The mission of Issues in Perspective is to provide thoughtful, historical and biblically-centered perspectives on current ethical and cultural issues.

Christian author, Ericka Andersen, has recently written of her struggles with infertility and her resolution of this struggle through in vitro fertilization (IVF).  Her piece offers an important perspective on IVF and how to think about this controversial procedure as a Christian: “At 33, after experiencing infertility for several years, I reluctantly turned to in vitro fertilization (IVF). A fertility specialist advised my husband and me to pursue the usual course of IVF, which involves using drugs to stimulate the growth of multiple egg follicles. These eggs would then be retrieved and fertilized with my husband’s sperm in a lab. The best embryo would be transferred to my uterus while the runners-up would be frozen for future use. We were told it would be unwise to waste any more time or money on other plans . . . We drained our savings for the $27,000 IVF package, which included four potential rounds, and prayerfully signed on the dotted line. I couldn’t stop imagining a newborn in my arms, even as I wondered if IVF would ultimately violate my Christian faith.  IVF ultimately gave me my two children, for which I am eternally grateful. But multiple embryos remain on ice, which breaks my heart. The embryos that became my children were simply chosen first. Each embryo already has the genetic blueprint that sets each of us apart. We all began the same way, at conception.  When someone creates excess embryos, the options are to destroy them, donate them to science, offer them to other hopeful parents or freeze them indefinitely. With over one million frozen embryos stored in the U.S., many couples pay for storage for years, unsure of how to proceed.”

After her two children were born, Andersen learned about an alternative IVF procedure known as “natural-cycle IVF,” which involves using a woman’s natural cycle to retrieve a single egg, inseminating it outside the body, then transferring it back to the uterus when it has the best chance of success. The procedure creates one embryo at a time, making it an appealing option for those of us who believe that life begins at conception.  Andersen presents the appeal as well as the risks of natural-cycle IVF:

• “All IVF procedures are prohibitively expensive, but natural-cycle IVF is potentially more cost-effective as it dispenses with fertility drugs, which can cost thousands of dollars per cycle. Researchers at Keck Medicine of the University of Southern California found that the procedure could save patients up to $7,000 for each live birth. Yet multiple cycles may be needed to secure viable eggs, which raises costs.”
• “Because patients aren’t injecting hormones for weeks before the egg-retrieval surgery, natural-cycle IVF tends to wreak less physiological havoc. Headaches, nausea, mood swings and other changes are common side effects from the drugs. Because the procedure retrieves just one egg at time, however, more surgeries may be necessary to make a healthy embryo.”
• “Few fertility specialists recommend natural-cycle IVF, as various studies put its success rate at 10-15%, versus 25-30% for stimulated IVF, and the success rates for all interventions decline as patients age. Given the physical, emotional and financial investment involved in any treatment, most physicians would prefer to optimize IVF outcomes.  ‘The likelihood of a pregnancy resulting is quite low, which is why the vast majority of reproductive endocrinologists don’t prescribe this type of treatment,’ Dr. Janet Choi, chief medical officer at Progyny, an insurance company for fertility coverage, told me.  Dr. Abby Delaney, a reproductive endocrinologist in Omaha, told me she doesn’t advise natural-cycle IVF because she wants the best odds for her patients. ‘We, as humans, are very inefficient at reproduction,” she explained. “Every reproductive endocrinologist lives for the day where every single fertilized egg turns into a baby, but unfortunately, that is not the case.’  For some women, however, the lower success rate is worth the risk.”
• “There is some evidence that fertility drugs can negatively affect egg quality. A 2017 meta-analysis of existing research in Reproductive Medicine Online reported ‘a higher risk of adverse perinatal outcomes after stimulated IVF’ compared with natural-cycle or modified natural IVF, which uses some drugs. A 2016 study in the journal Human Reproduction found that naturally produced embryos have a reduced risk of low birth weight.”

Andersen concludes, “I wish I’d had more clarity when I began IVF. No one counseled me to consider other options, nor was I told how many extra embryos may be possible. I wasn’t advised to think about what I might do with excess embryos. I simply hoped to produce as many as I needed.  Of course, clinics are businesses. This means there are real incentives to promote potentially costlier and more invasive treatments rather than to offer a more comprehensive evaluation of fertility problems and solutions.  Transparent conversations about reproductive choices are always necessary, but especially now, when so many Americans are struggling to understand what options they have about whether or how to have children.”

In conclusion, IVF and natural-cycle IVF fall under the stewardship responsibility of humanity to God.  In Genesis 1:26ff, God created humans—male and female—in His image and then gave them the responsibility to “be fruitful and multiply, and fill the earth and subdue it; and rule over the fish of the sea and over the birds of the sky, and over every living thing that moves on the earth (1:28).”  Verse 29 extends this dominion to plants, trees and seeds.  God affirms this dominion status, although affected by human sin and rebellion, to Noah in Genesis 9:1-2.  Because humans have dominion status, human accountability is a necessary corollary.  This matter of accountability has powerful implications when it comes to reproductive and genetic technologies.  These technologies give humans power never realized before in history.  But because of human depravity, it is difficult to be optimistic about the ultimate use of some of these technologies.  In His common grace, God has permitted the human race to develop these technologies—but we must always remember that we are accountable to Him as to how we use them.  The sobering fact of human depravity looms over its use.

How then should we think biblically about IVF and the freezing of embryos?  Several conclusions:

1. Freezing sperm and eggs does not jeopardize the life of a human being, because before fertilization there is no human being.
2. Natural-cycle IVF avoids the ethical problem of multiple embryos.  Normally, IVF involves multiple fertilizations and thereby multiple embryos, with those not implanted in the womb either destroyed or frozen.  What happens to the remaining embryos that are not implanted or frozen is an ethical problem. Psalm 139:16 makes it quite clear that God values even embryonic life.
3. Embryonic life must be protected.  Since the embryo is a person in God’s eyes, the embryo has the right to protection from harm.
4. Although there is not reliable data yet available, it seems reasonable to conclude that frozen embryos will likely deteriorate over time so that they will not survive implantation.  Today, success rates with frozen embryos are lower than successes with fresh embryos.
5. Permitting women to be rigorously selective in the sperm they choose to ensure that they the “right child” is getting close to the ugly specter of eugenics.

See Ericka Andersen, “Did I Need To Make Extra Embryos to Have a Baby?” in the Wall Street Journal (30-31 March 2024); Jan Hoffman in the New York Times (23 February 2024); Ryan T. Anderson in First Things Daily Newsletter (29 February 2024); Emma Waters in First Things Daily Newsletter (27 February 2024); and James P. Eckman, Christian Ethics, pp. 50-53.