The explanation that Rep. Trent Franks gave in announcing his resignation this week centered on a House Ethics Committee investigation that he said was prompted by his discussions of surrogacy with two female subordinates.
His statement turned a spotlight on the often medically complex world of infertility treatment, which many abortion opponents also consider ethically fraught. And the glare could intensify, with a former staff member alleging that the Arizona Republican offered her $5 million if she would bear his child.
The 60-year-old lawmaker had shared Thursday that he and his wife had endured three miscarriages and tried adoption on more than one occasion — only to have the women in each case change their minds before giving birth. It was then that the couple chose surrogacy through in vitro fertilization.
Having struggled with infertility, Franks said in a statement, the couple used a surrogate, "a wonderful and loving lady, to whom we will be forever grateful," to successfully have twins. He described the process used as a "pro-life approach" that did not result in throwing away any embryos.
But many within the antiabortion activist community, especially evangelicals and Catholics, have decried the use of IVF and surrogacy even when embryos are not discarded in the process.
"IVF raises more ethical questions than simply the question of whether you're going to destroy embryos," said Paige Comstock Cunningham, executive director of the Center for Bioethics and Human Dignity at Trinity International University. Those include the multiple risks involved, including the impact on a woman's body and the potential that an embryo could be lost after it is implanted.
According to his congressional biography, Franks and his wife have served as Sunday-school teachers at a Southern Baptist church in Phoenix. The church's overarching denomination, the Southern Baptist Convention, has not issued any resolutions on IVF or surrogacy, but an analysis by its policy arm suggested ethical questions about surrogacy.
"Almost all Christian bioethicists agree that most forms of surrogacy are theologically and morally problematic," the analysis states. "The moral qualms generally concern the exploitation of women (e.g., 'womb-renting'), the selling of children, the violation of the marital covenant, and the use of embryo-destructive reproductive technology."
There is also the issue of the commercialization of children, Cunningham said.
"There's a temptation to select a child or hope for a child to be a certain way," she said. "When you have surrogacy and the purchase of egg and sperm, there's an expectation to get what you paid for."
As one of the most conservative members of Congress, Franks was a member of the Arizona Right to Life organization and was known for picketing abortion clinics. In 2013 and this year, he introduced bills to ban abortions after 20 weeks except in cases of rape or incest. While IVF and abortion are two different and distinct medical procedures, many antiabortion leaders consider them similarly wrong in that they typically result in the destruction of embryos.
Many theologians point to the biblical case of when Abraham and Sarah could not have children and Abraham impregnated Sarah's Egyptian slave Hagar as a negative example of how humans have tried to take reproduction into their own hands. The Catholic Church teaches that reproduction should take place as the result of sex within marriage.
By contrast, just 12 percent of Americans say they personally consider IVF to be morally wrong, according to a 2013 Pew Research Center survey. Only small percentages of religious Americans opposed IVF: Hispanic Catholics (18 percent), white evangelicals (14 percent) and white Catholics (9 percent).
Franks did not offer any details about what took place during his wife's IVF treatment, such as how many embryos were created and fertilized, where his surrogate was from and whether she was paid. Surrogacy is illegal in Arizona.
A previous statement had said "a trusted friend told us of a medical organization that would allow us to pursue a surrogacy effort where a limited number of eggs would be fertilized and no embryos would be discarded."
The typical IVF procedure involves doctors creating multiple embryos — sometimes as many as 20 or 30 — and allowing them to grow for a few days, then testing them to see which have the best chance for success. The embryos are given letter grades, with A being "excellent," B "good," C "fair" and D "poor." The highest-rated ones are usually implanted first. Once a couple has the number of children desired, the leftover embryos are usually destroyed or donated to science.
"It's a classic example of our throwaway culture," said Charles Camosy, a professor in the theology department at Fordham University. "Even if you don't throw them away, you're participating in a process where embryos are thrown away or are frozen in storage. This is part of what it means to separate procreation from sex. It becomes a market force subject to all the whims of the market."
Another part of IVF that most antiabortion leaders oppose is "selective reduction," which usually occurs when three or more embryos are transferred to the womb to increase the probability that at least one will implant and grow into a baby. Sometimes all of them implant, however, and many modern doctors recommend aborting some for the safety of the woman and the pregnancy.
Franks's statement appeared to suggest the couple did not have to address this issue. Several women who gave birth to quadruplets or more — such as Nadya Suleman, who had octuplets in 2009 — had declined this option.
Regulations on surrogacy vary across the nation, and low-income women often are persuaded to sign over their rights and incur medical risks to have another person's baby, said Jennifer Lahl, who opposes surrogacy and runs the nonprofit Center for Bioethics and Culture in the San Francisco area.
"There's a myth that they did it to be altruistic angels. Most women don't want to sign up for nine months with zero compensation," Lahl said. "It's a trending-up, global industry, a multimillion-dollar industry that's become widely accepted."