Few things stir our deepest hopes and fears quite like the prospect of having children. The mere thought of children has a way of tapping into our strongest desires and deepest anxieties—often shaping the choices we make about fertility and family.

These concerns, along with the desire to delay fertility, has contributed to falling birth rates in the U.S. and worldwide. At the same time, more people are facing health issues that affect fertility, leading many to turn to reproductive technology for help. Technologies like in vitro fertilization (IVF)—where doctors combine an egg and sperm in a petri dish and then later implant the fertilized embryo in a woman to grow—promise parents more control over having children. For some, IVF offers a chance to have a child they couldn’t otherwise have. For others, it’s a way to select specific traits in their future child.

This essay explores the theological and moral implications of IVF from a biblical perspective, asserting that while the desire for children is a God-given and natural longing, the routine practice and cultural consequences of IVF often conflict with biblical teachings on human dignity, the sanctity of life, and God’s good design for marriage, sex, and procreation.

A Theological and Moral Reflection on IVF

There are three assumptions I bring to this conversation on IVF. First, the Bible is the inerrant and sufficient Word of God and is profitable for teaching, reproof, and training in righteousness (2 Tim. 3:16–17). So, even though the phrase “in vitro fertilization” does not appear in the Bible, the Bible is the ultimate authority for life and godliness, including any matter related to the conception of life. Second, God calls Christians to walk in knowledge, understanding, and wisdom, especially when it comes to questions about life and our use of technology. This means that faithful Christian living requires more than good intentions. Finally, life begins at the moment of fertilization, and bears inherent worth and dignity. Thus, IVF does not deal with “potential” human life, but actual human life.

Many Christians may be tempted to rely on a simplistic understanding of IVF that separates this issue from other pro-life teachings in the Bible. For example, since IVF may result in the creation of new life (something that Christians celebrate, recognizing that each child is created in the image of God), some have decided that all uses of IVF are morally allowable. This assumption, however, ignores the fact that many, or most, embryos created in IVF are destroyed, frozen, or fail to implant. For Christians who believe that life begins at conception, it is essential that Christians apply this teaching to protect all embryonic life—regardless of how conception occurs.

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The question of how embryos are created and treated in IVF is not merely a tertiary issue for the Christian but central to the Church’s beliefs on life and human flourishing. In the same way that Christians led the charge on protecting life from abortion or infanticide, so Christians must courageously face the destructive aspects of the fertility industry.

To assess the morality of IVF, and the pro-life concerns implicit in this technology, it is important that we consider all three elements: (1) one’s intentions behind the action, (2) the action itself, and (3) the resulting outcome.

Intention and Desire for a Child

As Genesis 1–2 shows, the desire to have children is God-given. Indeed, procreation was God’s good idea, not ours, and it is central to the formation of life and the display of his glory in creation. The Cultural Mandate (Gen. 1:28) is careful to frame this desire as a blessed gift from God, and not a right. Therefore, while it is natural to desire children, such desire does not justify pursing any means necessary to accomplish that end.

When sin corrupted the created order in Genesis 3, every aspect of the human experience, including our ability and desire to have children, fell with Adam and Eve. Indeed, the natural vulnerabilities that accompany each aspect of childbearing can lead people to approach children with fear, and a desire to assert their own control over the process, especially when infertility or miscarriage accompany our experience. While this fear can feel overwhelming, outside of our control, shameful, or just plain isolating, it is important to remember that we are not alone.

Indeed, the Old Testament is filled with stories of infertility and promises fulfilled. For example, each of the six covenants that God makes with His people include future generations of children, with the Adamic, Abrahamic, and Davidic covenants specifically based on the promise of descendants, ultimately fulfilled in Jesus Christ Himself in the New Covenant. But lest we assume this meant the process was always easy, it is important to remember that each of the first three Patriarchs—Abraham with Sarah, Isaac with Rebekah, and Jacob with Rachel—struggled with infertility.

After many years of waiting for God to fulfill His promise for a child, Abraham and Sarah took matters into their own hands. Sarah gave Hagar, her maidservant, to Abraham to bear a child on her behalf (Gen. 16:2). While these efforts were successful, resulting in the birth of a male heir, their approach violated the exclusive bonds of marriage between one man and one woman. Sarah, too, suffered the consequences of her actions as jealousy drove her to act cruelly toward Hagar and her son.

Perhaps learning from his parent’s mistake, Isaac’s experience with infertility led him to pray for his wife Rebekah, and God blessed them with twins (Gen. 25:21). In our own lives, the solution to infertility may require more than the prayer of a godly person, but never less.

And finally, Rachel, jealous of her own sisters’ fertility, relies on her maidservants and mandrakes (a fertility stimulant) to bear more children with Jacob (Gen. 30:3; 30:14–16). Despite her efforts, God still gave Leah more children. In each case, their desire for children, and the intention behind their actions, reflected God’s covenantal promise. Nonetheless, this did not justify pursuing any means necessary, especially when it violated God’s teaching on the sanctity of marriage or life.

Left unchecked, the temptation to idolize one’s fertility is one of the most powerful forces in the world. Indeed, since the fall of humanity, this idolization has led people to control (i.e., play God) rather than steward (i.e., be faithful with what God gives us) their fertility.

Such control over fertility can be seen in the examples just cited, but there is another instance of this in the way that Israel turned from worshiping the One true God to worshiping idols. And who was the false god that Israel most often turned? Asherah, the goddess of fertility (cf. Deut. 16:21; 1 Kings 16:33; 18:19; 2 Kings 13:6; 17:16; Mic. 5:14). As I note elsewhere, in their attempts to control their fertility, i.e., play God, “the Israelites would bring harvest sacrifices or perform sexual acts in front of this false goddess in hopes that they would receive fruitful crops or the blessing of children.” Going further,

It was normal in the ancient Near East to worship multiple gods in hopes of reaping maximum benefits from each; yet it resulted in sin and death for Israel. It also was normal to use one’s maidservant to bear more children, yet it violated God’s vision for marriage, and such actions brought suffering, envy, and strife.

Their desire for children and the intention behind their actions was to receive the blessing of fruitfulness that God declared over Adam and Eve in the Cultural Mandate. Nonetheless, God’s people erred when fear, futility, or idolatry corrupted their view of children and their subsequent actions. Thus, desire for children and intentions to be fruitful and multiply are not, by themselves, sufficient to justify illicit means of conception.

But this raises the question: What makes IVF illicit (i.e. not morally permissible)?

Actions Taken in Routine IVF Procedures

In a typical IVF procedure—which involves fertilizing egg with sperm in a petri dish—fertility doctors aim to create as many embryos as they can to increase a couple’s chances of success. Once an embryo—a distinct, image-bearing, living human life—is formed, there are only five options available to the couple. They can (1) implant the embryo(s), (2) freeze the embryo indefinitely, (3) discard the embryo, (4) donate the embryo to research (where it will be destroyed after 14–21 days), or (5) give the embryo up for adoption. Embryos may also naturally perish in the process or due to negligence on the part of the fertility clinic.

Immediately, these various scenarios remind us that IVF is hardly an automatic “pro-life” position. Often, it is just the opposite, whether interested Christians know this or not. Indeed, parents who pursue IVF are immediately confronted with many moral questions about how such embryos are created and what to do with them once they are formed. Further complicating this process is the use of preimplantation genetic testing (PGT), also known as embryonic genetic screening.

Standard PGT allows doctors to determine the sex of the embryo and potential health outcomes, such as Down syndrome and single-gene disorders like cystic fibrosis. In the United States alone, 75% of all fertility clinics offer PGT; 73% of these clinics allow parents to select or discard based on if the child is a boy or a girl.

While this may seem far-fetched, a growing number of parents report electively using IVF to select their child’s sex. In the United States, anecdotal reports show a strong preference for girls. Similarly, boutique companies have created an entire business model devoted to helping parents select the healthiest child possible. What is left unsaid, however, is that the “unfit” or unwanted embryos are either destroyed or frozen indefinitely. There is no third option. PGT assumes a conditional acceptance of the embryonic child, with doctors and parents selecting which ones are most valuable.

The moral and theological errors inherent to such uses of IVF are profound. It is natural for parents to desire a healthy child, and their intention may be to protect their children from difficult diseases or pain, but the action itself rejects the inherent worth and dignity of each child.

Instead of receiving the child as a gift from God, regardless of his or her sex or potential health complications, PGT rejects the Imago Dei and what Scripture teaches on the value of all life.

Given this, many parents undergo a form of life-sparing IVF where they reject the use of PGT and do not discard any of the excess embryos they create. But even in this situation, there are two lingering questions for the Christian to consider. 

First, there is the question of if it is morally acceptable to freeze embryonic human life, which is standard practice in IVF. Does the decision to suspend the natural progression of human life befit a child created in the image of God, especially if such freezing results in these embryos perishing or developing additional health complications?

Relatedly, more and more stories are circulating of children born after being frozen for two to three decades. Imagine being thirty years old in terms of your conception, yet just now allowed the opportunity to continue developing through each stage of life. While there is no set “shelf life” for a frozen embryo, most perish naturally after a few years. And the process of freezing and unfreezing leads to further health complications, such as an increased risk of childhood cancer or heart problems. And whether or not a child was frozen as an embryo, they still have significant health difficulties, as I’ll show later.

For siblings and children, this also creates a difficult moral scenario where parents transfer their own suffering onto future children. For example, a growing number of children will learn that they have unborn siblings frozen in nitrogen gas containers with parents now too old to gestate them. Friends of mine, not to mention many young adults across the United States, are already beginning to wrestle with the difficult decision of what they can, or should, do. Should such siblings agree to gestate their own brothers or sisters once they are married? Or do they stand by as they are given up for embryo adoption, or worse, destroyed?

This brings us to a second, and broader question. The Bible presents a clear vision of the “package deal” of marriage, sex, and procreation (Gen. 1:27–28, 2:23–24; Psalms 127–128; Mal. 2:15; Mark 10:7–9; Luke 20:27–40). As I noted in an essay for American Reformer,

Marriage, from Genesis onwards, is set apart in the Bible by its unity and exclusivity between one man and one woman. From within and through this bond, Christians may observe the threefold purpose of marriage—the procreation of children (Ps. 127:3), mutual comfort (Gen. 2:18), and protection from temptation (1 Cor. 7:9).

Further, key passages throughout the Old and New Testament further emphasize this biblical vision of marriage, sex, and procreation as an unmediated “package deal.”

For example, Malachi 2:15 ties each together saying, “Did he not make them one, with a portion of the Spirit in their union? And what was the one God seeking? Godly offspring. So guard yourselves in your spirit, and let none of you be faithless to the wife of your youth.”

Malachi describes marriage, sex within the bounds of marriage, and godly offspring together as a singular but multifaceted vision of what God intends.

While each marriage between one man and one woman is whole and complete in God’s eyes, with or without the blessing of children, God’s good design outlines a natural progression from marriage to sexual union to procreation. When infertility, miscarriage, and stillborn births sever this natural progression, the pain and heartbreak is immense.

Reproductive technologies can similarly sever the natural relationship between marriage, sex, and procreation. Indeed, such technology renders sex unnecessary for procreation, and marriage has little bearing on whose gametes are used. IVF thus decouples marriage from sex, sex from procreation, and, if a donor egg or sperm is used, biology from parenthood.

The Resulting Outcomes and Cultural Influence of IVF

When considering the moral and theological implications of IVF, Christians must not only weigh their intentions and their actions, but the (un)intended outcomes of IVF. Indeed, such technology does not merely form individual behavior, but it also shapes how cultures view children more broadly. Thus, in this third and final section, we need to consider IVF’s impact on individuals and society at-large.

Increases Maternal and Neonatal Health Risks

For starters, IVF increases maternal and neonatal health risks compared to naturally conceived children. For example, children born from IVF have a higher likelihood of preterm birth, low birth weight, cerebral palsy, cancer, minor cleft pallet, or a congenital heart defect. These children are four times more likely to be a stillbirth, twice as likely to have autism, and they have a 40% chance of non-chromosomal birth defects. Since the Centers for Disease Prevention and Control only tracks at-birth demographic outcomes, there are potentially more side-effects that develop over time.

Similarly, mother’s fare worse with IVF. For example, the risk of hypertensive disorders (including preeclampsia) increases by approximately 50%, women are more likely to undergo medically necessary caesarian sections, experience higher rates of gestational diabetes, and their risk of severe maternal morbidity, severe postpartum hemorrhage, of ovarian hyperstimulation, and severe preeclampsia or eclampsia (seizures) also spikes.

Of course, many children and mothers experience these difficult—or worse—conditions without the use of IVF. The primary moral difference is that in IVF, parents and doctors knowingly place the unborn child and mother at greater risk. As Oliver O’Donovan says, “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.” (Oliver O’Donovan, Begotten or Made?, 21st Century Ed. (Landrum, SC: Davenant Press, 2022), 100.)

Encourages Men and Women to Delay Childbearing and at Times, Marriage

Another consequence of IVF is that it can lull women (and men) into a false sense of security about a woman’s biological clock. Rather than pursue marriage and children in their early twenties and thirties, career-driven women may indefinitely delay childbearing. Rather than encourage women to pursue marriage and children as the cornerstone of their life, IVF invites women to treat marriage and children as the capstone of their life—once they reach their educational and professional goals.

In fact, many advertising models and corporate health benefits are structured to encourage women to pursue their career with the promise that children, with reproductive technologies, will always be available to them. The sad reality is that this is far from the case. Indeed, as women age, their ability to conceive children, even with the use of IVF, declines. Specifically, IVF’s overall success rate for a live birth is approximately 23 percent, and less than 10 percent for women over the age of 40 (after age 42 it drop below 3%).

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Researchers initially developed IVF for oncology patients, and in recent years the technology has been expanded to anyone struggling with infertility. Today, however, much of the fertility crisis doctors treat is the result of more and more people delaying children until it is physically difficult or impossible to get and stay pregnant.

Encourages Procreation Outside of Biblical Marriage and Sexuality

A final cultural impact caused by IVF and the thriving egg and sperm donation industry in America is that it enables (and encourages!) singles and same-sex couples to conceive and bear children apart from marriage as God designed it. In situations where a married couple lacks viable egg or sperm, the use of a third parties’ gametes poses a serious moral question about the exclusivity of marriage. We may rightly cringe at Abraham’s use of Hagar to produce a male heir, but the use of donor gametes in IVF is only a difference in degree, not kind. Technology may prevent sexual immorality in the bedroom, but the child conceived out of wedlock remains.

Moreover, such reproductive technologies have the unintended consequence of treating biology as a barrier to human flourishing. Rather than rely on a medical definition of infertility, states like Illinois, California, and New Jersey have redefined infertility to include any single person or same-sex couple that requires donor egg or sperm to conceive. Thus, infertility no longer reflects a medical diagnosis due to underlying reproductive health conditions, but is a social term that justifies the use of IVF beyond natural biological limits.

Conclusion

With all the challenges posed by IVF, Christians must approach the issue with moral discernment and biblical wisdom. While the desire for children is a natural and beautiful longing, fulfilling this desire in any way that compromises human dignity, God’s design for procreation, and the sanctity of life invites Christians to sin by violating God’s created order and breaking his commands for conceiving life.

As I noted above, routine uses of genetic testing, embryo selection, and the indefinite freezing or discarding of embryos violates the Christian belief in the inherent worth of human life from the moment of fertilization. Even more though, the cultural implications of IVF are destructive for life. From encouraging delayed childbearing to enabling procreation outside of biblical marriage, IVF reshapes the moral imagination with respect to the family and God’s good design of coupling marriage, sex, and procreation.

As followers of Christ, we are called to honor God’s design for procreation within marriage and to recognize children as good gifts received from a holy God and not made with impure hands. Indeed, children are so valuable in God’s eyes that Christians must ensure that our practices—from how they are conceived onwards—align with God’s good design. Embracing this perspective encourages a faithful response to the complexities of reproductive technologies, grounded in respect for life and confidence in God’s provision.