If you’re a pastor who’s never been diagnosed with infertility, you’d do well to consider the problem before the time arrives to counsel a struggling couple. It’s difficult for those on the outside to understand an infertile couple’s level of suffering. But some sense of the desperation can be gauged from the efforts many make to overcome their problem: the time and money spent, and the stress and pain of fertility treatment. The Bible itself validates this emotional pain when picturing certain insatiable natural realities:

Three things are never satisfied; four never say, “Enough”: Sheol, the barren womb, the land never satisfied with water, and the fire that never says, “Enough.” (Prov. 30:15b-16)

“Infertility” is a medical diagnosis that can be made when a couple’s been having normal unprotected intercourse for a year or more without conceiving a child. It affects around one in six couples of reproductive age. And in a church full of families it can be particularly hard to bear. Of course, it isn’t wrong to hope for children—they are a blessing from God (Ps. 127:3-5a). Yet at Christian weddings, for instance, we tend to pray for children but not the ability to be content if they aren’t forthcoming.

There may be several thoughts going through the minds of infertile couple. Fertility is described in the Bible as a blessing for the obedient (Deut. 28:4-11) and infertility as a curse from God (Deut. 28, Num. 5:11-28; Lev. 20:20-21). Some couples, then, may need reassurance that while all the sickness, suffering, and trouble of our world results from the fall, problems like infertility aren’t necessarily connected with our personal sins in a neat one-to-one correspondence. The examples of Job and the man born blind in John 9 make this point clear.

However, just as we shouldn’t conclude infertility is a particular punishment from God, nor should we conclude God is bound to bless us with fertility if we are obedient, godly Christians. Yes, the wombs of Sarah, Rebekah, Leah, Rachel, Hannah, and Elizabeth were opened, but God was accomplishing special purposes that apply to them alone. We can’t claim promises made to others in specific contexts we don’t share.

Nowhere in the Bible does God promise we’ll all have children.

Couples coming to terms with the idea they may be infertile are incredibly vulnerable. They can easily access child-promising treatment without stopping to consider what it involves. It’s vital, then, for any couple in this situation to seek careful counseling in the early stages of their discussions before deciding anything. Though it’s ethically acceptable for Christians to seek medical help to restore the natural function of childbearing, not all “standard” medical therapy will be morally acceptable to those who wish to protect life from the time of fertilization.

Permissible Options

Nonetheless, there are several morally permissible options for Christian couples facing infertility. Here are five.

1. It’s okay to pursue no further treatment. Some couples happily accept that childbearing isn’t God’s current plan for them and look to his guidance for the future. I’ve found some couples hear this word with great relief, especially given the stresses involved with fertility treatment.

2. It’s possible to wait. Even though infertility is diagnosed after a year of trying to get pregnant, only 85 percent of couples are expected to conceive in the first year. Sometimes “infertility” is really just impatience. For those considering taking things further, however, some doctors would advise they not wait longer than six months if any of the following apply: the woman is older than 35 years old; there’s a history of absent or irregular monthly periods or pelvic inflammatory disease; either partner has been treated for cancer or a serious illness such as diabetes or hypertension.

3. The couple can seek a diagnosis to determine the cause of infertility. This diagnosis can be helpful even if no further treatment is pursued—simply to know what’s going on. A cause for the infertility can be found in 80 percent of cases. Male factors account for about a third, female factors about the same number, and about 40 percent of cases are due to multiple factors. Sometimes the underlying problem can be corrected easily. It may have nothing to do with the reproductive system. Regardless, couples should continue to regard infertility as a joint problem within their marriage—rather than one partner’s problem—so that blame isn’t focused on one person. This approach helps marital unity.

4. Subsequent to diagnosis it’s increasingly common for the couple to receive a recommendation to go straight to Assisted Reproductive Therapy (ART) treatment rather than to try treating the underlying problem. At this point I’d particularly urge Christian couples to stop, pray, collect information, think carefully, and not just agree to anything that will help them achieve their desire for a baby. Ethical problems are avoided by looking ahead. In some ways, the advent of assisted reproductive therapies—in vitro fertilization (IVF), for example—has increased the anguish of infertility since these treatments can prolong the struggle for years. Moreover, pressure from other family members, such as potential grandparents, can make it even harder to choose. Someone familiar with the process needs to be involved in order to make sure decisions are based on facts. Costs are not just medical but also emotional, relational, and spiritual.

5. Couples may consider adoption at any point of their journey. It helps if they’ve come to terms with the loss of the potential for biological offspring before exploring this option. It is entirely possible to have a healthy, loving family without any genetic link. Embryo adoption is a new option to consider in this vein. And spiritual adoption—being the Christian parents someone doesn’t have—will always be available in the church.

Whichever option is taken—even with the choice to do nothing—most couples will still be “trying” in their own way. They may still wonder month to month whether this time will be the one. Help may be needed to work out how to be good stewards with regard not only to money but also to the time and energy required in the battle against infertility.

To stop trying for a baby is tough, a topic beyond the scope of this article. In many ways it’s easier if the couple can make this decision before starting treatment. How far are you prepared to go to get a baby? What are your limits? How long should life be on hold regarding certain opportunities for kingdom work? Moving on without looking back is hard, and it is sad. But when asking those who’ve been down this road before what their advice would be for others, the most common response I hear is this: “It’s okay to stop trying.” It helps to see this decision as a positive choice to get on with life rather than an issue of failed parenting, and it allows couple to grieve the loss of their dreams. God does not minimize this loss, and neither should we.