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 on the rise: current statistics say it now affects one in six couples.[1. http://www.abc.net.au/health/library/stories/2007/05/30/1919840.htm
.] If you are not personally affected, you may know someone who is, and certainly there will be couples within our churches who are struggling with infertility. With the rise of infertility and medical advances has come in-vitro fertilization (IVF). Ethics for Christians can be highly contentious, and the process and implications of IVF are no exception. We write this article to share with you our story, our struggles, our theological conclusions, our sadness and our joy. We hope that this article assists your walk through the minefield of ethical issues IVF raises for Christians.
How it all started
In July 2005, Susan had the usual blood tests you have when you decide to start a family (e.g. tests for iron levels, rubella, etc.). In March 2006, eight months later, we went back to the GP as we hadn’t fallen pregnant and were beginning to wonder why. The GP referred us straight to a fertility unit where we both underwent a series of tests. A couple of weeks later, we returned for the results. Now, we expected to find out that there was some small problem that would be fixed with a pill or a minor procedure. Imagine our surprise during this visit when we were told that there was very little chance that we would be able to fall pregnant naturally and that our best option was to start down the IVF track! We had plenty of questions, like “You’re saying we’re infertile, but you also said that that figure is within the acceptable range. How is that possible?” Perhaps our doctor felt a little bombarded by our questions because, in exasperation, he replied, “I’ll tell you what it means: you’re up the creek without a paddle!” (Well, he used the cruder version of that expression.) So he wasn’t able to give us too many specifics. But this was a fairly clear indicator of what he thought, and our rocky ride into the roller-coaster of IVF began there and then. The appointment ended with us being told that we could make another appointment with the IVF nurse to talk further about the procedure. So in a numb state, we walked down the hall and did just that, and left the clinic feeling like we’d been hit by a Mack truck.[2. I.e. lorry (for UK readers).]
What is an embryo?
It might be helpful at this point to explain some fundamental theological presuppositions, such as what we think an embryo is: • The moment of fertilization is the moment of the existence of human life
. Not all Christians agree on this point, but from our perspective, this is the earthly beginning of a human being. Some people have argued that it is at the point of attachment to the uterus that an embryo is a human being. This argument may arise for some because of the many fertilized eggs that naturally miscarry without anyone knowing. Nonetheless, IVF reminds us of what we are otherwise not privileged to see—that before attachment, there is a cluster of cells multiplying and growing, carrying all the information needed to grow and develop into a boy or girl, twins or more. • Every embryo takes on the value we attribute to a human life
. If you say that, at 1-5 days old, it’s just a bunch of cells, well, yes, point taken. But it is a bunch of human cells that somehow fuse together to make the human embryo. These cells are dependent upon one another, and arise from one another. The reason it can seem alien to call a group of cells a human being may simply be because we are not used to seeing a real person at days 1-5. It is difficult to think about and feel attachment to a cluster of cells compared to how we would treat the child who has been growing in the womb for three months. But this is because we are created. We are relational beings, and it is natural to feel a greater degree of attachment when you can see fully formed fingers, hear a heartbeat and feel a kick. However, this should not numb our minds to the miraculous joining of egg and sperm in the dish—the very earliest possible identification of a real person.
Kinds and ends
Fundamental to these two theological points of reference is a doctrine of kinds and ends. It’s important to bring this into play quite early because it underlies a great deal of what we say in the rest of this article. Scripture points to unalterable ‘ends’ for human beings
. If you have a doctrine of ‘kinds’ and ‘ends’ (i.e. that each kind has a natural end—the carrot for consumption, the embryo in a human being), then to fail to do your best to bring about God’s intention for that ‘kind’ may at times be sinful. Genesis starts the conversation about ‘kinds’ by referring to the various creatures of the earth: the fish, birds and other animals were created according to their “kinds” (Gen 1:21-27). The Apostle Paul incidentally affirms this when speaking about resurrection bodies in 1 Corinthians 15:39: “For not all flesh is the same, but there is one kind for humans, another for animals, another for birds, and another for fish”. Different kinds are very important because, firstly, they show that God recognizes real differences between human beings and other animal forms. If we cannot distinguish between them, we cannot justify having a higher regard for one kind over another, and then we have the potential in our own kind for cannibalism, bestiality and random acts of violence. Secondly, without kinds, we cannot distinguish between appropriate and inappropriate ends. However, what makes the ‘ends’ unalterable or inappropriate? For instance, corn can have alterable ends: it might be used for food, or in the production of methane for fuel. But a human being, for several reasons, seems to have unalterable ends. Firstly, we are not made to be messed with. Human beings are the pinnacle of God’s creative activity, and only of us is it said, “in the image of God he created him; male and female he created them” (Gen 1:27). Secondly, the atoning work of God in Christ was massively costly: God went to great lengths to redeem a people for eternal relationship with himself. This is suggestive of an unalterable end for human beings (1 Thess 4:17). If God is committed to eternal relationship with us, then surely this is another reason to ensure the combination of egg and sperm reach their fullest potential in a human being.
The first interview
We went to our first IVF interview in July 2006. We were given a heap of information, we came up with a billion questions and then we went home. Apart from the occasional conversation, we pretty much shelved the idea of IVF and waited to become pregnant naturally. After all, we believe in a God of miracles. A couple of months later, we un-shelved the idea, and started reading articles and asking questions of lots of people—particularly people who had been through IVF. Our major concern became the freezing process for embryos that aren’t used the first time (or that aren’t fresh). Tim was really worried about the embryo fatality rate during the thawing process. Susan was more concerned about what would happen to those embryos if one of us were to die before getting to use them. She said to Tim, “It’d be real tricky, asking some girl to marry you and, by the way, would she mind implanting your dead wife’s embryos?” Now, if you’re uncertain about the process of IVF, the whole thing is most stressful for the woman—physically and mentally. They pump her full of hormones to overstimulate the ovaries. The ovaries then produce a number of eggs that are sucked up or ‘harvested’ with a thin needle. The objective of the medical staff is to take as many eggs as possible and fertilize all of them in the hope of having a large selection of embryos to choose from. They would then implant one of the more robust-looking embryos for the best chance of pregnancy. But if a woman produced 11 eggs (which wouldn’t be unusual) and all fertilized well, we’d say the couple have the responsibility of giving all those embryos a chance of life, based on our doctrine of kinds and ends (see below). That means being open to the possibility of having 11 children and freezing some of those embryos for many years. We had other concerns as well. We wanted to know the risks to Susan’s health from the multitude of drugs she would be taking during each cycle. As the process requires hormone stimulation for the multiple production of eggs, there is the chance that the woman will hypostimulate. We didn’t know much about hypostimulation, but we were warned that the onset of this condition can be fatal. We had our own soul-searching to do as well: what were our motives for going through this process? Was it our ‘right’ to have children? Should we instead be using our childless state to work in ministry in ways that many couples aren’t free to practise? After much discussion, the main question for us became how many eggs we should fertilize. Should we simply fertilize one egg and hope this would work, or would the emotional trauma involved in preparing Susan’s body for another egg harvest be something we would not be capable of doing all over again? The only other alternative was to freeze some of our embryos. We left that first interview with a lot to think about. We eventually concluded that the risk to the life of an embryo was too great if we froze it. Before returning for our second interview, we determined to fertilize two eggs no matter how many Susan produced, and implant both immediately.
This is where our ethical world turned from black-and-white to grey. Was it all right to freeze and thaw a human being? It’s true that it’s not something we would normally think of doing. However, we don’t think this invalidates freezing for the simple reason that, in God’s wonderfully ordered creation, this is a stage in the development of human beings where science has exposed another remarkable trait of God’s creation—that a human can indeed be frozen and survive to tell the tale. Though it is not the intention of the authors to expound the merits of freezing a human being, perhaps we can say, as in Psalm 139:14, “I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well.” This view of the wonderful but mysterious world we live in is also supported in Proverbs and Job (Prov 30:18; Job 42:3). Having said this, the decision to freeze is not easy. The probability of survival is around 85 per cent. But if you want to care appropriately for this little one—this member of the human race, created in the image of God—is it an appropriate risk to take? If we framed the dilemma differently, it may help us to see more clearly what we are attempting to determine. For example, if you put a child in a car knowing that there is a 15 per cent chance they will die in that car that day, would you do it? We cannot answer this for you. Due to the circumstances at the time, it is a risk we decided to take.[3. Having decided to freeze, we’re not sure if we’d do it again. We have a tender conscience on the issue, and we are not fully convinced that this was the right course of action for us (see Romans 14).] The second thing to consider when freezing is the extended period of elevated human responsibility. We believe that responsibility for each embryo increases when it is outside of the natural environment (i.e. the womb). Our duty of care is such that in deciding to freeze, we had also decided to do everything humanly possible to ensure the safe implantation of the embryo in the womb—its rightful home. This duty of care comes with the doctrine of kinds and ends already considered on page 11. It is also part of the Christian understanding of what it means to protect the weak and vulnerable. Israel were reminded frequently that they were aliens once, and so should look after foreigners sojourning among them (Exod 22:21, 23:9). 1 Peter 3:7 reminds husbands of their duty of care to their physically more vulnerable wives. 1 Thessalonians 5:14 also urges us to “encourage the fainthearted, help the weak [and] be patient with them all”. If there is any stage in human development that could be classed as ‘weak’ and ‘vulnerable’, it would be that cluster of cells we call an embryo.
The second interview
Even with those two things worked out—not freezing and only fertilizing two eggs—we still hadn’t decided whether Christians should do IVF. After all, isn’t God the God of the miraculous—the God who raises the dead and heals the sick? Surely if he can raise the dead, he can coach a few Olympic quality sperm! Yes, God could do that, but in our case, for some reason he had chosen not to. For most Christians, it is normal to think of this world as fallen and in rebellion to God. With that, the world becomes a hostile place with varying degrees of hardship and suffering. Infertility is one such result of the Fall. However, just as we have faith that one day Christ will put everything right, so we unashamedly relied on him to perhaps grant us joy in this area through these means. Furthermore, should our attempt at redeeming barrenness fail, we would have still engaged this world with the wonder of a Godward life, and we would have at least confronted the world’s thinking about IVF with God’s perspective—perhaps, in the process, challenging some of the tenets of the scientific community as it rubbed shoulders with Christian ethics and the God whose ethical purity sets limits even on our scientific endeavours. So we decided that IVF was okay. However, we knew that the emotional pain of not having a child and our wanting one desperately meant that, for us, there would always be the temptation to compromise our ethics for statistically better results. No doubt many Christian couples have had to wrestle with this issue! This is why we felt it was important to set boundaries to ensure that when the pressure was on to conform to the world, we had the confidence to stand our ground. At the end of February 2007, we decided to go back to the fertility unit to discuss where we were up to in our thinking. They were quite willing to let us only fertilize two eggs—as long as we realized that we were significantly decreasing the chances of pregnancy. (Of course we did.) The problem was going to be implantation if, on the rare chance, both eggs fertilized. We were told that under no circumstances would they implant both embryos if they survived; we would have to freeze one. They argued that Susan was still young (she was 31) and healthy, and that once implanted, she had a relatively good chance of both embryos surviving. We were told that the risks for illness or death to an embryo in a multiple birth were much greater than the risks involved in freezing. After much debate, we conceded on their medical advice that if both embryos fertilized, we would only implant one and freeze the other. It wasn’t our ideal, but then neither was IVF. The second concerning conversation we had with the fertility unit was about ‘abnormal’ embryos. We were told that there was a chance that an egg might fertilize abnormally. This means that instead of multiplying nice and evenly, something strange happens to the cells, and they look ‘abnormal’. In this case, they would not want to implant. We said that if it’s alive, we would insist that it be implanted. Things got heated at this point. One of the most frightening things about the kind of knowledge revealed to you in IVF is that if you believe, as we do, that life begins at conception and that every life has a predetermined end, you will act with integrity and do your best to ensure that that ‘end’ is reached. This could mean bringing a severely handicapped child into the world. The nursing staff said that the doctor would refuse to do this, and that even if the embryo was not ‘abnormal’, but was deemed ‘weak’, they would not implant this either. At our clinic, a ‘weak’ embryo was one where cell division hadn’t reached 50 per cent. This did not mean it was dead—just that, in their opinion, it was unlikely to attach to the uterus successfully, or even survive long enough to get there. There was some debate at this point, and emotive arguments were presented to dissuade us from our course of action. We were asked, “Do you think a severely handicapped child would thank you for bringing him/her into the world?”—to which we responded, “If that were the case, the child would never be able to answer such a question. It would always be impossible to tell.”[4. In a later conversation, Susan said to Tim, “Would a suicidally depressed teenager thank his parents for bringing him into the world? Probably not. But if you had had that kind of foresight at his birth, I imagine you’d still risk it.”] At about this point, Susan started to cry; she was proud of Tim, and agreed in her head with his argument, of course. But in her heart, she was scared of miscarriage and of the prospect of bringing a severely disabled child into the world. The conversation, as we remember it, continued by Tim asking the nursing staff if the embryo would be discarded or terminated. They responded, “Your language is unfair and inflammatory”. Tim said, “How would you say it, then?” They answered, “We would let it take its natural course”. We responded, “But wouldn’t its ‘natural course’ be to put the embryo back into its natural environment, the womb, and wait and see if it attaches?” There was silence for a moment, and the nurse suggested it was such an unlikely prospect, it wasn’t worth discussing. (We subsequently found out this was not the case.) We signed the papers, and once again, headed home to think and pray some more.
We believe that Scripture says that human dignity is never derived from one person alone—unless, of course, that person is God. We imagine that the toughest scenario to face would be implanting an embryo that doctors had claimed would most likely produce a severely mentally or physically handicapped child. Yet it is not up to us to determine the value of one human life over another. Human dignity is derived from a doctrine of love, whereby Christians know they are to love one another (1 John 3:11)—even our enemies (Matt 5:44). In doing so, we give dignity to each other. It would be a very sad world if your dignity was derived from you alone, for when your body fails you and you can’t remember who you are anymore, that would just be tough. So human life has real value—derived not from the sufferer alone (in our case, a potentially disabled child), but also from the carer. No-one has said it better than this: “By this we know love, that he laid down his life for us, and we ought to lay down our lives for the brothers” (1 John 3:16). Of course, this is one instance where the one who gives dignity is both carer and sufferer.
In April 2007, we started the process. We decided that, seeing as we had agreed to freeze an embryo, we would try and fertilize three eggs to give ourselves a better chance of getting one fresh embryo to implant. We also decided that if an egg was to fertilize abnormally, we would push to have it implanted. With that, we began. On the day of harvesting Susan’s eggs, while we were sitting in the recovery room, we went through everything again—this time with a scientist, who was horrified that we would even consider implanting an ‘abnormal’ embryo. She went on to explain that with their definition of ‘abnormal’, up to 50 per cent of embryos are discarded. We felt physically sick. We felt even sicker when she told us that there was not a doctor in the country who would implant an ‘abnormal’ embryo. She even rang a leading IVF specialist on the matter, and came back with the news that it was illegal to do so. At this point, and in possibly the most painful moment of the process, Tim said to Susan, “I am never doing this again”. Subsequently, we researched the Australian ethical guidelines of artificial reproduction and found no such information. In fact, the term ‘abnormal embryo’ does not occur in the literature. What’s more, we found that the final decision on implantation is always the client’s, no matter the opinion of the medical practitioner.[5. In a government document titled ‘Contextual information for the objective criteria issued by the National Health and Medical Research Council (NHMRC) for determining embryos that are unsuitable for implantation’, we read, "In developing such objective criteria, the NHMRC is aware of a number of challenges, including that: The decision as to whether an embryo will be implanted is up to the couple for whom the embryos were made. That is, a couple may decide to implant an embryo that meets the criteria for ‘unsuitable’." (http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/contextual_info.rtf).] The government guidelines also state that there is a level of subjectivity involved in assessing an embryo’s health, which will vary from clinic to clinic.[6. The NHMRC acknowledges that “Observations of embryos under a microscope may give variable results and are open to subjectivity and there may be variability between IVF clinics regarding which embryos are judged to be suitable for implantation and which are not” (ibid.).] So in short, the guidelines acknowledge that no-one really has a definitive answer on what can and cannot be implanted, and ultimately, the couple have the final say. We had an anxious 24-hour wait to see if any of our three eggs fertilized ‘normally’. To our great joy, all three did. They all went on to survive to day 5, which is the point when one was implanted successfully and the other two were frozen. Susan went on to carry the implanted embryo to full term. We acknowledge that each couple will face their own experiences and so may not completely identify with ours. This article has looked at the dilemmas we faced: should Christians do IVF? Should we freeze embryos at all? What does the responsible care and fertilization of embryos look like? Finally, how should we regard the very real possibility of bringing a severely handicapped child into the world? We walked through the minefield of IVF ethics by attempting to put our theology into practice. This included a doctrine of ‘kinds’ and ‘ends’, the unalterable ends of humanity, the wonderful mystery of created beings, protecting the weak and vulnerable, and a doctrine of dignity derived from the Christian model of love. In writing this, we praise our God and Father for the wonderful gift of Rex Peter Stephen Ravenhall, who was born on 20th February 2008. He is our firstborn and only surviving son of three children. (Our other two frozen embryos survived the thaw, but did not survive in the womb.) We thank the Lord Jesus, who brought us great redemption at the cost of his life, and who, in his grace, even redeemed a barren womb—a sign to our world of things to come.