In vitro fertilization (IVF) is not mentioned in the Bible. Some Christians have concluded that this means the Bible is agnostic on IVF, a reproductive technology where sperm fertilizes an egg in a petri dish. While it is true that the words “in vitro fertilization” do not explicitly appear, the Bible has a lot to say about infertility, technology, and the value of life from the moment of conception.

For couples who struggle with infertility or inheritable diseases, it is important that they have a firm grasp on how IVF works, its moral implications, and what options are available for Christians. Today, I will address each of these questions from my perspective as a Protestant and as a subject matter expert on IVF.

How IVF Works 

When a couple is struggling with infertility, doctors often recommend that they use IVF.

To collect a woman’s eggs for IVF, doctors often rely on harsh hormonal drugs to stimulate a woman’s body to create as many as 35 eggs—far more than the single egg a woman’s body naturally forms each month. Given this cocktail of hormonal medications and the creation of multiple eggs, women have an increased risk for cancer, infertility, and ovarian hyperstimulation syndrome (a life-threatening condition).

On average, about 80% of eggs that doctors place with sperm will result in an embryo, who is a distinct, unique, and living human person. Doctors create an average of 15 embryos in a single round of IVF. Unfortunately, only 3-7% of all created embryos result in the live birth of a child. For the embryos involved in IVF, the success rates are very low indeed.

>>> Protestant Denominations Need Stronger Leadership on Assisted Reproductive Technology

Many IVF procedures rely on the routine destruction of human life—either intentionally or through neglect. Oftentimes, doctors even create a surplus of embryos to test and select those with the “best” genetic profile using preimplantation genetic diagnosis (PGD). While laws in Canada limit PGD’s use, this same technology can also allow doctors to determine a child’s sex, physical features, or intellectual aptitude. From here, parents and doctors decide which embryos to implant, which embryos to freeze for later use, and which (if any) embryos to destroy. All told, once a doctor creates an embryo in IVF, parents must either implant, discard, freeze, donate to research, or place the embryo(s) up for adoption.

Moral and Ethical Concerns in IVF

While it may seem obvious that parents want to implant the embryos they create, the fertility industry has a different goal: implant the right kind of embryos with the highest chance of success. Fertility clinics, in many cases, practice IVF with a eugenic assumption that some embryonic children are more deserving of life than others. Clinics often provide parents with predetermined packages that aim to create as many embryos as possible, test and select the healthiest ones, and discard the embryos that are unwanted or deemed not good enough. Christians must ask themselves whether they can, in good faith, participate in an industry with so little respect for human life.

Beyond the concerns about how embryos are treated, there is also the lingering question of what parents should do with leftover embryos. According to a recent poll from Scott Rasmussen, he found that only twenty-four percent of respondents think “leftover” embryos should be destroyed, suggesting that 76 percent of people favor another option for these embryos.

Unfortunately, the options available can quickly verge on dystopian. For example, some embryonic children have been frozen in a state of suspension until they were born 30 years after their conception.

In another example, a friend of mine (in her mid-20’s) who was created through IVF still has multiple siblings on ice. She was faced with a difficult decision when her mother asked her if she wanted to gestate her siblings to give them a chance at life. She ultimately decided against this option. Katy Faust, a child’s rights advocate has aptly argued that someone must sacrifice in the difficult journey of infertility and reproductive technology. It can either be the parents, or in the case of this friend, she herself will have to bear the burden of deciding part of her unborn sibling’s fate.

Another friend of mine, also in her mid-20’s, tells the story of her own conception. Her parents used IVF to avoid children with a certain inheritable and debilitating genetic condition. She lives with the daunting knowledge that she is lucky her parents thought her life was valuable enough to choose her unlike her untold number of lost siblings.

And the outcomes of IVF are not neutral. Children born through IVF have a higher likelihood of cancer, autism, minor cleft pallet, or a congenital heart defect. As bioethicist Oliver O’Donovan argues, “There is a world of difference between accepting the risk of a disabled child (where that risk is imposed upon us by nature) and ourselves imposing that risk in pursuit of our own purposes.” For Christians, who value and protect life from the moment of conception, such parents submit their own wishes to the wellbeing of children. That includes children who do not exist yet.

How Christians Think About Infertility and Reproductive Technologies

So, how should Christians think about reproductive technologies? Protestant theologians and pastors who have thought about the issue tend to fall into one of four categories.

• Explicit support for the use of all available reproductive technologies, including IVF and surrogacy.
• The belief that since the Bible does not mention IVF explicitly, the issue falls under the realm of Christian liberty, granted that the couple does not intentionally destroy embryonic life.
• The view that given the fallenness of human nature, Christians should assess reproductive technologies, for the use of treating infertility, on a scale from “ideal” to “less ideal.” With pastoral and biblical counsel, and an assessment of the couple’s own heart, Christians may decide where they draw the line in their use of reproductive technologies.
• The view that the Bible presents a “package deal” of marriage, sex, and procreation such that the use of in vitro fertilization, which circumvents both infertility and sex, inherently violates God’s vision of procreation. In each biblical example where degrees of separation are added between these three distinct and unified acts, sin enters the picture. I explore this perspective here, here, and here.

“Ideal” to “Less Ideal” Options

As the list progresses, each option is more intrusive than the last as it relates to the number of people involved in the act of procreation, additional delays or pauses in the natural act of conception and pregnancy, and in the tools and medications necessary. In short, each subsequent step adds additional barriers between the package deal of marriage, sex, and procreation. For couples struggling with infertility, such options from ideal to least ideal are as follows

Restorative Reproductive Medicine

Since infertility is not a disease, but a symptom that refers to several underlying conditions, couples should invest in restorative reproductive medicine to identify and heal the underlying causes of infertility. For women, these causes range from several issues including endometriosis, uterine fibroids, polycystic ovary syndrome, interstitial cystitis, and adenomyosis. For men, such causes may relate to low sperm count or low sperm motility, or lifestyle factors such as their diet, nutrition, and exercise. In many cases, doctors can heal a man and/or woman’s body so that they can naturally conceive and bear children without the use of reproductive technologies.

Artificial Insemination or Intrauterine Insemination (IUI)

Doctors may recommend artificial insemination or intrauterine insemination (IUI) where sperm is collected from the husband and placed within the wife using various methods. Some clinics provide the use of pornography, but many other options are available from surgical extractions to the use of a condom to collect the sperm.

Gamete Intrafallopian Transfer (GIFT)

Gamete intrafallopian transfer (GIFT) takes this one step further and collects both egg and sperm. Doctors place the eggs and sperm—separated by an air bubble—into a catheter before injecting it into a woman’s fallopian tubes. While both egg and sperm are extracted from the couples’ body, doctors ensure that the moment of conception occurs within the woman’s body.

Natural IVF or Mini Stim IVF

Given the many ethical and moral concerns inherent in IVF, many couples have turned to an alternative course of treatment known as “natural IVF” or mini stim IVF. In natural IVF, doctors only create one embryo at a time, avoid the use of harsh hormones, and work within the woman’s natural cycle to implant the embryo when she is naturally fertile. Many avoid testing the embryo for genetic or physical traits and do not freeze or destroy embryos, either. Mini Stim IVF, similarly, uses fewer harsh hormones and extracts fewer eggs at a time for the sake of preserving a woman’s reproductive health.

In Vitro Fertilization (IVF) and Zygote Intrafallopian Transfer (ZIFT)

In vitro fertilization (IVF) and zygote intrafallopian transfer (ZIFT) are similar procedures where sperm fertilizes an egg in a petri dish. The process of creating and treating the embryos is the same; the only variation occurs in where each method places the embryo. In a typical cycle of IVF, embryos are subjected to genetic testing and selection, indefinite periods in a cryopreservation freezer, and are selected based on conditional standards of viability.

>>> Why the IVF Industry Must Be Regulated

Third-Party Reproduction: Egg or Sperm Donation and Surrogacy

Finally, couples or single persons, have the option of third-party reproduction which may use donor egg, sperm, or womb (surrogacy) to create and gestate a child. While there are many reasons to avoid third party reproduction for the sake of the potential child’s well-being, it also doubly violates the Bible’s teaching on the exclusivity of marriage (which also extends to sex and procreation) by bringing a third person’s genetic material and the intimate use of their body into the act of procreation. We may rightly cringe when we read about Abraham conceiving a child with Sarah’s servant, Hagar, but the medicalized use of someone else’s of egg, sperm or womb in reproductive technologies create a child is only a difference of degree, not kind, from Abraham’s extramarital sex with Hagar. We should, as Leon Kass coined, listen to the “wisdom of repugnance,” or to put it bluntly, the “ick factor” when we consider this option.

Conclusion

Some Christians, like those in the third category, may draw the line before IVF, while others may allow for a limited use of such technology. Such couples believe that they can remain firmly within God’s vision for marriage, sex, and procreation by their limited use of reproductive technology within the boundaries of man-woman marriage with a firm prohibition against testing, selecting, or destroying human life. For couples who believe in the “package deal” of marriage, sex, and procreation, such that the connection between these acts should not be severed or separated by human hands or instruments, each of the options after restorative reproductive medicine are off limits.

Christians, even those walking through infertility, should be filled with hope. A diagnosis or season of infertility does not mean that a couple will never have children; only that it may require more work and time than they initially expected. Christians must be set apart from the world in their use of reproductive technologies and commit to treatments that diagnose and treat the underlying causes of infertility while upholding biblical teachings related to marriage, sex, procreation, and the value of life from conception.