Making babies: Infertility and the ethics of IVF

When does life begin? The Christian response to this question should have a profound impact on the way we live our lives. Thank you for your recent articles by Paul Grimmond (‘What do you say when …? Speaking out against abortion’) and Tim and Susan Ravenhall (‘Making babies when sex just isn't enough’).

The Bible does not give any direct answers to this question, although it does provide some excellent indirect guidance. There is the wonderfully familiar passage from Psalm 139 about God's knowledge of us as we were being formed in the womb. In addition, in Luke 1:29-45, we get another clue: the angel spoke to Mary of her impending pregnancy (“you will” not “you are”), and then “with haste”, Mary started off on her 90-mile journey from Nazareth to (probably) Ein Kerem where her cousin Elizabeth lived—a journey that took approximately 10-14 days. When she arrived, unborn John the Baptist (who was at three months gestation) and Elizabeth both rejoice in the presence of their saviour—a two-week-old embryo.

There are many scientific reasons for understanding conception as the beginning of personhood (i.e. the presence of the individual's unique DNA from the point of conception). But as a Christian, these two passages speak powerfully to me of both the incredible sacrifice of God to make his Son so vulnerable and the personhood of the embryo.

When this understanding sinks in, it should change the way Christians view abortion, IVF and methods of contraception that prevent birth using post-fertilization methods (e.g. oral ‘contraceptives’, IUDs, the morning-after pill, etc.). Young people need to be taught about this well before they consider starting a family so that they have the knowledge and strength to live a life not conformed to this world, but transformed by Christ. And those of us who are married and in our child-bearing years need to model well-informed, Christlike courage in our fertility management.

Mary Holland of Hobart, TAS, AUS (14/05/2010)

I find it more than a little disturbing that in both the recent articles on infertility and the (seemingly complete lack of) ethics of IVF, there is much talk of suffering, God's working of good in our lives, trusting in God and the like, but one word is never mentioned: adoption. If we are truly seeking to be godly when it comes to having children, why don't we embrace in our own lives that which we eagerly await—our adoption as sons (Rom 8:23)?

Rita McKinnon of Tempe, NSW, AUS (14/05/2010)

Today I read your latest issue of The Briefing. The cover suggested that you would be looking at the ethics of IVF. I was disappointed that your article was a self-justification for using IVF by a Christian couple who looked at only some of the ethical issues. By having an article written from a personal struggle, you have sidestepped the really hard questions; people who go through IVF have already decided that the end is worth the means.

One of the big questions that really stand out is the issue of embryo experimentation. Is it right to use a technology that is based upon the destruction of human embryos? While individuals can take care to ensure that their own embryos are not used for experimentation, donation of ‘excess’ embryos for research is essential for the continuing development of IVF. Success in IVF is built on research that destroys human life (see licence 309701). Is anyone that uses IVF complicit in embryo destruction?

IVF is big business for Australia. Sydney IVF is worth about $85 million dollars. The link between IVF and embryonic stem cell research is also strong: IVF provides the embryos for such research. Alan Trounson, the father of Australian IVF, is now a leading expert in stem cell research. He recently moved to California to head up stem cell research worth $3 billion dollars. The cost of IVF to individuals is also high, with around $7000 per attempt. With so much money involved, IVF advertising sucks couples in with photos of cute babies, misleading people into thinking that they too have a good chance of having a baby. Most IVF companies do not show their take-home ‘live birth’ figures, or if they do, they present them in a misleading way by not using all women receiving treatment.

Now that access to IVF has opened up to anyone regardless of their fertility (such as lesbians), live birth rates will appear to improve and further hide an infertile couple's real chance of a live baby. The reality is that many, if not most, couples will not have a live baby to take home. Is it really fair for them to spend so much money and put their life on hold for 15 years to go on an emotional roller-coaster that ends in failure?

For The Briefing to not ask any of the above questions shows that most Christians don't even want to consider many of the ethical implications of IVF. Asking “Do you agree with Tim and Susan's approach to IVF?” (see the discussion questions at the end of the article) is not really the question, as who could possibly think that they haven't struggled with the ethics of it all? It leaves us thinking that IVF must be okay because the Ravenhalls went through it and came out with a baby.

Would The Briefing use the same sort of soft, emotional approach for other ethical issues—for example, ‘John Smith presents a Christian perspective on the use of embryonic stem cells to treat his Parkinson's disease’? How about abortion or euthanasia: would these topics be presented as ‘What do you think’? A suitable analysis for The Briefing would be an impartial article examining the arguments for and against. Alternatively, another article that would have balanced the Ravenhalls' could have been about a couple who decided not to use IVF.

IVF is, without question, a live issue for Christians today—particularly for many of us who are middle-class evangelicals, training for ministry and sometimes delaying the commencement of a family until our late 20s or early 30s. However, the great danger is that our overwhelming and (yes) God-given desires to have children negates the cost of what we do. With IVF, the cost of supporting and upholding a process that uses embryos for other purposes may mean that it is too great for Christians who value what God values.

Roslyn Deal of Wingham, NSW, AUS (17/05/2010)

Thank you for your articles on infertility and IVF (Briefing #380). The experiences of both Tim and Susan Ravenhall and Karen Galvin closely match ours. After six years of trying to have children, we came to a similar conclusion as the Ravenhalls, and proceeded with IVF, stipulating that the medics must only fertilize two eggs, with both being used on the same cycle.

We thought it would be helpful to explain a particular aspect of our experience that the Ravenhalls didn't have. In the Ravenhalls' article, they highlighted the contentious issue of ‘abnormal’ embryos, although they didn't actually face this scenario. We were faced with this situation after the fertilization of our two eggs. The medics informed us that one of them appeared to have developed ‘chromosomal abnormalities’, and they asked if we wished to ‘discard’ that embryo, as was their normal practice. After confirming the potential ‘abnormalities’ would not affect the other embryo or my wife, we asked them to implant both. Wonderfully, we now have three-month-old twins—a boy and a girl. Both of them appear completely healthy, and currently show absolutely no sign of abnormalities.

The medics admitted that they had little concept of the long-term implications of implanting a so-called ‘abnormal’ embryo because it was so rarely done. They suggested that abnormalities may decrease the chances of implantation, but the long-term effects of doing so were largely unknown. They added that it was possible for the embryo to ‘right itself’ and thus develop normally. However, they typically ‘discard’ abnormal embryos because they would select the seemingly healthier embryos for implantation. Ethically, we could not agree to destroy the life that had been formed. However, unlike the Ravenhalls' experience, the medics were supportive and helpful throughout our treatment.

We thought it would be useful to let you know about this in order to help any couples in the same situation. Hopefully this will encourage them to insist on ‘abnormal’ embryos being implanted and, as a result, they will not have to compromise their ethical viewpoint.

Pete and Nicki Matthew of London, UK (17/05/2010)

Adoption and, indeed, fostering are great things that ought to be considered by all Christians, irrespective of issues of infertility. One Christian couple in my congregation (who already have four children) are currently applying to foster. I have nothing but admiration for their godly example. However, the point of my article (the bulk of which was originally written before I ever conceived) was to point out the spiritual issues I faced, and to help Christians know how to respond. Regardless of the period of infertility (whether it be five, 15 or 50 years) or its cause, it is a real and pressing issue, and finding solutions (such as IVF or adoption, for instance) is not always the immediate concern in terms of seeking godliness.

Karen Galvin of Charlestown, NSW, AUS (19/05/2010)

Roslyn Deal has indeed brought to our attention a ripper of a dilemma for Christians: if we view the embryo as a living being—a human being in its earliest days—then how can we justify IVF floating on the back of unethical research, including the use of embryos for stem cell research? Surely we are being complicit by even engaging in such a practice.

It is a paradox to say something good can arise out of something evil, but indeed it does happen. Joseph is sold into slavery through the wicked actions of his brothers, but God achieves his good purposes by saving the nation of Israel from starvation. God does not own the evil of the brothers, but determines that good will come out of it. So Joseph's words, “As for you, you meant evil against me, but God meant it for good, to bring it about that many people should be kept alive, as they are today.” (Gen 50:20).

We might be able to say this of those researching IVF: “You meant it for your own success (even if the greater good is a factor), and even experiment on the unborn to achieve this success, but God meant it for good—that the barren might bear children and rejoice in the redemption of God, even now”. Obviously this is a hypothetical, but a real possibility of good arising from evil. It may be possible for Christians to be complicit in unethical research, but to conclude this is the case for those who use IVF assumes too much. Christians ought to protest the evil, but not fear the use of the good arising out of it. But the human conscience is defective, and so Christians will always differ on what they feel they can and cannot participate in: “or whatever does not proceed from faith is sin” (Rom 14:23b).

Tim and Susan Ravenhall of Young, NSW, AUS (21/05/2010)

It was interesting to discover from Peter Bolt’s article ‘Stark truth about the Crusades’ (Briefing #380) that polemical Muslim literature on the Crusades only dates back to the late 19th century. However, I feel this observation should not be used to counter the view that the Crusades are a terrible chapter in church history.

It seems clear that the Crusades established a hideous principle in the medieval mind—that violence could be carried out in the name of Christ against any group perceived to be opposed to Jesus. It is no coincidence that Jewish communities throughout Europe suffered a wave of severe persecution during the time of the Crusades. The logic was simple, as expressed by French crusaders: “It is unjust for those who take up arms against enemies of Christ to allow rebels against Christ to live in their own land”.

Peter suggests that when asked, “What about the Crusades?”, we should reply, “Well, what about the Crusades?”, on the basis that, in his view, there is nothing shameful in that period of Christian history. Can I suggest an alternative response—one that helped me greatly when I received it as a young Jewish believer in Jesus struggling with the history of Christian persecution of my people? It is simply to say that what is done in someone else’s name may not in fact be authorized by that person. Perhaps that person’s name is being used illegitimately. Nothing that Jesus says authorizes the use of violence in his name, and so it is unfair to blame him for times such as the Crusades when people have wrongly harnessed his name to their violent activity. I feel this response will be more effective and respectful in cross-cultural outreach than the one Peter proposes.

Nick Howard of Gravesend, Kent, UK (02/06/2010)

We were more than a little disappointed with the Briefings recent treatment of the topic of infertility. As a couple who have struggled with the grief and isolation that infertility brought for many years, we were interested to read of the accounts of others and their reflections on this journey as a Christian. Instead we read only of the accounts of 2 couples who ultimately in the end sought to do IVF. There was no perspective from those who chose not to do IVF making alternative choices be they adopting, fostering or remaining childless.

On this occasion we felt that the Briefing, although unwittingly, has bought into the belief that IVF is a natural option for childless Christian couples. Our dismay mostly rests in the fact that we as Christians somewhere along the timeline of the emergence and use of IVF have failed to have the difficult and important discussion about whether or not this is a practice we should even be involved in.

The Ravenhalls stated at the beginning of their article that they would address the question “Should Christians even do IVF?” but never actually answered it. They presented us with some of the ethical dilemmas and their own struggles but then did not bring the reader to a place where we could understand why they ultimately made the choice to do IVF despite their significant concerns.

One of our many concerns surrounding this issue is that we as infertile couples can be drawn into the temptation to have a baby at any cost. When what should really drive our decision making is seeking the glory of God and his will not our own.

Additionally we cannot move past the fact that healthy embryos die during the thawing process – how can we as Christians participate in a practice that could lead to the loss of our own child’s life? It is also a struggle to understand how as Christians we can engage in a practice that walks hand in hand with embryonic stem cell research - countless human beings lives lost daily for the sake of medical research. It is IVF that fuels this science through both the provision of embryos and the financial proceeds that come from couples engaging in IVF.

Finally we were concerned by the Ravenhall’s response to readers’ comments regarding their article. They in the end seemed to argue that the end (i.e. gaining a baby) justifies the means engaging in a scientific practice which actively devalues and ends human life. This argument seems at odds with a Christian ethic.

They further likened their choice to engage in IVF to God using the evil done to Joseph in Exodus for good. In that instance the perfect God was acting for his glory according to his perfect plan. To liken sinful man engaging in practices which result in the loss of human life, for his own gain, to God working for his glory and perfect purposes is a poor use of Scripture.

Although we were disappointed with the Briefings treatment of the topic of infertility perhaps it may just stir up the discussions that should have happened years ago.

Paul and Angela Beeston of Terrigal, NSW, Australia (26/07/2010)

Thanks Rita for your comments on the IVF issue. Susan and I have been researching adoption possibilities for some time now. Praise God for such a wonderful biblical doctrine. We have a very strong theology of adoption because that is the story of every Christian. So we hear you loud and clear on that one. The reason we didn’t write about adoption in our article was in the main because we were trying to help our Christian brothers and sisters, who are engaged in the processes of IVF, to think clearly about the possibility of doing IVF without compromising the precious life of the embryo. I’m sorry you feel we have completely lacked ethics in our approach.

Tim and Susan Ravenhall of Young, NSW, AUS (24/08/2010)

A response to the Beestons, point by point:

The Ravenhalls stated at the beginning of their article that they would address the question “Should Christians even do IVF?” but never actually answered it. They presented us with some of the ethical dilemmas and their own struggles but then did not bring the reader to a place where we could understand why they ultimately made the choice to do IVF despite their significant concerns.

1. We did not state that we would be answering the question, should Christians even do IVF? We stated as below –

Even with those two things worked out – not freezing and only fertilizing two eggs – we still hadn’t decided whether Christians should do IVF. After all, isn’t God the God of the miraculous […]

It was a personal question we were wrestling with. It was never stated that the article was an apologetic for whether Christians should do IVF. Secondly, though not a thorough answer to that question, the article did make some inroads to answering it. For example, the very next paragraph states why we thought it was ok. Though not a definitive knock out answer, it is what we were thinking at the time and I still believe it to be quite reasonable. But whether you agree with our logic or not, you have misrepresented the claims of the paper.

One of our many concerns surrounding this issue is that we as infertile couples can be drawn into the temptation to have a baby at any cost. When what should really drive our decision making is seeking the glory of God and his will not our own.

2. Sure, that is a valid concern, but should this concern mean IVF is a not a real option for Christians. Does God cease to be sovereign over all of life because we make decisions to engage in IVF? Do we stop praying, “Your will be done Lord” because we can have a triple heart bypass? We might and that is where we need to speak to people. We need to remind them that it is not a right to have a child, but a merciful and kind hearted God who sometimes sees fit to gift us with them. We are firm believers that God gave us Rex for his glory and can even take Rex from us, for his glory. We are firm believers that God decided in his majesty that our other two little ones would not be with us in this world. That too, he did for his glory.

Additionally we cannot move past the fact that healthy embryos die during the thawing process – how can we as Christians participate in a practice that could lead to the loss of our own child’s life?

3. Again, we speak quite frankly about this in the article and I think this is the thing I wasn’t quite sure about doing. I did do it and I don’t think I’d do it again. But again, this is all in the article.

Human beings live with risk every single day. Adults put their children at some risk when they leave them to play in the back yard alone for a time. We risk our children’s lives each time we put them in the car, feed them, or send them to the shops for some bread or milk. My son has twice nearly choked on his food. There is always a risk factor. There is no easy answer to this. We need to ask ourselves, ‘how much risk is appropriate?’ If you think that you are participating in a risk free world, then you don’t live in the same world as me and you mustn’t drive a car with a child in it.

It is also a struggle to understand how as Christians we can engage in a practice that walks hand in hand with embryonic stem cell research - countless human beings lives lost daily for the sake of medical research. It is IVF that fuels this science through both the provision of embryos and the financial proceeds that come from couples engaging in IVF.

4. I feel the weight of this statement, but doing IVF ethically (which we attempted to do) does not affirm the evil it may have arisen from. As Christians we believe it is essential that all embryos have the best possible chance at life we can give them. We did not, and it is not necessary for Christians to have excess embryos that may be used in research. Secondly, on the first point is a rather subjective opinion. Yes, there are many embryos used for stem cell research. But just because an industry is reliant on another, doesn’t mean I participate in providing for the other. Part of the reason for writing the article was to gently warn Christians in the way they treat their little ones.

I think the real question for Christians is not whether an individual can participate ethically in IVF. I think this is possible. The real question is this, ‘Is IVF good for our society as a whole?’ Then I would say no because our society as a whole is one post-modern monster where right and wrong don’t matter. So if it’s not good for society as a whole are we being unloving in participating? I think not. My current position is this. If the opportunity arose in legislation to stop IVF, if we had the power to do that, I’d be in it. For the simple reason it may reduce the loss of thousands of lives. If the reason it wasn’t good for society was because no matter what you do in IVF, you were always going to harm children, then I’d say it’s a no go area for Christians. However, if it’s possible to honour God, even bring glory to his name through a Christian ethical approach to IVF, I don’t see a dilemma in participation, while voting to end the procedure. I think ending the procedure however, is about as likely as passing legislation that safeguards the embryo from any sort of scientific experimentation. I’m not saying, nor ever have, that participation is for everyone, but neither do I believe Christians are wrong to engage in something that when used constructively, can redeem something lost in the fall – fertility. It surely does glorify God to use what is good in IVF and in this redemption show the world something of what awaits the people of God.

Finally we were concerned by the Ravenhall’s response to readers’ comments regarding their article. They in the end seemed to argue that the end (i.e. gaining a baby) justifies the means engaging in a scientific practice which actively devalues and ends human life. This argument seems at odds with a Christian ethic.

5. In reading our article, I would have thought it was clearly more than an end justifies the means theology. We dealt with creation, sin, redemption, and new creation. We upheld a doctrine of kinds and ends which deals well with Christian anthropology, safeguarding humanity as those made in the image of God. If it appears we are happy to proceed with the process simply because the end was a good one, and there was nothing at stake ethically along the way, all I can say is that was not the intention of our answer and I apologise profusely if anyone came away thinking that. As I said, I think the article speaks for itself on that one. It’s hardly an ends justifies the means argument.

They further likened their choice to engage in IVF to God using the evil done to Joseph in Exodus for good. In that instance the perfect God was acting for his glory according to his perfect plan. To liken sinful man engaging in practices which result in the loss of human life, for his own gain, to God working for his glory and perfect purposes is a poor use of Scripture.

6. To tell you the truth I was always a little afraid of being misunderstood on this point. Indeed God was acting for his glory according to his perfect plan. It’s the next part I can’t agree with. You have confused the research with which IVF has arisen with the process of IVF itself. I think the research is unethical and results in the loss of human life. But I think the process, when navigated well by Christians does not necessarily result in the loss of human life, but the redemption of a barren womb. IVF itself does not have to be about ‘sinful man engaging in practices which result in the loss of human life.’ We don’t desire evil, but it’s not wrong to use something good to achieve something marvelous, the birth of a little one, still God’s, still wonderfully knitted together in the womb by the Giver of good gifts. There was never an intended one to one correspondence between the biblical historical event and our own lives. In context, the article was saying here is a real possibility, that God still works good out of evil. Doesn’t He? I think where we disagree with one another is that you believe IVF itself is evil and always un-categorically leads to the loss of human life. I stand by the possibility of God still today meaning something for good when humans do evil. In the article I only ever say, ‘We might be able to say…’ I never present our case as a concrete example, just a possibility. And so I say no poor use of Scripture, simply stating a precedent for a real modern day possibility.

I am against unethical research on embryos but I am not against the good results of IVF. I would happily protest against the misuse of embryos for research. I am all for ethical research, just as I am all for an ethical approach to IVF. Let me use a situation from Nazi Germany. In WWII, the Germans experimented on prisoners of war. One such experiment was to bring people to freezing point, near death and then use different methods to revive them. It was cruel, brutal and savage. Many suffered and many died. The USA then had a major dilemma on its hands when it sought to work on its own research in reviving hypothermia victims. There were serious gaps in their knowledge of how to successfully and carefully revive someone in this situation. The debate raged long and hard as to whether they should use the results of unethical German research to fill the gaps in their own. In the end they did. They used the research which helped significantly in their ability to save peoples lives. The research that got them where they needed to be was evil, but the process to revive hypothermia patients was a good one. Yes, the research for arriving at IVF may be unethical, but we are not engaging in it nor affirming the research by using the good that has arisen out of it. I would say the end justifies the means is an appropriate attack on our character only if we deliberately supported such research, only if we put our name to it. But we don’t. We find it a great sadness and willingly put up our hands in protest against such research, even if it meant there was no possible way of doing IVF.

Tim and Susan Ravenhall of Young, NSW, AUS (25/08/2010)