Infertility & Medical Options
Some couples blame God for their inability to conceive and bear children. Others blame themselves. They may interpret their infertility as a punishment for some past sin.
The Crisis of Infertility
While many couples have experienced the blessing which concludes Psalm 128, “Your wife will be like a fruitful vine.… your children will be like olive shoots around your table....” many others have lived the frustration imbedded in Rachel’s cry to Jacob, “Give me children, or I will die!” (Gen. 30:1). Approximately 3.5 million couples in the United States are infertile. Alongside the basic frustration of wanting children and not being able to have them, infertility presents a developmental crisis in the life of couples by calling into question their understanding of femininity and masculinity. Because of internal, familial and societal expectations, some infertile men and women consider themselves to be “failures,” because they cannot fulfill their “expected” roles in procreation.
Infertility is also a spiritual crisis for many couples. Some couples blame God for their inability to conceive and bear children. Others blame themselves. They may interpret their infertility as a punishment for some past sin.
Infertility in the Bible
Just as the Hebrews viewed children as gifts from God (Ps. 127:3, 4), they considered childlessness to be a curse. Childless couples in the Old Testament; however, were not left without hope. Not only did they have recourse to surrogate motherhood (see Gen. 16:1-6; 30:1-13) and levirate marriage (see Deut. 25:5-10; Gen. 38:8; Ruth 4:1-10), they possessed the stories of Yahweh’s determination to grant children of promise even in the face of infertility. Isaac was born to Sarah and Abraham after advanced age had all but eradicated their hope for the long-awaited covenantal heir. God similarly remembered Rebekah and Isaac, Rachel and Jacob and Hannah and Elkanah. With the advent of modern medical technology, infertile couples have many more options than did the ancient Hebrews. With more options, of course, come more technological and ethical complexity.
Options for Infertile Couples
Artificial insemination is the procedure in which a woman is inseminated with semen from her husband (AIH) or a donor (AID). In the United States, approximately 35,000 children are conceived annually by AIH and 30,000 by AID. The most common reasons why couples use AID are: (1) the husband may be sterile; (2) the husband may carry a known genetic defect; and (3) a severe blood group incompatibility may exist between the husband and wife, which would make a successful pregnancy unlikely.
Surrogate motherhood is the process whereby a woman is artificially inseminated with sperm from a man who is not her husband. The woman gives birth to a child, then relinquishes the child to be parented by the couple who donated the sperm.
In vitro fertilization (IVF) literally means fertilization of an ovum (egg) “in the glass.” Women who are infertile because of Fallopian tube disease are most likely to use IVF. IVF involves removing eggs from a woman’s ovary, achieving fertilization with the husband’s sperm in a petri dish, and transferring the resulting embryo at the six or eight cell stage (usually after three days in the laboratory) into the woman’s uterus.
Gamete Intrafallopian Transfer Procedure (GIFT) is a variation of IVF in which the gametes (eggs and sperm) are retrieved, transferred to the woman’s fallopian tube, and fertilization allowed to take place spontaneously in the fallopian tube. GIFT can only be done when the sperm quality is adequate and the fallopian tubes are intact.
Zygote Intrafallopian Transfer Procedure (ZIFT) is a fusion of IVF and GIFT in which fertilized eggs are transferred into the fallopian tubes. Fallopian tubes must be intact.
Tubal Embryo Transfer JET) is a variation of ZIFT in which the embryos are transferred by laparoscopy two days instead of one day after retrieval.
Intracytoplasmic Sperm Injection (ICSI) is a variation of IVF in which each egg is directly injected with a single sperm via a microscopic needle. ICSI has been successfully used for men with very low sperm counts.
Donor Egg is a variation of IVF in which a donor’s eggs are inseminated with the recipient husband’s sperm. Embryos are then transferred into the uterus of the recipient (the woman being treated). This procedure is used in women who are not candidates for regular IVF.
These and other options provide infertile couples with technological opportunities to solve their infertility problem(s). The procedures are, of course, more complex than their brief descriptions might imply. Couples seeking medical treatment should consult with a physician to determine which procedure(s) are medically indicated in their case and consider the medical and financial necessities entailed by the procedure(s) indicated. Christian couples should also ponder ethical issues that reproductive technologies may raise.
Paying donors. Gamete (egg, sperm) donors and surrogate mothers are paid for their services. While such compensation is understandable, does the practice turn children into commodities which are bought and paid for? Will the fact that their biological mother or biological father “sold” them affect the children’s sense of self-worth?
Sharing a genetic bond. In the usual parent-child relationship, both parents share an equal genetic bond with their children. This bond helps to produce family likenesses and a sense of shared continuity between parents and children. Surrogate motherhood, AID and other procedures which may use donor gametes can alter the shared sense of genetic bonding and produce asymmetrical relationships between the child and one of the legal parents. Couples who use reproductive technologies must consider how the procedure might affect the spouse who shares no genetic relationship with the child. They also must consider how reproductive technology might affect the children born as the result of their use.
Telling the child. An important consideration is whether to tell children the truth about the nature of their conception. Many couples who use reproductive technologies never intend to tell their children about their origin, because they want to (1) protect the child from having an identity crisis, (2) protect the husband/wife from having to admit infertility problems, and (3) avoid the uncertainty about how to share information concerning the child’s conception. As a rule, couples should contemplate the use of reproductive technology with the assumption that the child will eventually learn the circumstances of his or her birth and that it is usually in the child’s best interest to learn this information at an appropriate early age from a parent.
Discarding embryos. Couples who use IVF face some unique issues. If more than one ovum is fertilized, what happens to the extra ova? Are they implanted also, thus increasing the possibility of multiple births? Are they frozen for future use? Are they donated to other infertile couples? Or are they discarded? This last option concerns many people who believe that life or personhood begins at conception.
Adoption is another option for infertile couples. Couples who want to be parents, but who decide not to use reproductive technologies, sometimes choose adoption. Even though adoption is not a medical option, it remains a legitimate and sometimes preferable choice for infertile couples.
Threatening the marriage. Couples who contemplate using reproductive technologies should discuss how these technologies could affect their marriage. Will a particular reproductive technology serve in any way to strengthen the couple’s relationship? Or does the introduction of a third party (the donor) or another aspect of the technology threaten the stability of the marriage?
Separating love-making from baby-making. Some ethicists assert that moving conception from the sphere of sexual intimacy to the laboratory has dire consequences for the meaning of human procreation. Does manipulating procreation through technological means, rather than conceiving children through sexual intercourse, move humanity closer to being just another segment of human-made things? While this question raises a valid concern, its answer depends to some degree on the couple considering reproductive technologies. In most cases couples who choose to use these technologies do so only after attempts to conceive a child naturally have failed and after extensive medical intervention. Resorting to reproductive technologies can be understood as the next step in medical intervention. These couples are not using the technologies to make a “better” baby, but as part of an exhaustive effort simply to conceive a child.
Playing God. Some ethicists believe that using reproductive technologies is an example of humanity’s attempt to play God. Others; however, claim that using these technologies can be an act of good stewardship.
The Stewardship of Procreation. Two primary locations for biblical teachings on stewardship are the creation stories in Genesis and in the parable of the talents (Matt. 25:14-30). The first creation story describes God’s creation of humanity in the divine image and God’s bestowal upon men and women of procreative powers (Gen. 1:27-28). The parable of the talents speaks to the significance of human participation and responsibility. It emphasizes that God provides us with certain talents which enable us to participate in God’s work in the world and that we are responsible to God and to others for how we use our talents.
Stewards are not creators, but trustees. We can ignore neither our responsibility to others nor our dependence on God. We recognize that our procreative powers and the children resulting from those powers are ours only in the sense that they are entrusted to us by God.
Stewards are also called to be active participants with God in the world. Many infertile couples believe that reproductive technologies are gifts from God to assist them in overcoming their childlessness and that the carefully considered use of these procedures constitutes faithful stewardship of procreation. Just as God created the world out of love and shared the gift of life with the creation, so infertile couples can interpret reproductive technologies as means by which to share God’s gift of life with their children.
The Stewardship of Marriage. Couples are also stewards of their marriage covenants. Part of the Christian understanding of procreation is that the begetting of children should flow out of marital intimacy. Some reproductive technologies can be experienced by husbands and/or wives as disruptive to intimacy. If either partner has reservations about using reproductive technologies, including techniques which involve third parties, then other options (i.e., waiting for clarity, remaining childless, adopting) should weigh heavily in decision making.
The Stewardship of Parenthood. Even if couples determine that a particular reproductive technology is good stewardship of their procreative powers and of their marriage, they also must consider the possible effects this procedure might have on their children. As stewards, parents are responsible to God and to their children for how they treat their children and for their children’s physical and emotional welfare. Parents can exhibit faithful parental stewardship by instilling in their children the deep conviction that they are loved and valued by their families, by God and by the Body of Christ and by treasuring their children as gifts from God. Understanding children as gifts emphasizes that parents do not possess children for self-serving ends, but live with them as trustees of God’s loving providence.
Christians are called to be discerning in the sense that we must attempt both to judge the rightness of our actions and to anticipate their consequences. Couples considering the use of reproductive technologies as treatment for infertility must ask discerning questions: “How will this procedure influence our marriage? How will this procedure influence our relationship with our child? How will this procedure affect our child? How will this procedure influence our relationship to God?”
The impact of reproductive technologies is too complex to reduce into simple affirmations or condemnations. Some Christian couples will be able to work positively through the issues so that they can be good stewards of the technology. Others will decide against technology in favor of other options.
Couples who are considering reproductive technologies should not defer answering the central questions until they are well into the process, nor should they be paralyzed by their inability to answer every possible question. Rather, through prayer, study, dialogue with each other and dialogue with the community of faith, they can begin to understand the will of God for their lives.
“Infertility and Medical Options” is one of fourteen articles in the Getting Well: Christian Perspectives on Health, Sickness, and Ministry series. Getting Well deals with major health and biomedical issues.
The Christian Life Commission