The ethics of IVF

Infertility can be devastating for couples who desire to have children. But medical technology now enables some of these to have their own children.

I have been asked about what should be the Christian attitude towards in-vitro fertilization (IVF)? The world’s first baby to be conceived by IVF was born in July 1978. In 2012, about 3.5% of all children born in Australia were conceived as a result of IVF treatment. And many Christians consider IVF an acceptable means to overcome infertility.

In this blogpost we look at IVF which uses the gametes of a husband and wife, and not the use of eggs or sperm that are donated by a third party. So only the sperm and egg of the married couple themselves are being considered and not surrogacy.

IVF procedure

The process of IVF consists of taking a woman’s eggs (ova) and a man’s sperm, fertilizing them outside the body, and then implanting them back into the woman’s womb with the goal of pregnancy and childbirth. It generally involves the following stages.

Pituitary suppression – The mother’s natural menstrual cycle is switched off with drugs.
Ovarian stimulation – fertility drugs are taken to stimulate the ovaries to produce several mature eggs, instead of just one.
Egg collection – Under a general or local anaesthetic, fluid is removed from the mother’s follicles, which contain eggs. The average number of eggs collected is 8-15. This number is required because of the attrition that occurs during the IVF cycle.
Sperm collection – Sperm is obtained from the father. And the best sperm are selected.
Fertilization – After the eggs are removed from the ovarian fluid, they are placed in a dish with the sperm and allowed to fertilize. Approximately 60-70% of the eggs will fertilize. If the sperm fertilizes an egg, it becomes an embryo, which is grown in a special incubator.
Embryo transfer – After 5-6 days, the embryos are in the blastocyst stage, when the embryo is transferred to the mother’s uterus. The healthiest one or two embryos are chosen for transfer. In Australia single embryo transfer is usually recommended unless the mother is over 40 years old, if the embryos available are of suboptimal quality or if there have been several previous unsuccessful IVF attempts.
Pregnancy – If an embryo successfully implants, the mother becomes pregnant.

Some differences between IVF and natural fertilization are:
– the mother experiences large dosages of hormones and invasive medical procedures.
– several eggs are fertilized at once instead of one at a time.
– the fertilization is occurring in the laboratory (outside the body) instead of inside the uterus.
– the sperm and eggs that fertilize have been selected artificially instead of naturally. Natural conception is a complicated process that is not fully understood and so can’t be replicated in the laboratory.

What happens to surplus embryos?

IVF generally produces more embryos than those that are transferred to the mother. But what happens to these excess embryos? Poor quality embryos are usually discarded, while healthy (good quality) embryos not transferred are usually frozen and stored. What happens to these frozen embryos?
– They may be used in subsequent IVF cycles.
– They may be used in medical research and then discarded.
– They may be discarded after pregnancy and childbirth is achieved.
– They may be stored indefinitely and even completely forgotten about.
– They may be donated to couples seeking children. But donating embryos does not ensure they will survive.
– They may be implanted at a time where pregnancy is very unlikely. This is actually a means of discarding embryos.

If several embryos are made for every woman who undergoes IVF, and about half of the embryos are discarded (or frozen) during or after the process, then millions of embryos have been discarded (or frozen) over the past 40 years.

When does human life begin?

There have been many suggestions as to when life begins including:
– The moment of fertilization when 23 chromosomes from each parent are combined to comprise the genetic makeup of a new and unique individual, known as a zygote. The zygote begins as a single cell which can subdivide by mitosis.
– About six days after fertilization, when the zygote (known as a blastocyst) is implanted in the uterine wall. The blastocyst is comprised of about 200-300 cells.
– About 14 days after fertilization, when occasionally the embryo can split to produce identical (or Siamese) twins. Twelve countries restrict in vitro research on human embryos to within 14 days of fertilization. Now that the culturing of human embryos in vitro beyond 14 days seems feasible, there is pressure to relax this restriction.
– About 20 weeks after fertilization, when the thalamus (a central part of the brain that plays a role in consciousness) is formed.
– When the fetus can exist outside the mother’s womb, which with current medical technology is about 24 weeks after fertilization.
– About 26 weeks after fertilization, when brain and neural pathways are developed enough to enable mental activity.
– At birth when breathing commences.

After fertilization, an embryo usually grows within the mother’s uterus until its birth. The unborn baby is alive before it’s born as its movements can be felt by the mother and monitored by ultrasound (Lk. 1:41-44). The characteristics of life include: sustenance, growth, responsiveness and reproduction. The smallest unit of life is a single cell that has these attributes. An organism is alive when it is comprised of living cells.

As functional genetic information and cell division are characteristics of a living cell, I think that a human embryo is alive from the time of its conception (fertilization).  An embryo has a distinct human genetic code and exhibits metabolism, development, the ability to react to stimuli, and cell reproduction. And if the baby’s life is not interrupted, the embryo will someday become an adult man or woman.

As an unborn baby undergoes continual development with time, we can trace backwards in time to when life begins. But where do we stop in the list of suggestions given above? The most logical beginning of life seems to be the moment of fertilization when a new genetic organism is formed from the male and female gametes. The other suggestions are steps in the development of the fetus, with no one being more important than the other – they are all equally important. Only fertilization is unique because it’s the beginning of the sequence.

The Bible refers to the unborn as an actual person by using personal pronouns (Ps. 139:13-16). This indicates that God considers the unborn to be a person. Some contest this by saving that the passage is poetic. Here’s another passage that is more definitive:
“If people are fighting and hit a pregnant woman and she gives birth prematurely but there is no serious injury, the offender must be fined whatever the woman’s husband demands and the court allows. But if there is serious injury, you are to take life for life, eye for eye, tooth for tooth, hand for hand, foot for foot, burn for burn, wound for wound, bruise for bruise” (Ex. 21:22-15NIV).

The context of this passage is Israelite laws for dealing with personal injuries. It is interesting that a pregnant woman is described in the Hebrew language as being “with child” (harah, Strongs #2030). So an unborn fetus is described as a “child”. In the first case there is a fine when a child is born prematurely because a pregnant woman was accidently injured. According to the Brown-Briggs-Driver lexicon, it was an “untimely birth”. But in the second case, injury to either the child or the mother incurs a more severe punishment. The same penalty applies to the unborn child and the mother. They are considered to be of equal worth under the laws that God gave Moses at Mt Sinai. So the Bible values the life of unborn children and teaches that it is wrong to harm or kill them. In this case it was accidental harm. The same would apply to intentional harm. This means that the Bible forbids intentional abortion. The Bible does not give us permission to destroy innocent human life—this would be murder (Jas. 2:11).

This understanding of the beginning of human life means that embryos are alive as a human being at the beginning of their life. What about an embryo that aborts naturally? Should we be concerned about this as the death of a human being? As this is a natural occurrence which happens according to the will of God, it isn’t necessarily wrong. Sometimes the mother may be unaware of this event. But if the parents are aware of it, then they can experience grief and loss. But for reasons only known to God, He allowed that to happen. We just need to be assured that that was the best outcome for the baby and the parents (Rom. 8:28).

Implications for IVF

One’s view of IVF will largely depend on one’s view of human intervention in the process of conception and one’s belief on the beginning of human life. If you are against human intervention, then IVF is not for you and you should seek other more natural ways to promote conception. On the other hand, if you believe that human life begins at or after implantation, then the use of IVF may be acceptable. In this case a young embryo is just a bunch of cells with the “potential” to be a baby, but it’s not a living being. However, you also need to appreciate the financial cost of IVF and the physical impact of the procedure on the mother.

IVF is more problematic if you believe that human life begins at fertilization. This means that the embryos produced in the laboratory by IVF are human lives. Usually the embryos that are not implanted are frozen or discarded. As these are not usually given the opportunity to develop into adults, their fate is equivalent to abortion. To destroy an embryo is to destroy a human being near the beginning of their life. If you want to respect human life and not destroy a human being, then IVF is only acceptable if no embryos are discarded. God values human life and does not condone murder (Exodus 20:13; Jas. 2:11).

Is the ethics of IVF a debatable matter?

As one’s view of IVF will largely depend on one’s view of human intervention in the process of conception and one’s belief on the beginning of human life, the ethics of IVF could be a debatable matter (like politics or tattoos). These are secondary matters that are not essential to the Christian faith (Rom. 14:1 – 15:7; 1 Cor. 8:1-13; 10:23-33). The Biblical principles that can help us determine God’s will in debatable matters are given in the Appendix.

What about freezing embryos?

Excess embryos are often frozen for future usage. However, in practice the majority of these are eventually discarded. As mentioned above, this is a concern if you believe that human life begins at fertilization, as it represents the death of a human being.

Another possibility is that excess (frozen) embryos can be donated to other infertile couples. Embryo donation programs exist to enable this process. Embryo donation is legal in Australia. Some clinics have a policy that you can only donate two or more embryos, but other clinics will facilitate a donation of a single embryo. Also, the NSW Health Central Register allows for information to be shared between donors and donor conceived children with the consent of both parties.

However, when excess embryos from IVF are frozen, they are placed in immediate danger and face an uncertain destiny. It’s not possible to guarantee that the frozen embryos will be kept safe.

Are there any alternatives to IVF?

Some alternatives to IVF are mentioned on the internet, but these may not be widely available. For example, in natural cycle IVF, there is no ovarian stimulation and only one egg is collected and one embryo implanted. So there are no excess embryos. However, it appears as though there is a lower probability of pregnancy than for normal IVF.

Mild stimulation IVF also works with a woman’s natural cycle, and uses mild ovarian stimulation. In this case 2-7 eggs are typically collected and the probability of pregnancy is similar to normal IVF. In-vitro maturation (IVM) also uses significantly less hormone drugs than IVF. Artificial insemination (also called intrauterine insemination, IUI) is a simpler process that introduces sperm into the woman’s uterus.

Also, one could use a natural method to enhance the possibly of natural conception such as the Billings or Creighton or Sympto-Thermal Methods which involve identifying the fertile period during a woman’s menstrual cycle.

Options for a Christian

If a couple believes that life begins at fertilization, then they would probably want to ensure that any human embryos are not intentionally lost or discarded. This could make it difficult to use IVF unless they can find a clinic that is willing to limit the number of eggs collected to the number that they plan to implant in the womb and willing to donate any excess embryos to other couples that are unable to conceive themselves. Unfortunately, this approach usually reduces the probability of pregnancy. This means that the woman may have to go through additional procedures and expense to have more eggs collected later on.

Conclusion

IVF is a product of medical technology which can enable some infertile couples to have children. Some people accept it as an example of modern technology, while others have some concerns. For example, it is an artificial way of producing human life. Also, many of the human embryos created by IVF are discarded. The ethics of dealing with these embryos depends on one’s view on the commencement of human life. If you believe that human life begins at fertilization and if you want to respect human life and not destroy a human being, then IVF is only acceptable if no embryos are discarded. This seems to be difficult to achieve. And although they can be donated to infertile couples, the majority of embryos that are frozen are eventually discarded.

What do you think?

Appendix: Biblical principles for debatable matters

The Bible gives principles that can help us determine God’s will in debatable matters.

God’s honor

First, we are to honor God with our bodies (1 Cor. 6:19-20). When Paul said to “flee from sexual immorality”, he gave the following reason: “Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your bodies” (1 Cor. 6:19-20). This means considering questions such as: Will it honor or dishonor God? Will His reputation be enhanced or harmed? Will God be exalted or disgraced? Will others think less of God, His church or of His word?

A related principle is that whatever we do should be done for the glory of God. When Paul discussed whether to eat meat that had been offered to idols he concluded, “So whether you eat or drink or whatever you do, do it all for the glory of God” (1 Cor. 10:31).

The next six principles involve the welfare of others.

Acting in love (Rom. 14:15)

With regard to debatable matters, Paul wrote, “‘I have the right to do anything,’ you say—but not everything is beneficial. ‘I have the right to do anything’—but not everything is constructive. No one should seek their own good, but the good of others” (1 Cor. 10:23-24). In this area, although there is freedom of action, acting in love means that we consider the impact on others, particularly those whose conscience is weak or strict (1 Cor. 8:7). As a result of this we may need to modify our behavior and not enjoy all the liberties that we could otherwise.

Acting in love means forbearing those with a stricter conscience, not insisting on doing what we want without considering the views of those around us, in order to build them up; “We who are strong ought to bear with the failings of the weak and not to please ourselves. Each of us should please our neighbors for their good, to build them up. For even Christ did not please Himself …” (Rom. 15:1-3a).

Acceptance

The practice of acceptance features in the passage in Romans, which begins with “accept those whose faith is weak” (Rom. 14:1). Those whose convictions allow them more freedom are to accept those with stricter consciences on debatable matters. Despite our differences of opinion with regard to debatable matters, believers should accept one another just as Christ has accepted us; “Accept one another, then, just as Christ accepted you, in order to bring praise to God” (Rom. 15:7).

Our fellowship with one another shouldn’t depend on one’s viewpoint on such matters. As Christ died for all believers and they have been accepted as His children, we should accept them as well (Rom. 14:15). The call to the Christian is to accept every other believer without having to pass judgment on every opinion they hold. In other words, we are to allow for differing opinions, because differing opinions do not necessarily mean a differing faith.

Harmony

With regard to debatable matters Paul wrote, “Let us therefore make every effort to do what leads to peace and to mutual edification” (Rom. 14:19). This means promoting peace and spiritual growth and determining whether the matter would help or hinder the harmony of believers.

Don’t quarrel

Paul also wrote, “Accept those whose faith is weak, without quarreling over disputable (or debatable) matters” (Rom. 14:1). One way of accepting other believers is to not engage in disputes about their strict views and not force our convictions on them (Rom 14:22). We can share our opinion, but it is important to give others space to grow and to allow for the possibility that we may be wrong.

Don’t judge

Those with a strong conscience shouldn’t despise those with a strict conscience; “The one who eats everything must not treat with contempt the one who does not” (Rom. 14:3a). On the other hand, those with a strict conscience are not to judge others as being sinners; “the one who does not eat everything must not judge the one who does, for God has accepted them” (Rom. 14:3b).

As far as our service goes as the Lord’s servants we are all accountable to Him, not to each other (Rom. 14:4, 10-13). This means respecting each other’s opinion as we can have differing views on what pleases the Lord (1 Th. 4:1). We are to allow for differing conclusions of honest believers seeking the mind of Christ, without criticism, without contempt, and without judgment (Rom. 14:10). Don’t judge one another critically to put others down (Rom. 14:13). React with love not criticism. Remember, God has accepted them. He is the judge in these matters, not us.

Note that these verses are dealing with debatable matters. We can certainly make judgements about matters that involve the fundamentals of the faith and sinful behavior.

Don’t hinder spiritual growth

There are many references to not stumbling a weaker believer (Rom. 14:13, 15, 20-21; 1 Cor. 8:9-13; 1 Cor. 10:32-33). This means refraining from doing something that is not forbidden in Scripture if it hinders the spiritual progress of those with a strict conscience, by causing them to act against their conscience. Otherwise, both parties sin.

Don’t let debatable matters destroy the work of God. Paul even extends this principle to unbelievers because he wanted them to accept Christ as their Savior; “Do not cause anyone to stumble, whether Jews, Greeks or the church of God—even as I try to please everyone in every way. For I am not seeking my own good but the good of many, so that they may be saved” (1 Cor. 10:32-33). It’s loving and unselfish to think of others above ourselves (Rom. 14:15; 15:1-2).

Order in the Church

Finally, there should be unity within the local church. When he was addressing disorder in the meetings of the church in Corinth, Paul wrote; “For God is not a God of disorder but of peace—as in all the congregations of the Lord’s people” and “everything should be done in a fitting and orderly way” (1 Cor. 14:33; 40). In this situation, Paul imposed some boundaries to ensure there was order instead of disorder.

Some debatable matters can affect the unity or functioning of the local church. Because the local church is to operate in an orderly way, in the case of debatable matters that directly affect the unity or functioning of the local church, there should be boundaries on what is taught and practiced. In these situations, what is taught and practiced within the church needs to be consistent and it will not always match everyone’s opinion because after all, we can have various opinions on these topics.

Written, March 2017

Also see: What does the New Testament say about Christians getting tattoos?