The Evolving Ethics of Infertility Treatment
For many young couples, starting a family comes completely naturally. A first child is welcomed into the world with excitement and love.
But for many couples, conception does not happen so naturally. We were one of those couples, struggling for months before seeking medical intervention. We weren't alone in our struggle; one in eight couples has trouble conceiving. One in four known pregnancies ends in miscarriage.
While everyone says that a baby is a "miracle," infertility can provide a special glimpse of just how miraculous a baby really is, how audaciously beautiful life itself is. However, infertility and its treatment can also bring many ethical quandaries.
Though we may consider ourselves pro-life, and feel that we are educated on matters of life, it is safe to say that our churches and communities are not educated about infertility and the myriad of ethical problems that treatment can bring to a desperate couple. From the growing prevalence of stem-cell research, to the recent advances in the UK toward three-person in vitro fertilization, it is clear that while in vitro fertilization becomes more normalized, the most vulnerable humans on the planet are becoming ever more commoditized.
It is more important than ever that we understand how the next generation is not just going to be raised but conceived.
Infertility for the uninitiated
For the uninitiated, infertility treatment works much like an exercise program. A couple generally starts with the "lowest intensity" and hopes to see results. This might be hormone treatments, perhaps a few minor tests to ensure that fallopian tubes are open. If a treatment does not work, a couple may opt for a more intensive, more invasive (and generally more costly) form of treatment, such as intrauterine insemination. None of these options have any moral implications, other than the possibility of side effects.
This is where my wife, Cheri, and I were four years ago after unsuccessfully trying to conceive our first child. We began with the lowest intensity treatment to see if we could get lucky. We did seem to have some luck that first month, and Cheri actually got pregnant. But she quickly lost the pregnancy. Month after month ticked by with nothing to show for our efforts, and so every so often, we would try something new.
However, when we were contemplating our treatment options, we felt there was no way we could go down the road of in vitro fertilization (IVF). We had an image in our minds of what that entailed, and we just felt that we could not do it.
Eliminating the variables
The common thread between every treatment option is that the doctor is trying to eliminate variables from the equation. There are perhaps dozens of variables that determine whether any of us get to be born: The woman must ovulate, the egg must be healthy, the fallopian tubes must be open, the sperm must be healthy and motile enough to find the egg, the egg must develop into an embryo, the uterus must be receptive, and the egg must implant itself in the uterus and grow for nine months.
What is important to understand is that treatment accomplishes nothing that does not already happen inside the body. Treatment only tries to replicate a natural process.
And so after years of trying different treatments, we came to our final option, the treatment that is the last, most intensive, most expensive choice for desperate couples: IVF.
The image we had in our minds of IVF was something akin to Aldous Huxley's dystopian classic, Brave New World. We imagined a "baby factory," where children are grown and harvested in a laboratory.
In reality, IVF does the same thing that any other infertility treatment accomplishes: It eliminates variables. Eggs are extracted from the woman and sperm from the man. A number of eggs, according to the couple's wishes, are fertilized and allowed to grow in a lab, typically for five days. At the end of that time, those that survive are released back into the woman, where it is up to them to find the uterus. Meanwhile, the woman has been taking a very specific protocol of hormones to make sure she is ready for pregnancy.
Some Christians may object to IVF because it sounds like we are "playing God," as we had assumed at first as well. In reality, even after the whole process, there are still no guarantees of a baby. There is nothing a doctor can do to force fertilization or implantation to happen. When we considered IVF, our doctor did not sell it like a used car dealer. She told us the truth. And to our surprise, we found ourselves excited about the prospect.
But here is where things become problematic.
In nature, as in the lab, there is about a one-in-five chance of any of us being born. What this means is that each of us had about a 20 percent chance of making it past all the hurdles, all of the variables, on the way to our birth. It humbled, conflicted, and inspired awe in us to contemplate that this is how God has allowed things to be. For each of us on Earth, there are up to four people who never got to be born.
These are the same odds that a couple is given when they approach IVF, and so the logical person concludes that if we desire one baby, then we need to start with five eggs…
At least, that is what you would think.
While some couples face a shortage of eggs, other couples, like us, had eggs to spare. We were able to get 25 eggs from Cheri in a single extraction—a mega-haul. The embryologist who was working with us told us that most couples start with 10 or 12 eggs.
This is the problem of IVF. We concluded that we were ethically free to pursue this treatment. But of the treatments available, it was the most morally perilous. We saw many couples, couples who considered themselves life-affirming Christians, who suddenly seemed to contradict themselves. While there is a difference between creating life with the intention that it survive, which defines IVF, and the intention that it not survive, as in stem-cell research, surely our moral freedom is undermined as we pursue our desire for children at all costs.
What to do with all the leftovers?
What is a couple to do with the "leftovers" they may well have when they start with 12 embryos?
If a couple does not consider a five-day-old embryo to be life, then IVF is not really such a moral dilemma. But if a Christian couple wants to be consistent in their ethics of life, things get very difficult, very quickly.
First, couples need to be educated on what happens to the embryos in those first few days of life. While some doctors only monitor the embryos for healthy growth, others may discard those they deem to be less than "optimal."
Second, couples need to think seriously about what will they do with their leftover children if she becomes pregnant on the first attempt. We wound up with two healthy embryos. They both spent a few months in the deep-freeze, as Cheri had unexpected complications that prevented us from implanting right away. (Interestingly, the freeze-thaw process has a negligible effect on the viability of embryos.) One embryo was implanted, the other stayed in the freezer, where it remains to this day, technically only five days old, though conceived over 18 months ago.
We are still committed to giving our other little baby a chance at life when we are able. Last year, we paid a couple hundred dollars to the lab to keep it there. But this is where the IVF industry reveals just how morally compromised we are. There are so many leftover embryos that you can now adopt an embryo.
It is clear that many couples, vulnerable in their desperation, are making choices that they might not otherwise make, choices which do not affirm the sanctity of life. We are making far too much life, more than we can possibly commit to. There is an army of babies, trapped in the limbo of perpetual winter, while their siblings get to go to school and have birthday parties.
Supporting couples in their journey
That is the quandary of IVF—and all infertility treatment. There are ways to affirm life while we seek to bring children into our homes. But it is so easy to compromise our beliefs about life in the process. If we are going to be truly consistent in advocating for life, then we must be able to advocate for life when it is just a little blob of cells in a dish.
We must support struggling couples with prayer and wisdom, to help them make godly, life-affirming choices.
Matt and Cheri Appling are the authors of Plus or Minus: Keeping Your Life, Faith and Love Together Through Infertility, released by Moody Publishers. Find the book on Amazon and other online retailers or Matt's blog.