Is IVF Morally Permissible? A Dialogue, Part 1

Is IVF ever morally permissible for Christians? And if so, what conditions must be met? Is it ever morally justified to freeze embryos? These are just a few of the questions Sean and Scott discuss in this first part of a two-part discussion on the morality of IVF. If you are looking for a substantive discussion about the case for and against IVF, you will enjoy this first part.

Join us next week for part 2.

Episode Transcript

Sean: Is in vitro fertilization ethical? Is there a morally permissible way for Christians to practice it? Today my co-host and I, Scott Rae, are going to have a conversation about this. And Scott, one of the reasons I want to do this is I saw arguments for in vitro fertilization online. So, arguments against it, but no one taking the time to walk through what is it, what are the concerns, and help people understand what's at stake from a biblical perspective. So, we're going to make this a part of the Think Biblically podcast and dive in. You ready to go?

Scott: I am. And hopefully we can have some nuance and appreciate some of the complexities here, too.

Sean: That would be the idea. Now, that said, maybe a helpful place to start with is, just, what is in vitro fertilization?

Scott: In vitro is simply Latin for “in glass,” and fertilization taking place in glass in a petri dish. We'll assume here that it's gametes of husband and wife, because you can have donors, you can have surrogates—we'll keep them off the table for now for simplicity's sake. The woman is given high-powered hormones that enable her to release as many eggs as possible in one cycle. The average is, I’d say, normally somewhere between 8 and 15, although with some women, it's a bust, and some women go way over that. So, it's just…but that's sort of the average. And sperm samples are taken from the husband, and they put the eggs and sperm together in a petri dish and see how many, you know, pick up a dance partner. And so, usually, there's a decent amount of attrition. Not every egg fertilizes successfully, in the same way that not every egg fertilizes successfully in the body. So, let's just say we get 10 eggs that we harvest, and 5 successfully fertilized. Then they will…within a pretty short period of time, they have to implant the fertilized embryos. Now, they will test them, they will grade them to see what the likelihood of implanting successfully is, and take the high-grade embryos first and implant those, usually two, sometimes three, depending on a number of different factors. And then they'll see…if they get a successful pregnancy, they will freeze the rest and put them in storage so that if they don't get any, if none of the initial implants take, instead of having to start over again at the very beginning, which is much more costly—the lion's share of the expense comes from the hormone treatments and the egg harvesting, and it's much more wear and tear on the woman's body, too, to have to go through that again—so instead of starting over, they can just thaw out embryos and implant what's remaining.

Sean: Okay, that's helpful. So, ideally, it would be the father and the mother, the man's sperm, the woman's egg, and the woman carries it. But sometimes, there's a surrogate.

Scott: That's right.

Sean: Sometimes it's not the woman's egg. Sometimes it's not the man's sperm. There's all sorts of ways that this is practiced, which raises other ethical questions.

Scott: Right.

Sean: So people know a sense of...

Scott: But those are not intrinsic to the process itself.

Sean: Fair enough. And, yeah, we can let that set. So, this raises some of the questions we'll get to—not right now, but when you mentioned that some of them don't fertilize, like, in in vitro as in the human body, some of the questions people are going to raise is, like, is it okay for conception to take place in a glass as opposed to in the body? We'll come back to that. These are some of the issues that we will come and address and talk about. Are there effects on the unborn because of this, et cetera? Before we get there, what's the typical cost? I've heard it's about $20,000 for one cycle, and I know some women go through two, three, four, five, six plus cycles. Is that roughly the cost?

Scott: I think that's pretty close. When it started out, you know, it was around $10,000, and it's increased significantly. Part of the reason it was so high is back in 1978 when it first started, there were only a handful of clinics that were doing this. Now, you know, supply and demand has taken effect, and it's driven the price down, but it's still, you know, it's 40 years later, so the cost of everything's gone up since then. But it could be much worse. Now, you get donors and surrogates involved…if you have a surrogate involved, then you probably put another 50 grand on top of that.

Sean: Yeah. Fair enough. Okay, so, some of the other questions this raises is, just, the process itself, and I know we're gonna make a distinction between what might be considered an ethical Christian practice and what all Christians should agree is out of bounds. But when the eggs are fertilized in a glass, in a beaker, et cetera, then they are judged whether they are suitable for life, and some are discarded that are not. Obviously, you would say Christians shouldn’t do this, but that's an area that some would say, time out, this process itself is problematic, practiced in certain ways. We'll come back to that. Just highlighting for people some of the issues at play. Is it ever okay to freeze a human being? That's a question we need to talk about, but as far as I could tell—correct me if I'm wrong in this—2.3% of babies are now born through IVF. That's the most recent stat I could find. So, this is growing from 1978—the first, 46 years ago, now 2.3%, and it's getting more common, and it's getting cheaper. That's probably only going to increase, but with that I also found, interestingly enough, that from embryos that are created, only 2.3% actually result in live births once they go through the entire process from screening out, damage from thawing, a miscarriage, et cetera. So, if a hundred embryos are made, 2.3% result in life with IVF as a whole. Do both those sound right to you?

Scott: That sounds about right. Another way to look at this, which is typically the way the couple would look at this, is they evaluate success on the number of live births you have per clinic. And so, roughly…I mean, we're dealing with major cases of infertility, these are problem pregnancies from the start, and so you wouldn't expect a significantly high success rate. So, roughly—and this has held pretty steady over the years—roughly 25 to 30% of all couples who come into an infertility clinic for IVF will emerge with a healthy baby, which means that two-thirds to three-quarters of the couples who invest in this procedure will, at the end of it, walk away with nothing. And I think what's particularly challenging about this is that with each successive attempt that you try, the success rate goes down. Because we're just dealing with really tough fertility challenges. And even sometimes doing an end run around them like IVF does doesn't solve anything. So, I think couples need to be aware of that. And it breaks my heart to see couples taking out second and third mortgages on their homes to pay for the latest round of this when the success rate is going to be less than what they did with a first try.

Sean: Raises interesting questions that we don't have to spend time on, but the money and the cost in doing this is a factor that's a part of the moral equation as well.

Scott: No doubt.

Sean: And it favors those with more resources, and people handle it irresponsibly. Like, that's a piece that's often ignored. And having that child becomes the highest good within itself in a way.

Scott: Yes, not only having that child, but it's having our own child.

Sean: That's fair enough.

Scott: And the genetic connection to that. When it seems to me that in the Scriptures, the emphasis on parenting is not so much on the transmission of genetics, though in the Old Testament that was important for property distribution and things like that. But the more important emphasis is on the transmission of values and spirituality to the next generation. More so, I think, than the transmission of genes in that regard.

Sean: Which it makes sense in a modern, scientific-focused worldview that we would see things a little bit differently. Now, it's pretty obvious why a couple would choose to have IVF. You just explained it. Your own biologically connected child. That is a natural yearning God has given us that is good.

Scott: Part of our procreative constitution.

Sean: I have friends who have told me they've used IVF. I have not. I probably have a lot of friends who have who haven't even told me that will watch this, and maybe they'll let me know afterwards. But, like, apologists and writers that do the same kind of thing that I do. And I found it's hard. Not always, and I don't want to generalize too much, but it's so personal for people. If you raise moral questions about IVF, it's as if you're questioning the legitimacy of the kids themselves. And I understand why somebody would feel that way. But you and I firmly agreed at the beginning. Number one, we just recognize the pain of infertility. You dealt with that four years. You've talked about it publicly in a way I didn't. We had a miscarriage, and that was incredibly painful, but have not dealt with infertility. And also, we want to affirm that every single human being, regardless of how they are conceived, has value. So, I made the point—separate issue—that my own sister, who went to 51����, has been public about being conceived in date rape. IVF, date rape—whatever the conception is doesn't take away human value. Is there anything you want to add before we kind of jump into this about that?

Scott: Well, I think it is personal for my wife and me. We never had to go down the road of IVF. We did go down the road of some less expensive, less technologically intrusive things to try and get through this. And ours had a happy ending, in ways that were entirely providential. That's the only way I can explain it. Because they’re things that my wife's obstetrician would never have discovered. So there's a long, long story behind that.

Sean: Sure.

Scott: But, just, you know, that was pure providence, that other doctors discovered this in ways that we never would have figured out. But the pain of this was real, and it was deep. And it was magnified by the number of clueless friends we had who were offering what they thought was helpful, well-meaning advice, which turned out to be incredibly counterproductive. So, we stopped going to church on Mother's Day and Father's Day. Those were the two worst days of the year. “Family” holidays like Thanksgiving and Christmas, very tough. But ours, you know, had a good ending. We're very grateful for that. And we see our kids as the gifts that they are.

Sean: Well said. That's helpful. Two questions. Let's just quickly talk about this, and then jump to the ethics of it itself. In my estimation, probably no or almost no churches are talking about this topic at all. Maybe people don't feel equipped to talk about it. They don't understand the nuances of it. Is that your sense? I mean, like, 10%, if I had to guess, are even addressing this in any substantive way.

Scott: I think, yeah, our churches are drastically under-educated about this. And, here's the thing, most couples who go into IVF are not going to hear about the moral issues from the infertility clinic. And if they're not hearing them there, and not hearing them in our churches, where else are they going to get it, you know? They're not.

Sean: On the Think Biblically podcast. [laughs]

Scott: Well, I mean, bless our hearts for that. But, you know, for people who aren't listening to this, they're probably not going to get it anywhere unless they seek out somebody who they know and trust.

Sean: And there are other people. You've written on it, we have other friends who have done videos. Not downplaying that, but as a whole, people just are not informed. Hence, that's why we're having this conversation.

Scott: And I think churches just don't want to deal with it because they know that they've got lots of people who have had kids with IVF, and they don't want the fall out from that.

Sean: Fair enough. Now, we could go into some depth, like, why are we talking about this now, because it started in 1978? But recently there's been, like, the accident in the clinic in Alabama where somebody sued for [wrongful] death, where their embryos were destroyed. And some people are like, wait a minute. Christians are pro-IVF and pro-family, but they're not treating this unborn like it's really a human being. Are there some inconsistencies there? We've seen some political parties promising support from the government. So, it's kind of launched into the public conversation where I think we need to have this. Maybe let's start with…I think there's gonna be some areas where you and I maybe differ on this. Let's talk about areas where we see it similarly. So, what are some ways IVF is practiced that probably a lot of clinics will not say that we can or at least should all agree are unethical?

Scott: Well, I'd put it like this, Sean. I'd say the standard of practice in IVF contains a plethora of ethical dilemmas for couples to face. One is, what do you do with leftover embryos? And the general rule that I think is nonnegotiable is that every embryo created in the lab deserves to be implanted. No discarding embryos, no giving them off to experimentation which will result in them being discarded. I think it's okay for couples to put them up for adoption to another infertile couple. That may be an area where we differ on. But, destroying embryos is one. Selective termination is a second. Even if I was pro-choice, Sean, I would think this is just a callous disregard for life. You go to these lengths to create life in the lab, and then you destroy it because you don't like what you've created. And so, that's a problem. And that can easily be fixed with, just…you just don't implant the number that you can't safely carry. That's easy to fix. I think selecting for gender is a huge problem. And IVF is one of the technologies required to select for gender. You can screen for it, you can screen for other disabilities. But I think discarding embryos, regardless of the reason, is morally very problematic. And I think part of the reason that its use has increased is, we have a lot of same-sex couples who are using this. And we have single mothers by choice who will do this in some cases. Though not normally, you do have single adults who are doing this. And I think donors are off the table. Surrogates, I think, are off the table. There may be a rare exception to surrogate. I've consulted on a couple of cases that we can talk about—

Sean: Sure.

Scott: Where I think that's an exception.

Sean: Generally it's a rule.

Scott: But generally, I say that's off. And then the other one that is an issue that I think you don’t often think about is related to the guy. Because usually what happens is, you go into the clinic, and for the guy to give a sperm sample, you’ve got your choice of magazines and movies to get you aroused. And if I were a woman married to a guy who was going to be the father of my child, I would not want him obtaining a sperm sample like that. So, we can talk more about that, but I think there are lots of things in the standard of practice that are very problematic. Now, I think you can probably also make an argument that freezing embryos, per se, is a problem. Though one physician who I trust on this has said that usually the reason embryos don't thaw out successfully is because there's some sort of abnormality that would prevent them from implanting successfully. Now, I don't have the expertise to evaluate whether that's true or not. If that's the case, then I might look at freezing embryos a little differently. But we do know there is attrition in that. Now whether that would be attrition, you know, where that would take place—I think that may change how I regard that.

Sean: That's helpful. I didn't know what list you were going to come up with. I agree with almost all these. A couple that I see differently. So, destroying embryos, out. We're seeing gender selection now. Interestingly, for the first time I'm aware of in, like, world history, choosing girls over boys.

Scott: Let me suggest, I think there is an exception to that.

Sean: Okay.

Scott: Because there are genetic diseases that are sex-linked. There are about 300 of them. And I think that's the one case where selecting for sex would be okay, to do an end-run around a clear genetic abnormality that you're at serious risk of inheriting.

Sean: Okay, so let's hold some of those exceptions aside. But fair enough. Donors, surrogacy—

Scott: There is nuance and complexity.

Sean: I know! You're a philosopher. That's what I want. That's helpful. Porn use, like you said, for the production of the sperm. Gay couples doing so, in part because that intentionally creates a child and denies them a father and a mother. That is violating the rights of this child. Single couples, I agree with you. Now, this is a separate issue.

Sean: There's a difference between a single adopting someone—

Scott: Totally different.

Sean: Than creating somebody through the process of IVF. I think where I would start to differ on is, is it ethical at all to freeze embryos? And we'll come to that. And is it ethical at all to make embryos in a lab? That's where I would start to take issue, and we can unpack that one. I think we'll get to it. As far as I understand, some estimates say there's about 1.5 million frozen embryos. And so, let me ask.

Scott: That's just in the United States.

Sean: Yes, thank you. Yes, just in the United States. Correct. I'm not sure anybody really knows what that number is. That's just the estimates I've seen. Do you think, given that many Christians and evangelicals have uncritically utilized IVF…Catholic Church obviously has not. And it's enabled all of these kinds of technologies to go forward. So, we've counseled people to do so in churches. We haven't preached against it. We haven't educated people on it. And there's so many drastic stories we could give, dramatic stories of people that are affected by IVF. Do you think there's any responsibility within evangelical Christians, even if there is an ethical way to practice IVF? We haven't even gotten there yet. I think the church as a whole needs to step back and say, you know what? We uncritically jumped into this. We've contributed to some harm. This is on us. Or no?

Scott: I think it's been more what I would call benign neglect on behalf of lots of churches. It's just not being addressed. And I think the church does bear some responsibility for that. And I think, in part, it's schools like Talbot that also bear some responsibility too. Now, we have courses where we're educating the next generation of pastors and church leaders to do this better. And I tell my students, I say, "Look, the measure of which I've succeeded in the classes is when people in your church call you instead of me for advice about these issues. Because I want you to be the ones who are addressing this with the people that you're going through life with. You know them, you know their values, and you should be the one walking with them through this." But I've had to chide my students, my graduates, sometimes, who still call me and say, "Would you meet with this couple?" I say, "No, you meet with them. You should know how to do this. And I've got stuff for you to reread if you need help." So I’d say it's just more benign neglect.

Sean: I might be a little stronger on that. I think there's sins of commission and sins of omission. I think there's things we've failed to do and think about reflectively that we should have known differently, and need to take some ownership in that. And that's what it means to be a Christian, to say, I got something wrong, and I repent, and here's what we need to do differently. I think that's a sign of strength, not weakness.

Scott: Well, I think part of the reason for that is just from our experience. I think it's really hard to identify with what infertile couples go through if you hadn't been down that road yourself. And, you know, the pastors we know who've been down that road are much more sensitive to this, and I think do tend to do a better job of educating their churches on it. But I think there are a lot of folks who had no trouble having children, and they can relate to infertile couples from a distance, but it just doesn't resonate quite the same way.

Sean: That's fair. I do remember the first time you mentioned in—I think it was Ethics 1 that I had with you—four years of infertility. And I was just newly married. It's the first time it ever crossed my mind as a grad student, about the pain and difficulty. I had never even thought about it.

Scott: Wasn’t in your premarital counseling?

Sean: No, it wasn't. That’s one of my suggestions—this needs to be a piece of it, and done well, and it's not at all. Okay, let's keep going. Maybe this would help, if we…some consider IVF a way that we can work with God to remedy the brokenness that exists in our imperfect world. Do you see it that way? That's maybe where we start to view things a little bit differently. You go ahead first.

Scott: I think, yeah, and Sean, we have to distinguish between the standard of practice in most clinics and other ways that IVF could be done, in my view, acceptably. So, the question is, I think, more basic than that: is there anything intrinsically wrong with conceiving a child outside the womb, outside normal sexual relations? Because, in my view, that's at the heart of this. Now, in general, I think most medical technology are ways that we can work with God—I like the way you put that—to remedy the brokenness that exists in our imperfect world. Medical technology, I think, is God's good gift to human beings, that through general revelation and common grace we are able to alleviate the effects of the general entrance of sin, primarily disease, decay and death. I know there's lots of others, but those are the ones that affect medical technology most. And I would make the argument that infertility is a result of the general entrance of sin into the world. Not the way God intended it to be. Make sure our viewers hear this correctly: I'm not saying personal sin.

Sean: Right.

Scott: It's the general entrance of sin into the world, the general brokenness of the world. And, just the number of couples—you know, one in six couples of childbearing age are technically infertile. That's a lot of folks, and that's a lot of brokenness that people are dealing with. So, I don't think there's anything problematic with using medical technology in general to alleviate infertility. And the fact that IVF doesn't cure anything is irrelevant to this, because it's doing an end run around the problem, much the same way that kidney dialysis does an end run around kidney disease. It doesn't fix anything. It just averts the problem. The dialysis doesn't fix a broken kidney.

Sean: There might be some differences between the process of what a kidney does and the process—

Scott: I'm coming to that. Now, the question is, is there anything morally, biblically problematic about conceiving a child outside the womb? I think that's the central question. And my answer to that is no. I don't see anything problematic about that, assuming that we're not doing the standard of practice. Just that question. And the reason for that is that what the Bible indicates is that procreation has to take place within the general sphere of heterosexual marriage. I don't believe the Bible teaches that procreation has to take place within the sphere of always normal sexual relations. Now, I think the reason people think that is because in biblical times, that was the only way available for people to procreate anything. I mean, surrogates…that had to be done the old-fashioned way. I have a question about that for my Old Testament friends—why surrogacy didn't also constitute adultery in the Scriptures. And I don't believe, contrary to our Catholic brothers and sisters, that the unitive and procreative aspects of sex always have to go together. I don't think that's true. I don't think the Scripture requires that. I don't even think the natural law requires that. Now, in the Scriptures, we have several instances where the unitive aspect—which us Protestants would call the one flesh aspect of sex—is considered, I think, a sufficient end in itself. Things like the Song of Solomon, for example, that celebrate, just, the beauty and the enjoyment of sexual relations without any mention of procreation. And I think in 1 Corinthians 7, when Paul says husbands and wives ought to give each other regularly to sexual relations so that the temptation to have those desires satisfied wouldn't extend outside the realm of marriage, without any mention of procreation. And I think there's even a natural law argument to this, because I think there's a God-ordained separation of the unitive and procreative aspects of sex. And we refer to that as menopause. And I think even having a procreative intention after menopause is a somewhat meaningless concept, because unless we're hoping for miracles, or virgin births, or anything like that, I think the concept of having…And that's when our Catholic brothers and sisters would come back and say, well, you don't have to have a procreative intention. You just have to be open to procreation. But even, I think, openness to procreation after menopause is a meaningless concept. Some women after menopause get their ovaries removed, they have hysterectomies for health reasons. And to even have an openness to procreation, I think, is a meaningless concept. So, I would say that is a God-ordained, natural law separation of the unitive and procreative aspects of sex, which means that the requirement for “those always have to go together” can't be an absolute. And the fact that God ordained it, and that human beings are separating those through IVF and other types of things, is a distinction without a difference, because if God ordained that separation, then it can't be intrinsically problematic. And, therefore, that requirement that the unitive and procreative aspects of sex always go together can't be an absolute absolute.

Sean: I think that's the root of it. Well, I think there's two questions. I think the way it's often framed is, can we create human beings by science rather than sex? That's the root of it. One of the questions. The other one is, are there—

Scott: Clearly, we can. The question is, should we?

Sean: Well, morally can we? Should we? Agreed.

Scott: Sorry.

Sean: And are there effects in doing this to the child, which is more consequential? I think there's some harms that have been raised. That's a follow-up question, but you're right. The root principle is, do the unitive and procreative elements go together? Now, this could open a huge can of worms, but I think there's a difference between, like, Paul and the Song of Solomon talking about the duties that we have, husbands to wives, and the beauty of pleasurable sex, and saying that means we can separate it, therefore, from its procreative function. It's one thing to highlight it, talk about that purpose. It's another thing to say we have this purpose, but it can be severed from the other purpose. That's one pushback I would have on that piece.

Scott: Let me respond to that, just briefly.

Sean: I just let you talk for, like, five minutes, but go ahead. [laughs] I didn't cut you off once.

Scott: I didn't know you were so sensitive about this. [laughs]

Sean: No, I'm not. I'm giving you a hard time. [laughs] Go ahead and respond.

Scott: Back to you. I lost my point.

Sean: Aw, man.

Scott: I'll get it up again. I'll get it back.

Sean: You're right that at the heart is a connection, can we separate…is it okay to have sex without babies and babies without sex? Now, technology has enabled us to do both. Obviously, IVF on one end, birth control, or, of course, abortion, on the other, which are different. I recognize that. You made a point about…I think when it comes to the God-ordained end of menopause, there's arguably a difference between God ordaining that for reasons that God has, and us choosing to do an end run around that through technology. I think those are very, very different things. One is natural. It's built in. Doesn't seem to be the result of the Fall, as far as we can tell. And then using technology to do an end run around that in things like IVF.

Scott: But don't miss the point I was making. Because I do think that's an important distinction, but I think for the question that we're raising, it's a distinction without a difference. Because, again, if God has ordained it, what that means is that that mandate that the unitive and procreative aspects always have to go together is not an absolute. And whether a human being separates it or not…or if God separates it, if God has separated it through menopause, then it can't be intrinsically wrong. And whether human beings separate it or not is beside the point.

Sean: So, I don't see why that's beside the point. If God has built into our bodies a certain separation, then what we learn is that there comes a time where a man and woman who are married can have sex, and it's not going to naturally result in a child. Does that mean we can turn around before that God-instituted season and say, oh, since God did it, therefore we can separate it in other ways? I don't think that follows. Maybe that's just a point that we differ on.

Scott: I mean, that’s going to be where we differ. I think it does follow from that. Because what that means is that there's nothing intrinsically wrong about that separation. Now, I think we can agree that human beings separating it has caused effects. I would acknowledge that. And I think that we talk about this with birth control a lot. But that's another conversation here. But I think…well, let's go on.

Sean: [laughs] I can see the nuances in your mind.

Scott: There's so much to do here.

Sean: I want to read something, and then you just respond in terms of what you think. I think you'll disagree. We're actually going to stop this conversation right here because Scott and I talked for about an hour and five minutes, longer than we're planning. So, this is the conclusion of part one. But if you come back next week, we're going to pick up part two and keep this conversation going. This has been an episode of the podcast Think Biblically: Conversations on Faith and Culture. Please submit your comments or questions to us at thinkbiblically@biola.edu. That's thinkbiblically@biola.edu. And just a reminder, we have courses and programs, masters in spiritual formation, in apologetics, in Old Testament, New Testament, and many, many more online, fully distanced, that we'd love to have you join us for. Please consider writing a review on your app. Every review helps. Thanks for listening. We'll see you Friday for our weekly Cultural Update. In the meantime, remember to think biblically about everything.