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How IVF Can Be Morally Right

Editors’ note: 

As a part of our ongoing series featuring multiple views, see also “Breaking Evangelicalism Silence on IVF,” by Matthew Lee Anderson and Andrew Walker. This article is adapted from Christian Ethics: An Introduction to Biblical Moral Reasoning (Crossway, 2018), chapter 30.

In vitro fertilization (abbreviated IVF) is the process of joining a woman’s egg (ovum) and a husband’s sperm in a lab rather than inside a woman’s body. (The Latin phrase in vitro means “in glass.”) When the egg is fertilized by the sperm, the result is a living embryo, which is then implanted in the woman’s womb so that it can develop like any other baby.

Evangelical Christians differ on the moral acceptability of this procedure, and some respected evangelical writers argue that IVF is always morally unacceptable.

My own position is that, in principle, the teachings of Scripture present no moral objection to a married couple using IVF (as long as no human embryos are destroyed in the process), because it is simply enabling an infertile husband and wife to overcome their infertility and thereby experience the blessing of having children.

(I won’t address the morality of several related issues such as adoption, surrogate motherhood, embryo adoption, and the possibility of human cloning, but I’ve discussed them at length elsewhere.)

1. Overcoming Infertility Is Pleasing to God

Infertility has been a source of deep sorrow for both men and women—but especially for women, for all of human history, as we see from some of the early chapters of the Bible. Sarah (Sarai) was unable to bear children to Abraham (Gen. 11:30; 16:1) for most of her life, until she miraculously bore Isaac in her old age (see Gen. 21:1–7). Jacob’s wife, Rachel, was unable to bear children for a long time after her marriage to Jacob (Gen. 29:31), as was Samson’s mother, the wife of Manoah (Judg. 13:2). Hannah, the mother of Samuel, cried out to the Lord in deep sorrow because of her infertility (1 Sam. 1:2–18). In the New Testament, Zechariah and Elizabeth “had no child, because Elizabeth was barren, and both were advanced in years” (Luke 1:7), but, again through God’s miraculous intervention, Elizabeth eventually gave birth to John the Baptist (vv. 57–66). These narrative examples portray overcoming infertility as something that pleases God, and it is often a manifestation of his special blessing on a couple.

Other passages show God’s great blessing when “he gives the barren woman a home, making her the joyous mother of children. Praise the LORD!” (Ps. 113:9; see also Ex. 23:26; Deut. 7:14; Isa. 54:1; Gal. 4:27). And God in his wisdom shows compassion for the deep grief of childlessness in several passages, such as the stories of Rachel (Gen. 30:1) and Hannah (1 Sam. 1:5–10). These passages are entirely consistent with the frequent theme in Scripture that children are a great blessing from God: “Behold, children are a heritage from the LORD, the fruit of the womb a reward” (Ps. 127:3; see also Gen. 1:28; Ps. 128:3–4; Mal. 2:15; 1 Tim 5:14; see also Christian Ethics, 747).

My own position is that, in principle, the teachings of Scripture present no moral objection to a married couple using IVF, as long as no human embryos are destroyed in the process.

Given the force of these biblical passages, it is right to consider infertility as something that, in general, we should seek to overcome with the confidence that God is pleased with such efforts. Infertility shouldn’t be something about which we’re indifferent, such as the color of our hair or eyes, but rather something we see as yet another result of the fall, one of the disabilities and diseases that entered the human race after Adam and Eve sinned. Infertility was not part of God’s good creation as he originally made it or intended it to function.

2. Modern Medicine in General Is a Divine Blessing That’s Morally Good

Modern medicine (and medicine in the ancient world, for that matter) can be used to overcome many diseases and disabilities today. We should view this as a good thing, and as something for which we can thank God.

God put resources in the earth for us to discover and develop, including resources useful for medicinal purposes, and he gave us the wisdom and the desire to do this. The warrant is found in God’s command to Adam and Eve to “subdue” the earth (Gen. 1:28), and it is reinforced by the fact that all of the medicines we have today are made from resources found in the earth, and “the earth is the LORD’s and the fullness thereof, the world and those who dwell therein” (Ps. 24:1).

Jesus was not neutral regarding the blessings of restoring health to people. His ministry of healing indicated that God is pleased when we try to help people overcome diseases and disabilities:

Now when the sun was setting, all those who had any who were sick with various diseases brought them to him, and he laid his hands on every one of them and healed them. (Luke 4:40)

This was a common pattern in Jesus’s earthly ministry, and the inclusive nature of the expression “all those who had any who were sick with various diseases” allows us to suppose that Jesus also healed the infertility of many women (and men) who’d previously been unable to conceive and bear children.

Consistent with Jesus’s example, James encouraged Christians to pray for healing (see James 5:14–16). This New Testament pattern makes me think we should also view modern medical advances positively. It is generally morally right to support and welcome advances in medicine that can bring health to people with various diseases and disabilities, including infertility.

3. We Should Treat an Unborn Child as a Human Person from the Moment of Conception

Various passages lead us to consider the unborn child as a human person from the moment of conception. Reflecting on the beginning of his existence, David mentioned his sinfulness even at the moment of his conception: “I was brought forth in iniquity, and in sin did my mother conceive me” (Ps. 51:5; David is speaking about his own sin, not his mother’s). In addition, David said to God, “You knitted me together in my mother’s womb” (39:13). In the old covenant, if an unborn child died—even because of an accidental injury—the one who caused the unborn child’s death was subject to capital punishment (see Ex. 21:22–25: “You shall pay life for life”). Jacob and Esau were viewed as two unique children who would become two nations struggling within Rebekah’s womb (Gen. 25:22–23). And Elizabeth, in the sixth month of her pregnancy, said, “The baby in my womb leaped for joy”—surely a human action (Luke 1:44). (See Christian Ethics, 566–86, for further discussion of these passages.)

These passages are relevant for the question of IVF, because they mean we shouldn’t condone any medical procedure that will certainly lead to the death of even one unborn child who was conceived when the man’s sperm fertilized the woman’s egg, the cells began to divide, and the human embryo began to grow into a little baby.

4. Children Should Only Be Conceived by and Born to a Married Man and Woman

I affirm this fourth point not because it is based on a direct command of Scripture, but because of a pattern of biblical narratives and probable implications from biblical moral commands about related topics.

Today, many ethical questions related to modern technology and reproduction have to do with the medical possibility of a woman becoming pregnant and bearing a child even when the child’s biological father is not that woman’s husband. But the entire scope of the biblical narratives and moral standards views this situation as contrary to God’s intended plan for the birth of a child.

At the beginning of creation God said to Adam and Eve (who were husband and wife), “Be fruitful and multiply and fill the earth” (Gen. 1:28). This verse by itself does not say that no other means of producing children would be pleasing to God, but it is the foundational pattern for marriage in the entire Bible, and it is the first instance of the command to be fruitful. (Scripture calls Adam and Eve “the man and his wife” in Gen. 2:25, and uses the relationship between Adam and Eve as the pattern for marriage generally in v. 24.)

God’s repeated commands against adultery (Ex. 20:14; Lev. 20:10; Deut. 5:18; Prov. 6:32; Matt. 15:19; Rom. 13:9; James 2:11; 2 Pet. 2:14) also support this idea. One reason sexual intercourse should occur only within the context of marriage is it guarantees that children will only be born to a man and a woman who are married to each other.

A child should only be conceived by and born to a man and a woman who are married to each other, and in no other situation or relationship.

Another piece of evidence supporting this conclusion is found in the detailed laws in Exodus:

If a man seduces a virgin who is not betrothed and lies with her, he shall give the bride-price for her and make her his wife. (Ex. 22:16; the rare exception is seen in v. 17, but the general principle is that marriage should occur; see also Deut. 22:28–29)

Here again, the specific provision of the law guaranteed that if a man and a woman had sexual intercourse, they would be married—again guaranteeing that a child would be born in the context of a married man and woman.

The prohibitions against “sexual immorality” (in older translations “fornication” [Greek porneia]) also seek to ensure that sexual intercourse occurs only within the context of marriage. This would guarantee that children would be conceived only within the context of marriage (see 1 Cor. 6:18; 2 Cor. 12:21; Gal. 5:19; Eph. 5:3; Col. 3:5; 1 Thess. 4:3). Finally, there’s no indication anywhere in Scripture that God ever considered it morally right for a child to be conceived by a man and a woman who weren’t married to each other.

This broad pattern of scriptural teaching, then, leads me to conclude that a child should only be conceived by and born to a man and a woman who are married to each other, and in no other situation or relationship (Christian Ethics, 775–77).

Therefore IVF Is a Morally Good Action in Some Circumstances

The previous four points lead me to conclude that, if IVF is used by a married couple, and if care is taken to prevent the intentional destruction of embryos, then it is a morally good action that pleases God because it violates no scriptural guidelines, achieves the moral good of overcoming infertility, and brings the blessing of children to yet another family. “He gives the barren woman a home, making her the joyous mother of children. Praise the LORD!” (Ps. 113:9).

However, this does not mean that couples have an obligation to try IVF, only that it is a morally acceptable thing to do. Many couples may reason that the process is too expensive. On average, the cost of a basic IVF cycle in the United States ranges from about $12,000 to $15,000. (Another less-complicated process, called “Mini-IVF,” is approximately $5,000 to $7,000.)

Others may reason that the likelihood of success is so slim that they don’t want to embark on such a difficult process. Or a couple may decide the pregnancy would carry increased risks for the mother’s health that are too significant for them to think they should try IVF.

In such cases also, the medical possibility and the moral acceptability of trying IVF don’t mean there’s any obligation to use this procedure if they don’t want to.

Objections

Several objections may be raised against this conclusion, but I do not find them persuasive. Here are some of the most common.

1. “This is not a natural process.”

Someone may object that this isn’t the “natural” process of conception through sexual intercourse that God intended. But such an argument must assume a definition of “natural” that arbitrarily excludes modern medical means from what we consider part of nature. Is not the laboratory equipment used for IVF also made from resources God planted in the earth? Are not the medical researchers and medical technicians, with all their wisdom and skill, part of God’s creation also?

To cite another analogy, consider a woman who uses a modern thermometer to take her body temperature each day in order to determine the best time to have intercourse so that she’ll be able to conceive. Is this an “unnatural” process because she uses a modern medical thermometer in order to know when she’s ovulating? Surely not. The thermometer is made from part of the natural world that God created. Similarly, consider a husband who uses Viagra or a similar modern medicine to overcome erectile dysfunction so that he and his wife can have intercourse and conceive. Is that process to be rejected as “unnatural” because he’s using modern medicine to overcome his medical problem? Surely not. The Viagra is made from materials God placed in the natural world, and so it’s also part of nature considered in a broad sense.

When IVF is carried out in a way that destroys multiple human embryos, it is morally wrong, because it results in the wrongful destruction of human life.

Or consider the medical process known as “artificial insemination by husband” (or AIH). This process also uses some modern medical developments but does not violate any of the biblical principles named above. It simply enables a wife to become pregnant by her husband’s sperm when, for some reason, it is physically unlikely or impossible for this to happen through ordinary sexual intercourse. The husband’s sperm is first collected and then injected into the wife’s cervix or uterus using a needleless syringe or other medical device. The child is conceived by and born to a man and a woman who are married to each other. No unborn human person (or embryo) is destroyed in the process. And the wonderful result in many cases is that infertility is overcome for this couple.

Therefore, there seems to be no valid reason to reject IVF on the ground that it is not part of the natural process that God established for the conception of children. The essential considerations in this issue are all satisfied: (1) modern medicine is used to overcome a disability, (2) no unborn children’s lives are destroyed, and (3) the child is conceived by and born to a man and a woman who are married to each other.

2. “This wrongly separates sex from the conception of a child.”

Another objection might be that God designed the conception of children to be connected with sexual intercourse between a husband and wife, but IVF separates sex from conception.

My response is that IVF did not separate sex from conception because, for this couple, there was no connection between sex and conception. They were unable to conceive. It was the infertility that separated sex from conception—and IVF is overcoming that infertility. For many infertile couples, they have perfectly normal and happy sex lives, but due to some medical reason, they’ve been unable to have children. There is no biblical command that says “conception must only be the result of sexual intercourse,” but there is abundant biblical testimony that clearly teaches the blessing of children, the blessing of overcoming infertility, and the blessing of using God-given wisdom and resources to develop medical solutions to disease and disability.

Yes, someone may argue against IVF by saying that “it wasn’t done that way in the Bible.” But in the absence of clear moral teachings on the topic, it is precarious to rule out modern inventions simply because they didn’t exist in biblical times—otherwise we wouldn’t use automobiles or cell phones or even eyeglasses or the printing press.

3. “Many embryos are destroyed.”

To increase the probability of pregnancy, IVF is often done in such a way that many (or at least several) of the woman’s eggs are fertilized, many embryos are created, and only those that appear “healthiest” are saved and implanted in the woman’s womb—with the rest being either frozen or discarded (Georgia Reproductive Services; The Mayo Clinic).

I must be clear that when IVF is carried out in a way that destroys multiple human embryos, it is morally wrong because it results in the wrongful destruction of human life.

And yet this objection doesn’t rule out all IVF procedures, because the fertilization of multiple eggs is not necessary. Technological development of IVF has reached the point where, if the couple wishes to fertilize only one egg or two and then have both implanted in the mother’s womb, that can be done. In fact, one 2012 British study found that women should never have more than two eggs implanted. “Previous research—before more modern techniques for IVF—still showed that implanting three [embryos] increased the likelihood of successful live birth rate, compared with the transfer of two or one,” said the lead researcher, Debbie Lawlor of the University of Bristol. “Our research shows this is no longer the case.” In such cases, where no embryos are destroyed, I think IVF is morally acceptable.

In fact, a Swedish study found that a woman with just one embryo implanted in her womb had nearly as great a chance of getting pregnant as a woman who had two or more embryos implanted. Transferring only one embryo also reduced the chances of twins being born with low birth weight and accompanying complications.

For married couples struggling with infertility, IVF may be seen as a morally good choice, a choice that brings the blessing of children to their families.

John Feinberg and Paul Feinberg disagree with my position here and argue that IVF is morally unacceptable, even when only one egg is fertilized, because the success rate is so low in such cases. They write:

We believe the embryo is human and a person from conception onward. . . . Our views on the embryo’s status lead to our greatest moral objection to IVF, namely, its waste and loss of embryonic life. . . . If the success rate of IVF had risen to 95 percent or even 80 to 85 percent, we would be more sympathetic to it, but . . . IVF technology is currently nowhere near such success rates. We find the loss of so much human life morally unacceptable. . . . Success rates [are] at best only about 17 percent when one embryo is used. . . . Too many human lives are lost to think this is morally acceptable.

I have much respect for the Feinbergs’ book, which I used as my primary textbook for teaching Christian ethics for many years. I agree with their conclusions far more often than I disagree. I find their objection at this point to be significant, and I take it seriously, but in the end I’m not persuaded by it.

My response is that fertilizing only one egg or two at a time, and implanting these with the hope that they will survive, is far different from the common practice of IVF, where several eggs are fertilized and then most are intentionally destroyed. In that case, there is a willful, intentional destruction of human lives.

But with the fertilization of only one or two eggs at a time, the intent of the doctor and the husband and wife is that all the fertilized eggs will live and come to normal birth. Therefore, I still think IVF without the destruction of embryos is morally acceptable.

And the success rate for IVF continues to improve. According to the Society of Assisted Reproductive Technologies (SART) in 2014, the live birth rate per IVF cycle with their own eggs is 54.4 percent among women younger than 35; 42 percent for those aged 35 to 37; and 26.6 percent for those aged 38 to 40. The success rate drops to 13.3 percent in those older than 40, and success in women older than 44 is rare, approximately 3.9 percent.

Conclusion

My conclusion is that, for married couples struggling with infertility, IVF may be seen as a morally good choice, a choice that brings the blessing of children to their families.

“Behold, children are a heritage from the LORD, the fruit of the womb a reward” (Ps. 127:3).

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