr. Polito's number is 562-907-7600. One More Soul's number is 1-800-307-7685.

James McCoy is a freelance journalist based in Pittsburgh.