In Vitro Fertilization
Written by L. W. Bilkes
|Reformed Ethics - Pregnancy/Reproduction|
A Sensitive Topic
Recent decades have seen rapid developments and increasing use of ‘In Vitro Fertilization’ (IVF), a reproductive technology. It has become a standard option in our society for couples struggling with infertility, as well as other situations. Many Christians have been quick to embrace in vitro fertilization as a legitimate way for infertile couples to have children, without questioning the ethics of it. However, as ethicist Nigel Cameron has said: “I think evangelicals ... haven’t thought about these things very much at all.” He adds: “If you don’t think about something, you tend to end up doing it.” The desire to become parents is tremendous, and it is natural and moral. The church should have more of a sympathizing ministry of prayer, counsel, support and love for married couples who bear the very heavy burden of infertility. The end never justifies the means, but both the means and the end must be right. We must be careful that powerful emotions and good and natural desires do not justify means or ends that the Bible prohibits.
‘In vitro’ literally means “in glass,” for the actual fertilization of the egg takes place in a laboratory context, rather than in the woman’s reproductive system. IVF involves the removal of an egg from a woman, its fertilization in a laboratory setting by the insertion of sperm cells into the dish. Once the egg is fertilized and the exchange of chromosomal material takes place, the embryo is implanted in the uterus, with the hope that implantation will occur and the ensuing pregnancy will produce a healthy child.
IVF technologies were developed as a means of assisting married couples who were unable to achieve successful pregnancy through natural means. In Vitro Fertilization and Embryo Transfer (IVF-ET) have become widely accepted as treatments for women with excessive, irreparable damage to their fallopian tubes. It is also used in cases of an inability to ovulate (oligospermia), a failure to conceive due to abnormal genes or an unidentified inability to conceive. The technologies are also available to people who are not biblically married.1
Due to the high cost of each implantation and the IVF sequence, multiple eggs are usually fertilized and sometimes multiple embryos are implanted, or remaining embryos are kept frozen for possible future use. This practice often leads to multiple pregnancies, and in some cases healthy implanted embryos are removed from the womb and destroyed-a process known as “selective reduction,”2 an inhumane procedure. The practice of IVF is not free of physical, mental, and emotional risks. Edwin Hui notes:
[I]t can be physically painful and emotionally disconcerting. Particular concerns have been raised with regard to the use of hormones to hyperstimulate the ovaries. The painful memory of those mothers using DES (diethylstilbestrol) who gave birth to female offspring susceptible to infertility and cancer should continue to serve as a warning against the frequent employment of hormones in high dosages. The long-term effects of the drugs used in the IVF-ET procedure are still unclear, and some researchers are concerned that women who have taken these drugs may become more susceptible to ovarian cancers and other neurological damages. Furthermore, couples employing ET have also experienced unexpected emotional problems. These practices and technologies raise very important questions, for which we must turn to Scripture for an answer.3
The Bond of Marriage
There is no doubt that IVF technology raises the issue of the meaning of parenthood and the conjugal bond. IVF clearly brings a significant measure of artificiality into the process of human conception. The separation of sexual intercourse from the process of conception creates a new and artificial process into human reproduction – one that demands technological intervention at virtually every stage, from the collection of the sperm and eggs, to the actual fertilization, to the implantation of the embryo in the uterus. We cannot pass over this fact.
The new technologies of IVF underline the extent to which the modern mind has reduced human reproduction to a technology rather than a divine gift, mystery, and stewardship. The biblical language reminds us that we are “begotten,” and not merely made.4 Scripture clearly shows and teaches that children are not the products of a technological process, but the gifts of the Creator, the loving and merciful God whose intention it is that children should be born to a man and a woman united in the bond of marriage, and the fruit of that marital bond realized in the conjugal act.5 Indeed, they are neither by-products of this act, but neither are they mere “products” of our technological innovations.
While we sympathize with couples unable to achieve conception by means within natural limits, we cannot help but stumble over the discrepancy that Scripture calls for the intrinsic relatedness of parenthood to the conjugal bond, and the act of marital intercourse as the design of a loving and merciful Creator, who has imposed limits for our good. It could be countered, that there are many technological innovations that the Bible does not explicitly anticipate. We use many or most of these without blinking an eye, especially in diagnosing and seeking to fight diseases. What is different about IVF, however, is that one’s very personhood, the very constitution of his person is, as it were, engineered, as opposed to “begotten,” as was mentioned.6
Human Dignity and Destruction
There is another formidable moral obstacle. As mentioned, the usual practice in IVF calls for the fertilization of numerous embryos, which are then frozen until needed for implantation in the womb. These embryos – fully human in chromosomal development – are treated as human “seedlings.” These embryos are denied human dignity and are reduced to a frozen existence, awaiting either implantation, indefinite storage, or wilful destruction. We cannot but grieve, when we hear that in recent years thousands of human embryos have been destroyed, as they were no longer needed or wanted for implantation.7
The embryos “produced” by IVF technologies face danger in the womb, as well as in the laboratory. There is the casual disrespect in which the embryo is held by so many who are ready and willing to destroy innocent life in the name of life-giving technology. A society that will destroy human life and discard unwanted frozen embryos has lost the vital sense of human dignity, which is foundational to a civilized society.
With a Christian world and life commitment that is based on a biblical understanding of the integrity of the marital bond, the integrity of the family, and the sanctity of human life –from the moment of chromosomal exchange to the moment of natural death – we cannot agree that all this has little to do with how children are conceived.
The intense pain of a married couple unable to achieve conception can be very great. Christian couples, however, must not embrace the new reproductive technologies without clear biblical and theological reflection. As I have sought to argue, I believe IVF is too fraught with ethical dilemmas to warrant consideration. As one doctor I consulted suggested: “IVF is not viable as a technology without the numerous immoral situations it aids.”8
The bare minimum that can be expected from a Christian couple is to be committed to the life of all their children, and consequently have this same commitment to the implantation of all the embryos, as well as the selective reduction of none.9 But this does not alter the fundamentally artificial character of the technology or the moral status of the embryos. Therefore IVF presents grave moral issues and concerns to the Christian conscience. For these reasons, I cannot encourage it. Adoption, on the other hand, has clear biblical precedence and sanction, though this should not be entered into without much prayer and the recognition of what is all involved. We must affirm our creaturely limits and trust our gracious Creator as the Lord of life, who imposed those limits for our good. And we must learn to count the costs before those limitations are denied.10
Dr. L.W. Bilkes is an emeritus pastor in the Free Reformed Church. This article was previously printed in the FRC Messenger and has been republished here with permission.
1 It goes without saying that the use of IVF that would necessitate bringing in a third party, which sadly is becoming more prevalent, is unethical. This applies to both a third party that would provide genetic material, and or surrogacy.
2 Christianity Today, “U.K.’s Solution to Multiple Problems: One at a Time. Britain may tighten IVF laws to prevent multiple pregnancies.” Tabby Yang, posted 4/12/2007: “New legislation proposed in the U.K. will introduce tighter regulations for in vitro fertilization (IVF) procedures....” If passed, the legislation “will prohibit doctors from implanting more than one embryo at a time in women under 40.” Doctors usually transfer multiple “blastocysts”— embryos made up of 80 to 100 cells—at a time to a patient’s uterus. The Human Fertility and Embryology Authority (HFEA), which regulates U.K. fertility clinics, allows doctors to implant two embryos in women under 40 and three in women over 40. Transferring more than one embryo increases the likelihood of a pregnancy, but it also increases the likelihood of multiple pregnancies. For mothers carrying more than one fetus presents an amplified risk of lifethreatening conditions such as diabetes and heart attacks. It also presents risks to the fetuses, who are more likely than single babies to be stillborn, to die in the first week of life, to be disabled, or to be born prematurely, according to Nigel Cameron, director of the Center on Nanotechnology and Society at the Illinois Institute of Technology and president of the Institute on Biotechnology and the Human Future. While the legislation is beneficial in the sense that the proposed law would decrease health risks for mothers, limiting the number of embryos implanted does have its drawbacks. “The downside of this legislation is that it may preclude a small number of women and their spouses from having children, as it may require more attempts in successive cycles and time may run out before they are successful,” said Hessel Bouma III, biomedical ethics expert and biology professor at Calvin College. According to Stevens, although the legislation is likely to pass in the U.K., it is unlikely that a similar measure would be introduced and passed in the U.S. anytime soon. “Our country has this unspoken right to reproduction,” he said. “[Most people believe] no one should tell you anything about having your children.” Ultimately, Stevens says, this is not a helpful presupposition, as it has prevented the reproductive health industry from governmental regulation.
3 Edwin C. Hui, At the Beginning of Life: Dilemmas in Theological Bioethics, 198.
4 Cf. Oliver O’Donovan, Begotten or Made? (Oxford: Clarendon Press, 1986).
5 This connection is made very explicit from the very first conception onward (Gen. 4:1; see also Gen 4:17; Ruth 4:13; 2 Sam 12:24).
6 To be sure, the babies and growing children of couples who conceived and bore children through IVF technologies – are to be welcomed and loved. The moral status of a child born through IVF technology is not in question. Yet, from a biblical perspective we must consider both means as well as ends in a moral and theological frame.
7 The legal status of the embryos has been the subject of legal actions and judicial determination. In the case of a divorce, who “owns” the embryos? When a genetic “parent” dies, who inherits the embryos?
8 I’m indebted for this observation to Dr. Greg Kenyon, family physician and member of the Free Reformed Church of Mitchell, Ontario.
9 The effects of multiple births on both women and children are considerable however, including, higher rates of Caesarean sections, low birth weight, higher mortality rates (13 times that of single births), higher risks for later lung and heart problems, higher risk for mental retardation or learning disabilities. This, too, raises the question of whether these risks do not point away from IVF being a real option.
10 Edwin C. Hui, At the Beginning of Life: Dilemmas in Theological Bioethics, 198, 199: “With the advent of ARTs, many are rightly concerned that some scientists and physicians – backed by profit-seeking corporations and operating under the guise of meeting the desires of desperate infertile couples purely out of a pure altruistic humanitarianism– are in fact engaged in the activity of changing and controlling procreation and, with it, the very nature of human lives.”
“Through the donation of gametes and the use of gestational surrogates, essentially anyone’s egg can be combined with anyone’s sperm and placed in an unrelated uterus to produce a child to be parented by yet someone else, fragmenting parenthood into genetic, gestational and social parts. What ART scientists seem to celebrate most is the fact that ‘the process is wholly independent of each of its contributors,’ the sobering result being that procreation is now in the hands of scientists, doctors and technicians rather than in the hands of the married couple.”
“This directly challenges the ethic of personhood” – proposed by Edwin C. Hui – “which stressed that human personhood is not only characterized by relations, but ultimately constituted by relations. Specifically in terms of the procreation of life, God is the Creator and parents are the only legitimate ‘procreators,’ through whom God gives the gift of life. Scientists, physicians, single people and same-sex couples who engage in IVF-ET are counterfeit ‘procreators.’ In the name of the progress of science and medicine on the one hand, and in the name of the rights of freedom and autonomy on the other, medical and scientific professionals and their clients/ consumers, respectively, are threatening to strip the onto-relational foundation from human personhood on the very first day of life’s conception. I believe that by disrupting the foundation of the relational structure of human personhood, all the human persons involved in the process will be worse off as persons – will be depersonalized – in the process, some more directly and perhaps more visibly (e.g., the infant, the parent or the surrogate) and some indirectly and only opaquely (e.g., the physicians and the scientists). To the extent that modernity has allowed science to replace God and modern people are left all the more disoriented, modern anthropology has allowed scientific technological reproduction to replace divine-initiated human procreation. Modern persons are left all the more depersonalized.”