Josh and Emily have been in your small group for nearly two years. Because you have laughed, cried, and prayed together almost every Sunday night, you and your spouse have formed a bond with this young couple strong enough to share your deepest struggles. This past Sunday evening, Emily stunned everyone with the news that she is pregnant. You had been praying for their desire to have a baby, and this welcome news was music to your ears. But her next line is what took the air out of the room: “and we have three more waiting to be implanted in the future.”
Emily’s pregnancy is the result of in vitro fertilization (what is commonly known as IVF), a procedure in which a doctor retrieved several of her eggs, fertilized them with Josh’s sperm, allowed them to grow in a petri dish for 4-5 days, then placed them in a freezer. There they will stay until Emily chooses to undergo an embryo transfer—usually one at a time, over several years.
Upon hearing the news, a number of questions pass through your mind. What am I supposed to think about this? What am I supposed to say to Josh and Emily? Is this welcome news, or cause for concern?
“What am I supposed to think about this?”
You are not alone. IVF is one of the most hotly debated subjects in biotechnology among concerned Christians. It is for this reason, I suppose, that I have been asked to address the topic. I direct the Center for Healthcare Ethics & Human Dignity at Harding University where we attempt to expose students to a myriad of challenging ethical questions, equip professors with sound arguments within a heathy theological perspective, and educate the public on how to approach difficult cases with empathy, discernment, and Christian grace. We get asked this question all the time. How would I advise you to react to Josh and Emily?
Approaching the Question
It is both good and natural for couples to desire children. In the Genesis creation story, God picked a day to make humans, fitted them with the potential to bare and beget, and gave them the command to “be fruitful and multiply”; and God saw that all of this was good (Genesis 1:26-31). This means barrenness is a problem in search of a solution. The burden of not having biological children is described in Scripture as understandably tragic (Genesis 20:18; 1 Samuel 1:5-6; Isaiah 66:9; Hosea 9:14), and “barren” was used as a metaphor for something wrong in God’s good creation (Proverbs 30:16). The Bible tells us the painful stories of six barren women and even personifies Jerusalem in such a predicament; yet in all seven cases, the miraculous and providential hand of God provides children. Throughout Scripture, for God to open a womb is considered a blessing (Genesis 29:31; 30:22; Psalm 127:3).
Even if one wishes or chooses to go without children, infertility is not a good to be celebrated; it is a lack that can often lead to longing, reminding us that we are still awaiting the renewal of all things, where nothing shall be found wanting. For this reason, we all can (and should) empathize with those unable to conceive or bring children to term.
“We all can (and should) empathize with those unable to conceive or bring children to term.”
Fortunately, we live in an age when technology may provide a helpful reprieve. Since the late 1970s, the medical industry has provided us with a wide variety of assisted reproductive technologies (ART) aimed at helping a couple give birth to a child. For the Christian who accepts a high view of common grace, medical technology to treat infertility is a blessing from the Lord, used by God to assuage the pain of barrenness. But when it comes to IVF, we are bound to ask a more basic question: is this permissible? That is, should IVF be considered at least as a possible inclusion into God’s providing as a blessing to pursue, or is this approach an example of human hubris, a God-denying usurpation that Christians should avoid?
Appreciating the Negative Case
In a previous article, I laid out the thorny complications involved in pursuing IVF for inquiring believers. In that post, I encouraged a 4-fold process of discernment:
- think the best of one another,
- ascertain the facts,
- consider aspects outside your own experience, and
- gather and consider the best arguments.
This includes seeking out conversation partners with whom you disagree. The negative case against IVF is strong and nuanced; if you cannot think of any good objections, then you simply need to read more. Read Paige Cunningham, Kristin Collier, Megan Best, Christopher Tollefsen, and Robert George. If you believe there are no good reasons for caution, I would gladly turn your attention to their reasoned arguments or to my previous post.
First, there is the financial concern, since how we handle our money is a matter of stewardship. The world of assisted reproductive technology is big business, and spending thousands or tens of thousands of dollars for a result with no guarantee is a good reason to pause.
Second, there are the emotional and social dimensions: practicing IVF has been linked to a depleting sex life within marriage (for a variety of reasons) and a tremendous strain on a relationship, not to mention the stress upon the woman.
“The negative case against IVF is strong and nuanced; if you cannot think of any good objections, then you simply need to read more.”
This leads to the health dimension: a woman’s body was not designed to engage in hyper-ovulation, and time will tell how the myriad of drugs and shots, along with poking and prodding through invasive procedures, will ultimately have a toll on her health. There is what might be called the “education” problem, where many couples come to IVF after trying everything else. Being at their wits end, they are ready to try almost anything. But the IVF doctor is not a neutral conversation partner, and it is easy to be talked into far more than you would normally be willing to try as the clinics administering IVF want to increase their success rates.
Finally, there is the difficult question of how to handle human life. To knowingly produce a child that has a low chance of survival, or to plan to add frozen embryos to the millions already on ice, strikes some as child endangerment or even a new form of eugenics. These are all very good reasons for caution, and they reveal that IVF is not necessarily a morally neutral case. And for some thoughtful Christian bioethicists, the solution is not just caution, but cancellation.
In my previous article, I expressed genuine appreciation for those expressing principled opposition to IVF; but I tipped my hand in my conclusion revealing that I am cautiously optimistic that, when done with certain precautions, IVF may be a defensible practice and viable option for the Christian. Always reserving the right to change my mind as truth becomes clearer to me, I believe caution—not cancellation—is the proper Christian response to the challenge of IVF.
“I believe caution—not cancellation—is the proper Christian response to the challenge of IVF.”
In this act of reflection, I will assume the procedure involves a Christian heterosexual couple in a monogamous marriage, using their own eggs and sperm, with the determination to implant all viable embryos. I encourage you to join me as I prayerfully present that brief.
The Positive Case
The Bible gives no direct teaching on the subject of IVF, but that shouldn’t be surprising. The Bible does not attempt to answer all of our questions directly, and when it does, it primarily addresses issues directly affecting the original, ancient audience. When a Christian attempts to apply this ancient text to modern problems for which there is no direct prescription, we must use good theology to lay the groundwork for principles that honor the character of God and are consistent with the entirety of God’s revelation.
First, I would suggest that we see reproductive technology as a potential good. Virtually all medical technology is generally welcome to ends ordained by God, and one end ordained by God is to be fruitful in procreation (Genesis 1:26). Just consider all the ways we, as a society, have used medical technology to repair, restore, and enable every part of our body. We have rejoiced over answered prayers through what we can only describe as a “medical miracle.” It is reasonable to view organ failure and conception failure as similar problems that can be overcome by using God’s good gift of medical intervention. Of course, Catholic teaching would argue a clear theological difference exists between technology that assists normal intercourse and that which replaces it. But the general claim that medical technology is a gift from God—a potential good—even with regard to this aspect of our bodies and our marital life seems both intuitive and theologically sound.
“I would suggest that we see reproductive technology as a potential good.”
Second, we should see children as a gift from God (Psalm 127:3-5). There is no reason to assume that children who are born through questionable means are anything less than fully human persons made in the image of God. For the sake of this short article, we will also posit that any fetus—of any age—should be treated as a fully human person made in the image of God. This fencepost will naturally create limitations on what can and cannot be done with human embryos.
Third, as a result, we should assume that a faithful Christian couple, seeking medical technology to be fruitful in procreation, treating all resulting embryos as gifts from God to be treated as image-bearers, is seeking a good thing. I view this starting point in a similar fashion as one wishing to do an organ donation, or to restore functionality to a limb. It seems to me the burden is on those who wish to deny IVF to explain why it is uniquely unacceptable as an option for the Christian. For opponents, the differences between organ repair and IVF are stark, since the latter deals with the creation of a new life, the handling of another person, and the requirements of neighbor love as opposed to self-care. It seems to me the differences are not as stark, despite the counter-arguments, and our intuitions confirm this.
Thought Experiments
Let us engage in a thought experiment. Suppose you were to happen upon a burning house with just enough time to rescue one person or thing from within the house. Looking through the window, you see two options: a 2-year-old baby or a crate of frozen 5-day-old human embryos. Which would you choose to save? Suppose the crate contained 10 fertilized eggs. Now suppose it contained 100. Is there a number—any number—that would make you choose the crate over the 2-year-old baby? My intuition says no.
Consider now a second thought experiment. Suppose a person was dead, having died from a dreaded disease. Technology was such that you could bring them back to life, complete with their terrible suffering, though we did not have a cure for their disease. Would you do it? Again, my intuition say no, you would not do it.
Now consider a third thought experiment. Suppose your child were suffering from a life-threatening disease for which there was no known cure, but scientists were in the final stages of testing a prototype. Without intervention, the child would surely die. However, our advanced technology could allow us to freeze them—with no complications, side-effects, or pain—until such a time that the cure was tested and implemented. Would you believe it a reasonable decision to freeze that person for 1 to 5 years in such hopes? In this case, my intuition says yes; I imagine you would.
“Would you believe it a reasonable decision to freeze that person for 1 to 5 years in such hopes?”
Finally, consider one more thought experiment. The earth has reached a crisis point where it is virtually uninhabitable, but humanity has set up a livable environment on a different planet. It takes 150 years to get there. In an effort to save your child’s life, and to allow them to flourish and eventually have kids of their own, you place them in cryogenic preservation (or suspended animation) for the long-distance space flight (with no complications, side-effects, or pain). Would you believe it a reasonable decision to do so? Again, intuition speaks: I would, and I imagine you would, too.
It is important to be clear on what these thought experiments do and do not tell us. At best, these reveal basic intuitions—which are not arguments. To go further, these thought experiments can be used to set up arguments for abortion or euthanasia—both of which I reject. Why begin with non-argument intuition-checking that I would not want to apply to terminal ethical cases?
In our first experiment (the case of the crate of embryos versus a 2-year-old baby), several factors can play a legitimate role in determining which we save without devaluing the one we leave behind (as bioethicists Robert George and Christopher Tollefsen rightly point out in their book Embryo). The question is not necessarily about the moral status of the embryos, the personhood of the embryos, or whether a utilitarian calculus is advisable. When applied to the abortion debate, there is far too much question-begging for the thought experiment to be of real moral worth. But in the IVF discussion, it seems more prescient. It is a simple recognition that we think we are dealing with something different—either in degree or in kind.
“At best, these reveal basic intuitions—which are not arguments.”
In our second experiment (the case of reviving a dead person with a dreaded illness), euthanasia is not applicable since this is a case of death-to-life, rather than life-to-death. But in the case of IVF, it suggests a basic intuition that starting something is a greater question with more of a moral burden than stopping something that is already in process.
The situation is the same with our last two thought experiments. These hypotheticals in no way would support fetal abortion which involves terminal death, not preservation of life. Nor would it support end-of-life cryogenic freezing of terminally ill patients since in real life we do not have a mechanism for ensuring the assumptions given in our hypothetical cases (that the subject would experience no complications and be restored to full life and health). But these do relate to the question of IVF with the usual practice of freezing embryos, for these assumptions are, in fact, in place concerning them.
To summarize, none of these thought experiments inherently deny personhood, value, or moral worth of a human embryo. But I would think our intuition gives us pause before making all of our moral judgments involving embryos equivalent to how we would treat a toddler. Just as we who oppose abortion would not treat women who engage in abortion the same as a woman who drowns her two-year old, we ought to recognize that our intuitions make some sort of distinction that may be helpful to use in the IVF debate. 
Dealing with Objections
Consider three broad objections to the practice of IVF: improper motives, improper outcomes, and improper theology.
The first objection is that IVF as it is traditionally practiced is related to (or arises from) improper motives. For some, the process by which “excess” embryos are created is due to selfishness and a quest for control. Others note that the process legitimates or at least increases opportunities for genetic engineering.
It is good to carefully consider our motives and ensure we are seeking procreation (a loving, relational act of parenthood, complete with moral responsibility), not simply the technological achievement of reproduction. But I fail to see how, even if some have improper motives, those must be the motives involved for everyone, or how the fact that a process which can be abused makes it impermissible to be used. The desire to have children, and the desire to use technology to assist in the production of children, need not be considered selfish or “creating” any more than any reproductive technological assistance. It may be your intuition that using reproductive technology “instrumentalizes” the body, treats children as “products,” and is thus a temptation rather than a blessing. But this impulse need not be a universalized intuition. After all, one could find the same motivations among those utilizing natural processes, yet that would not eliminate the natural process as a legitimate means.
“Consider three broad objections to the practice of IVF: improper motives, improper outcomes, and improper theology.”
The second objection is that IVF yields improper outcomes and involves unjust actions, particularly with regard to cryopreservation, which involves placing embryos in liquid nitrogen where “they remain in a state of suspended animation” for what appears to be an indefinite amount of time. Some opponents simply point out that freezing a child is morally wrong, a horrid act of child endangerment. But this seems to me like apples and oranges. The very ability to freeze an embryo for months or years suggests to many that dealing with embryos and dealing with a toddler are different conversations. Cryopreservation of embryos has a 40-year history, and studies show there is no deterioration of frozen embryos over time. Frozen embryos have been successfully implanted and brought to birth decades later.
Plus, there are several scenarios in which it would not go against our intuition to freeze a child if the procedure was instantaneous, offered no pain, involved no deterioration, and could be reversed (that is, the child could be brought back to full life and health). This is where our thought experiments come into play. Would you take the same position on suspended animation for a long-distance space flight, or in the case of one with an incurable disease, but with hope of a cure still in the testing phase?
“There are several scenarios in which it would not go against our intuition to freeze a child if the procedure was instantaneous, offered no pain, involved no deterioration, and could be reversed.”
Another way to challenge the notion that freezing embryos is impermissible is to employ reasoning from greater to lesser. Suppose a woman was beginning to experience egg attrition and her husband was experiencing rapid sperm loss. Desiring to have several children, they chose to fertilize embryos now. It would be morally irresponsible to implant at one time more embryos than could safely and successfully be carried. In such a scenario, freezing the other embryos would be both an act of love in a desire to bring them into the world, and a subtle form of rescue in saving them from immediate peril. The only other scenario, it seems to me, is to never bring them into the world in the first place. If it is better to exist than not to exist, better to be born than not to be born at all, then I believe the considerations above negate the view that it is always morally impermissible to freeze embryos.
A more serious angle is to note that too many embryos are left frozen, and there is a possibility that some will not thaw. Thawing success rates vary, but the thawing process argument must be compared with the risk of embryos being naturally discarded in a mother’s body (a number that, while technically unknown, is estimated to be extremely high). The question of multiplying frozen embryos in perpetuity is a serious one, even if it is reduced in the case of one who is committed to implantation or adoption. But I fail to see how this objection can make any and all freezing of embryos morally impermissible.
“A more serious angle is to note that too many embryos are left frozen, and there is a possibility that some will not thaw.”
Finally, consider the objection that IVF is theologically improper. Borrowing lines from an early Christian creed, some have maintained that children deserve to be begotten, not made, and that only God should have the prerogative to unite sperm and egg. My intuition is that given the assumptions of this article, IVF children are begotten, not made, that God is both the creator and sustainer of each embryo, and that trust in his providential care is both needed and required given that some fertilized eggs do not make it to the blastocyst phase, and some that do will have genetic issues so severe that they will prove inviable. The goal of IVF is diametrically opposite to the goal of an abortion: the attempt is to welcome life, not destroy it—to be fruitful and multiply, and to trust God for the results.
A common critique from Catholic circles is that the unitive (“one flesh”) aspect of marriage and the procreative aspect of marriage must always be held together: that is, sex must always be open to conception, and conception must never be isolated apart from the marriage bed. But a common Protestant reply is that the Song of Songs and the apostle Paul both rejoice in sexual intimacy as unitive and pleasurable without mention of any openness to conception as a necessary corollary. (Of course, it could just be understood behind the scenes.) The natural state of menopause might also suggest that God did not design sex and procreation to be indivisible. For many of us, there needs to be a stronger case to demand that the unitive and procreative cannot be separated without violating the nature of sex in marriage.
“A common Protestant reply is that the Song of Songs and the apostle Paul both rejoice in sexual intimacy as unitive and pleasurable without mention of any openness to conception as a necessary corollary.”
Others claim that Scripture gives no warrant for IVF, and that all positive language and examples surrounding conception, pregnancy, and birth in both testaments speak to reliance on God rather than seeking shortcuts (which, when attempted, are frowned upon or condemned). But this response begs the question whether advanced medical technology is an aid to God’s providential grace or an unwanted addition to his will. What is needed is theological humility: recognize the limitations of our hermeneutical and theological reflections. There is no “chapter and verse” on this subject, and what we can offer is best described as “fenceposts” (in the words of Scott Rae) or signposts for wise decision-making. Christians are to be guided by the ethic of love (Matthew 22:37-39), which includes respect for the dignity of all persons, and fellow feeling for those who face difficulties.
Help at Every Stage & Suggested Conclusions
In conclusion, I view IVF in a similar way to Paul’s language concerning marriage in 1 Corinthians 7—allowable, in certain circumstances, but not always advisable. It becomes a matter of wisdom. Both wisdom and prudence are needed at all times, and people who find themselves in the midst of their ordeals need an encouraging word from the Lord that is more prescient than what they should have done before they entered into their current situation.
So, with great reserve, allow me to offer some practical advice in the language of the apostle Paul who wades into the troubled waters of marriage and divorce to attempt some practical advice for a mesmerizing plethora of complicated cases.
If you are a married couple experiencing infertility, I understand your deep pain and join you in prayer for God to bless you with children. As you wait on the Lord, may you practice the Christian art of patience. We learn a great deal about God and grow in spiritual fortitude as we wait expectantly on the Lord. Studies also show that some who think themselves infertile may eventually prove otherwise. In other words, give it time.
But if God does not grant our prayerful wish, may I encourage you to consider marriage without children as an opportunity to serve the kingdom in fruitful ways, unencumbered. Paul speaks of singleness as a gift to be received, and as choosing to forego marriage to concentrate on kingdom work as a sensible position. Following the same principle, a married couple faced with difficulty in pregnancy may choose to live without children and recognize their situation as one which could allow for a focus on kingdom work as a couple.
“As you wait on the Lord, may you practice the Christian art of patience.”
If you do decide to have children, may I encourage you to consider adoption. Adoption is not without its challenges, but with so many children awaiting a forever home, please do not pass over this option lightly.
But if you cannot contain the desire for biological conception, and the emotional burden of infertility is too great so that you choose reproductive technology (including, but not limited to IVF) for biological progeny, in my opinion you have not sinned. But just as Paul requires marriage “in the Lord,” I would suggest one pursue such technologies “in ethically appropriate ways.” Though there are many gray areas, here are my suggestions:
First, proceed from lesser to greater. Only consider IVF after less invasive reproductive technologies have been exhausted. Intrauterine insemination (IUI) and even egg freezing are either less invasive or less morally questionable. If choosing IVF, consider first the surest (though most financially burdensome) option of producing one embryo and engaging in a live transfer (though I do not consider it immoral to freeze embryos for a later transfer). This would avoid questions of cryogenic freezing and remove any need for discussion of excess embryos.
Second, only agree to the number of embryos you could reasonably raise, understanding that there is no guarantee how many of those will be viable. Since there is a chance that all will be viable, do not engage in the creation of more embryos than you would choose to naturally conceive.
“Adoption is not without its challenges, but with so many children awaiting a forever home, please do not pass over this option lightly.”
Third, determine to implant all embryos over time. There may be extreme circumstances involving clearly inviable embryos, in which case you will have to consider the same or similar weighty issues involved in a non-viable pregnancy. I would spare you the emotional burden of this as much as possible by limiting the number of embryos involved.
In all things, pray for wisdom, believe the best about one another, respect the difficulty of this topic, and honor one another with your love. Treat all IVF babies as children made in the image of God, parents considering the procedure as those attempting to pursue godly means for godly ends, and opponents of IVF as genuinely concerned for God’s will, the well-being of all involved, and the witness of the church before a watching world.
