The quiet heartbreak and pain of infertility is well known to many evangelicals, whose aspirations to have a child have been frustrated for reasons they cannot understand or control. It is frequently a secret burden that couples carry, which only emerges into the open as they reveal their struggles to family, friends, and doctors.
The weight of infertility and the value of children has increasingly prompted infertile couples to pursue procreation by every means possible: artificial insemination, in vitro fertilization, and even surrogacy have all found their way into evangelical communities.
Yet while evangelicals have become increasingly aware of the emotional challenges infertility poses, we have not yet considered the hidden costs of our desperate pursuit of children through artificial reproductive technologies.
Few movies have brought those challenges into the open like Netflix’s Private Life (warning: show contains explicit content). The film narrates the hope and heartbreak a couple experiences as they walk through various means of aiding conception, and the personal and relational distress that arises from their efforts. After receiving one final, disappointing report of failure, the husband callously asks his wife while lying in bed next to her, “Will we ever have sex again?” The wife, not surprisingly, denounces the question as self-interested and insensitive.
We have not yet considered the hidden costs of our desperate pursuit of children through artificial reproductive technologies.
The moment poignantly captures how fertility treatments reconfigure how infertile couples sometimes experience their sexual lives together. Ironically, the couple had consigned sex to marriage’s dustbin; the very act that might naturally generate children has been relegated to an inconvenient, cloying annoyance. What should be a source of joy and deep union has become a painful reminder of their frustrated desires.
For many evangelicals, though, the ethics of in vitro fertilization begins and ends at the question of how many embryos are created and what happens to them. Beyond this, many evangelicals do not even think in vitro fertilization is a “moral issue.” Why would it be, when it seems to be simply a medical technology that helps couples satisfy their deep desires for what God has deemed good—namely, the birth of a child made in God’s image? To say “no” to such technologies is, for many couples, equivalent to saying “no” to the satisfaction of their deepest, most heartfelt desires.
While not every couple experiences the direct marital hardship Private Life depicts, there are serious costs to and from accepting technologies that separate the “one flesh” union of husband and wife. We think those costs are high enough that evangelical couples and pastors should say no to in vitro fertilization. It’s past time to break evangelicalism’s silence about our complicity in the unethical circumstances that arise when sex and conception are divided.
Understanding In Vitro Fertilization
In Vitro Fertilization (IVF) is a process in which medical doctors create human life outside the boundaries of sexual intercourse. According to Pew, since 1996, more than 1 million babies in the United States—or 2 percent of children—have been born through some form of artificial reproductive technology.
IVF requires eggs and sperm to be harvested. For men, this often involves masturbation, but may also include surgical removal of sperm. The woman’s ovaries are hormonally stimulated to harvest multiple eggs at once. Clinicians then create an embryo by fertilizing the egg in the lab, before transferring the embryo to the woman’s uterus. (In intracytoplasmic sperm injections, which are increasingly common, doctors select a single sperm and inject it directly into the egg.) One cycle of IVF can produce multiple embryos, or only one. Even after transferrence, a woman’s body can still reject the embryo. Embryos not transferred are usually stored.
God bound sex and procreation together in creation, and what God has joined together, no evangelical should separate.
While this process seems like a safe medical treatment for infertility, moral questions abound. Questions about what happens to embryos, for instance, are paramount: The embryo is a person, and so deserves love and respect. If a couple opts to create many embryos, what happens to those who are not transferred? Is freezing them indefinitely, or giving them to research, just? Even if a couple intends to transfer every embryo they create, what happens if future events make that impossible? Some couples get pregnant naturally after undergoing IVF, or are otherwise prevented from following through on their intentions, leaving their embryos in frozen limbo.
Evangelical couples aware of such questions have increasingly opted to only create a single embryo at a time. Yet the separation of conception from sexual intercourse raises problems on its own, problems that outweigh any justification for using IVF to overcome infertility. To put our worry bluntly, God bound sex and procreation together in creation, and what God has joined together, no evangelical should separate.
Bible and IVF
For many Christians, Scripture’s silence about IVF means that the only moral question is how we treat embryos created in the process. Such an argument, though, intrinsically undermines the normativity of Genesis 1 and 2 for both sexual ethics and also bioethics—a normativity that Jesus himself ratifies in Matthew 19:4. Genesis 1:26–28 clearly indicates human fertility has been folded by God into the structure of creation and into his providential plan for the earth’s cultivation. And while Genesis 2:22–25 does not mention procreation directly, the interdependence of sex and generation is explicitly presumed. The man and woman cleave to each other and become “one flesh.” But they do so only within a context already structured by kinship bonds established by procreation: “Therefore a man shall leave his father and his mother and hold fast to his wife, and they shall become one flesh.” Sexual intercourse is inherently and intrinsically ordained by God toward procreation: A union that is “one flesh” cannot escape this reality, even if the couple chooses to deny it. To view this interdependency as simply contingent, rather than normative, radically undermines the place of Genesis 1–2 in both theological anthropology and ethics.
Such a principle is not, in this way, only founded on biology or considerations from natural law; it stands beneath the whole of how Scripture speaks about marriage, children, and God’s action in bringing about both. The biological reality of procreation simply demonstrates how special and general revelation speak with one voice. Children are a heritage and gift from the Lord: we are “fearfully and wonderfully made” by God in the womb. Such divine action happens in and through the human act that is a union of unmediated love between the potential mother and father and no one else. In this way, exclusivity within human generation corresponds to the exclusivity of marriage.
We think Scripture is unambiguous about the inextricable normative union of procreation and sex.
The normative inter-relationship of marriage, sex, and procreation stands beneath Abraham’s wrongness in turning to Hagar in attempting to bring about the fulfillment of God’s promised gift of blessing (Gen. 16). It is not sexual intercourse per se that Abraham seeks, but an heir. Abraham’s decision moves the continuation of the covenant outside of his union with Sarah, and in that way is nearer to surrogacy than to IVF. Yet in dividing what God holds together for the sake of bringing about the blessing on his own terms, Abraham enacts the same problem that besets contemporary artificial reproductive practices.
We think Scripture is unambiguous about the inextricable normative union of procreation and sex. What God has established in creation should be respected. We will elaborate on that principle by specifying four different concerns.
Four Concerns About IVF
1. IVF Severs the Unified Goods of Marriage
In the first place, the practice of separating conception from sex in order to bring about a child risks reconfiguring evangelicalism’s understanding of sex, marriage, and family. Dividing the natural and unified process of procreation into a variety of stages makes it more difficult to imagine why they were created together in the first place.
The bifurcation between sex and procreation already has deep roots in our moral imagination. Fundamentally, IVF offers and reaffirms the same divide between sex and conception that hormonal contraception made plausible, even if it does so in the reverse way: Where contraception offers sex without conception, IVF offers conception without sex. But while many evangelicals would affirm the legitimacy of contraception, the ethic that stands beneath the division between procreation and sex permits many practices they would rightfully protest. Gay marriage, fornication, contraception, and IVF all sever the natural and creational link between sexual acts and the generation of human life.
The erosion of this link helps explain why the Christian sexual ethic retains less purchase culturally with each passing generation. If sexual pleasure and conception are not held together within marriage, they will not be held together outside of it.
2. IVF Reconfigures Our Understanding of Human Life
While those who pursue in vitro fertilization are often animated by love for each other, the specific acts that bring about human life are disconnected from the loving union that ordinary conception involves.
But this point introduces new factors into our understanding of where human life comes from. In ordinary acts of procreative love, there is no question who is conceiving the child: The process of generating life is begun and completed wholly by the couple. Third parties are only involved externally: They aid and support the process, and sometimes correct it, but they cannot in any material sense claim to be an originating agent in an infant’s life.
The presence of multiple parties in conceiving life, though, introduces peculiar uncertainties and risks for the children who are born. Can we say that the married couple conceived this child, or the doctors? In cases of ordinary procreation, children might have complaints against their parents or God for how their life goes. But in cases of extracorporeal conception, such complaints might reasonably include the lab technicians materially involved in their conception. The diffusion of agents in creating human life that IVF demands risks diminishing the child’s sense that they were “knit together in their mother’s womb.”
IVF is not a medical treatment for infertility, but a way of sidestepping the appropriate use of one’s own reproductive organs and the limits of one’s own bodily life.
Moreover, IVF reconfigures how we think about the body and its reproductive capacities. IVF is not a medical treatment for infertility, but a way of sidestepping the appropriate use of one’s own reproductive organs and the limits of one’s own bodily life. Medicine is a practice ordered toward therapeutically restoring capacities to an individual’s organic human life that have been lost due to illness, disability, disease, accident, or other disabling events. As reproductive systems are incomplete without a member of the other sex, their proper fulfillment happens in sexual intercourse.
But the “medical” interventions required for IVF are crucially distinct from those that would restore or repair the reproductive systems. For instance, women do not “use” their reproductive organs in having their eggs harvested. The interventions required for IVF don’t accord with their reproductive system’s design. To see this, consider a case where IVF is pursued because of male infertility; the woman’s reproductive system is functioning properly in only generating one (presumably healthy) ovum every month. IVF artificially stimulates the woman’s ovaries to produce multiple eggs concurrently, and then subjects her to an invasive procedure to harvest them. Neither of these acts can plausibly be described as “therapeutic” or remedial for her reproductive system. Even in cases where the woman’s reproductive system is disordered, IVF does not fix the fundamental problem so much as attempt to sidestep it.
In this way, circumventing sex for the sake of conception outside the womb threatens to undermine the intelligible purposes of our bodily life. This is the force of the scene in Private Life: Aiming for children without sex changes the character of the latter, and with it the rest of our bodily life as well. IVF enshrines in the Christian moral imagination an attitude that, if applied consistently, would radically reconfigure not only our sexual ethics, but medical ethics as well.
3. IVF Tampers with Human Life and Human Dignity
The process of conceiving life in a lab establishes a principle of efficiency that intrinsically and inexorably inclines participants in the process toward weighing the value of persons based on the qualities of their lives.
In ordinary procreation, the human person emerges from a mysterious, invisible process of organic development. While we know from science what happens in the early days of conception, it is a work that remains hidden from the couple or any other human beings. Conception is an exceedingly fragile event, whether in the womb or the lab. But the doctor’s presence within the process of forming human life practically demands grading embryos for their viability, and opting to “use” those that seem to show the best “quality.” Such a tendency within the practice itself will make preimplantation genetic diagnosis almost an inevitable feature, especially as it becomes cheaper. As IVF is aimed at overcoming the inefficiencies of frustrated procreative efforts, the use of such screening measures will inevitably expand, as will the pressure on parents to employ them.
Those conceived in a lab are fully made in God’s image, but that doesn’t diminish the rupture to our theological anthropology that IVF requires.
In this way, IVF as a practice orders our imaginations toward determining what types of human beings are the most likely to or capable of living a good life. Oliver O’Donovan (among others) has spoken of the distinct logic of begetting versus making, and the importance of the former to forming human life. When humans become comfortable making other humans, we will doubtlessly begin to construct them in the image of our own preferences and desires. Those conceived in a lab are fully made in God’s image, but that doesn’t diminish the rupture to our theological anthropology that IVF requires.
4. IVF Poses Risks to Women’s Health
Finally, procreating human life is not only an immensely fragile process, but an exceedingly risky one as well. And the children created are subject to those risks. In the short term, pregnancies from artificial reproductive technologies are more likely to be subject to complications than through ordinary conception. The long-term effects of such treatments on children conceived through them are still wholly unknown. But those risks are even more pressing for women.
As mentioned above, the process of harvesting eggs is exceedingly invasive, and requires the non-therapeutic use of hormones. The long-term effects of this procedure are, as with children, disputable. But that’s partially because fertility treatments are a lucrative industry, and there’s systemic pressure to avoid closely considering such questions. As medical anthropologist Diane Tober admitted to The Washington Post, there are “no known risks [to fertility treatments] because no one has looked.”
The double burden IVF places on women should be sufficient by itself for evangelicals to say no. Every woman risks her own health in generating human life. Yet the invasive, non-medical hormonal regime required for IVF doubles this risk. In this way, IVF extends the logic of hormonal contraception—which allows men to pursue their interests by disproportionately burdening women with the task of regulating their bodies—rather than requiring men to pursue the virtue of continence.
Other considerations could be brought forward against IVF and its acceptance within evangelical communities. Such a practice increases the economic costs of generating life, which inherently limits it to upper-class households (or requires insurance or the state to fund it for low-income couples). As a practice, IVF has generated millions of embryo deaths—which raises questions about complicity in systems founded upon moral wrongs, even if an individual’s couples intentions are “pure.” And there are others.
Fundamentally, though, accepting the division between sex and conception that IVF requires undermines evangelicalism’s witness to the integrity of God’s good creation even within and under the conditions of sin. This should be reason enough to say no to in vitro fertilization.
We recognize that this is a hard word to those couples who long for children. Few desires run as deep as that one, and it can seem like a cruel burden to be denied what God seems to give so freely to other people—especially when there appear to be means available to satisfy those good desires. But as one of us has written elsewhere, our churches desperately need childless couples to help us recover the witness of lament for a tragic world, and of hope in Christ’s kingdom. The gospel is good news for childless couples, who hope in Christ—not in procreation.
Pastoral counsel from within the gospel, though, requires clearheaded thinking. Those whose hearts are broken with sorrow need direction about what they may and may not pursue. We have to consider and scrutinize the extent to which the Christian moral imagination is formed more by the world’s drive to overcome infertility than by a uniquely Christian response to the absence of children. As with all of God’s gifts, the good desire for children can become disordered. Especially if attaining children requires a process contrary to the form of generating life that Scripture lays down as normative.
The gospel is good news for childless couples, whose hope is in Christ—not in procreation.
What does this argument mean for couples who have successfully conceived through IVF? Such couples must treat and love that child in the same way as a child conceived through marital intercourse. This child bears God’s image: The wrongness of IVF is never imputed to the child. God loves the world so much that he gives good gifts even in and through our wrongdoing (Rom. 8:28). (This, however, is no justification for doing wrong—Rom. 6:1.)
What if a couple went through IVF and has a frozen embryo (or more) remaining? First, we’d urge them to see this embryo as a person awaiting future development: He or she is owed love, care, and respect. The embryo is also made in God’s image. Second, if they have no intention to transfer him or her, we’d encourage the couple to consider allowing the embryo to be given to a family through embryo adoption. Third, we’d implore them to never allow this embryo to be destroyed or used for research. Absent these options and considering the toll that would come with possible embryo degeneration, couples might consider allowing the person they created to go into the hand of God and engage in the penitent lament that marks grief at our complicity in human death.
And if a couple is infertile and considering IVF? We’d advise them to alert their pastor and community so they do not walk through infertility alone. We’d urge them to avoid IVF, but to pursue every therapeutic medical treatment that might make natural conception more probable. Most importantly, we’d exhort them to explore how their life together might bear witness to God’s kingdom by forging non-biological, parental bonds. In doing so they bear witness to a hope fundamentally fulfilled not through the birth of children, but through the advent of our Lord.
We believe, and have tried to argue, that the good news for infertile couples means saying “no” to means of generating life that are contrary to the integrity of God’s good creation. We tear apart what God has joined together only at grave peril to ourselves: By dividing sex from procreation, we reconfigure the form which God has laid down for us to understand the nature of his agency in bringing new life into the world. If a people who emphasize the gospel cannot say no to that division, we are a people unworthy of our name.