Beginning-of-Life Decisions | Christian Perspective

The Pain of Infertility

Having children is a wonderful blessing—God loves children.

• Children are a gift from the Lord (Psalm 127:3). What joy it is when the Lord “settles the barren woman in her home as a happy mother of children” (Psalm 113:9).
• From the beginning, God has intended people to “increase in number” (Genesis 1:28).
• Jesus made it clear that he sees children as special and worth blessing (Mark 10:13-16).
• God considers his followers so dear that he calls them “God’s children” (Romans 8:16).

Being unable to have children can be a terrible burden.

• It’s a particularly severe form of our “bondage to decay” (Romans 8:21) in a fallen world.
• The longing for “the redemption of our bodies” (Romans 8:23) can be especially intense.
• Infertility is defined as the inability to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.
• According to the World Health Organization, 1 in 6 people of reproductive age (15 to 49 years old) worldwide endure infertility in their lifetime.
• According to the U.S. National Institutes of Health, the source of the infertility is as likely to be the man as the woman.
• Infertility can be caused by body malfunctions, age, lifestyle (weight, foods, drugs), and environmental issues.
• Infertility afflicted all three of the ancestral couples.
  • Abraham and Sarah
    • Sarah was “childless…because she was not able to conceive” (Genesis 11:30).
    • God commends Abraham’s “ by faith” (Genesis 15:6) in response to his accepting God’s plan for children via Sarah, who was to birth his covenantal heir (17:19).
    • Yet, observing that God has kept them infertile (16:2), they take things into their own hands and use a surrogate mother, Hagar.
  • Isaac and Rebekah
    • Rebekah was “childless” for a while (Genesis 25:21).
    • The cause isn’t specified: either women or men can be “childless” (Deuteronomy 7:14).
    • Isaac “prays” that Rebekah will become pregnant—the unusual word for “pray” here meaning “plead”—suggesting the great pain of infertility.
  • Jacob and Rachel
    • Rachel was “childless” because “her womb was childless” (Genesis 29:31).
    • She’s so upset by her infertility that she tells Jacob: “Give me children or I’ll die!” (Genesis 30:1).
    • When Jacob observes it’s in God’s hands, she gives Jacob a surrogate mother, Bilhah, to have children for her (Genesis 30:2-3), which leads to a surrogacy race with Leah.

God is the one who determines whether or not a particular person is to have children.

• Sometimes infertility is by God’s design, but we don’t know why. In the case of Hannah we simply read: “the Lord had closed her womb” (1 Samuel 1:5).
• Sometimes infertility is by God’s design, and we only come to understand much later the unguessable reasons why it occurred. In the case of people working in Abimelek’s house, their infertility was because Abimelek intended to have a sexual relationship with Abraham’s wife Sarah since Abraham said she was his sister (Genesis 20:4-5, 17-18)!
• Sometimes infertility is for reasons unknown in a fallen world (e.g., Sarah in Genesis 16:1; Samson’s mother in Judges 13:2; the Shunammite woman in 2 Kings 4:14).
• We should not presume anything about what God will allow us to do in life (James 4:15).
• Even things we think are obviously good for us may not be, based on all that God knows. God has good purposes for those who love him even in the face of trials (Romans 8:28).

Finding a Biblical Way Forward

The priorities of Jesus for godly living.

• The first, most important commandment is to love God (Mark 12:28-30): i.e., live within any relevant boundaries rooted in how God has created the world to be.
• The next most important commandment is to love people (Mark 12:31): i.e., within those boundaries, maximize the balance of benefit over burden for the people affected.

The boundaries to live by, out of love for God.

• Marriage and childbearing
• Human lives
• [Technology is not a boundary]

Marriage and Childbearing

The model for marriage: A man and woman so unified together that nothing separates them.

• From the beginning, God’s model has been that “a man leaves his father and mother and is united to his wife, and they become one flesh” (Genesis 2:24). Being “one flesh” includes not only relational unity but also sexual unity (1 Corinthians 6:16).
• Jesus quotes the Genesis passage, saying it’s this way because “at the beginning the Creator made them male and female” (Matthew 19:4-5; see also the echo in Ephesians 5:31.)

The model for childbearing: A married man and woman producing children through their one-flesh union.

• Genesis 1:27-28 indicates that Adam and Eve, a married couple (Genesis 4:1) created to have a “one flesh union,” are to “be fruitful and increase in number.”
• If one wants to have sexual union with someone, they must marry (1 Corinthians 7:1-2).
• “Sexual immorality” and “adultery” (e.g., 1 Corinthians 6:9-19; Exodus 20:14) involve having a one-flesh union with someone other than one’s partner in marriage.
• Science teaches how appropriate the “one flesh” model is for the childbearing aspect of a marriage relationship: a wife’s egg and her husband’s sperm become one (embryo). That is the “fruit” that results from the sexual aspect of the one flesh union in Genesis 1.
• Marriage is a “covenant” (Malachi 2:14) that commits a man and woman to keep the marriage distinctives, including sex and childbearing, within the marriage relationship.

Human Lives

• In Genesis, God creates many categories of living things. Those that are “human” are created “in his image” (1:27) and for that reason are never to be killed (9:6). Human embryos are living beings and are human (as opposed to some other category).
• Embryos are morally responsible persons. David sees himself as the same sinful person in the womb as when an adult (Psalms 139:15-16; in 51:5 he refers back to conception).
• Jesus affirms the significance of the entire human lifespan by coming to this world not as an adult but as an embryo whose discarding would have indeed killed the Son of God.
• Right after Jesus’s conception, Mary visits Elizabeth who calls her “the mother of my Lord” (Luke 1:43). She’s a mother already because she has a son already—an embryo.
• Elizabeth is also pregnant and her “child” leaps in response to Mary’s arrival. The word here (Luke 1:41) refers to a born “child” (brephos) all six other times it is used in the New Testament. In other words, one is a person regardless of how old, born or unborn.
• Human embryos are not yet nearly all that they will become; however, they are not “potential persons”–they are “persons with potential.”
• The common slogan “My body, my choice” should be replaced with the better slogan “My body, my responsibility”–people are responsible to make choices reflecting what God wants.
  • For Christians: “You are not your own” (1 Corinthians 6:12).
  • For all people: “People’s lives are not their own” (Jeremiah 10:23).

Technology Is Not a Boundary

Two mistaken views about how using technology to do something affects the ethics:

• It makes it more ethical: Doing something using technology somehow distances us from what’s going on; unethical actions can become ethical if done by technology.
  • For example, one might say it’s wrong to conceive a child with a neighbor; but if the two people use technology to bring the sperm and egg together, that’s OK.
• It makes it less ethical: ethical actions can become unethical if technology is involved.
  • For example, one might say a married couple can have a child; but if they use technology to bring the sperm and egg together, that’s unnatural/wrong.

A biblical view instead asks us to look at what the people involved are actually doing. Technology enables them to do it more efficiently. But technology is basically a means rather than what’s making an action right/wrong. The right people must be doing the right action.

• Using technology won’t make something right if the wrong person is using it: In 2 Chronicles 26:18-19, King Uzziah holds a censer to burn incense. Though that technology would burn it more effectively, that doesn’t mean it’s OK for him to use it. Burning incense to God in the temple is wrong for a king to do.
• Using technology won’t make something right if the wrong action is being done: In Genesis 11:3-4, the people use building technology, well-used elsewhere, to build a tower as high as the heavens. Using technology doesn’t change the wrongness of their action—i.e., trying to become so great that they can rival God.
• Not using technology doesn’t make something better: In 2 Kings 5, Namaan travels to Elisha to be healed of leprosy. Elisha proposes a low-tech solution—wash in the Jordan River 7 times. Namaan refuses, saying that using a human procedure is wrong—health should just come directly from God in response to prayer (v. 11). He is chastised for being unwilling to use human means.

So Many Ways to Create a Baby

So many technologies have developed now, used in so many combinations, that there are so many ways to make a baby! Here are some of them that people commonly consider:

• Medical Healing
  • Examples of medications:  In males, treating hormone imbalances or erectile dysfunction; in females, stimulating ovulation using Clomid or Letrozole.
  • Examples of surgeries:  In males, removing blockages in tubes transporting sperm within the body; in females, removing growths or fallopian tube blockages.
  • Examples of restorative reproductive medicine (iirrm.com):  efforts to remove root causes of infertility.
  • There are usually no relevant boundaries here rooted in how God has created the world to be; treatment involves restoring the body to how God designed it to work best.
  • Using technology doesn’t make the process wrong.
  • Therefore, information on the benefits and burdens of each relevant treatment must be gathered in order to identify the option(s) with the greatest balance of benefit over burden for the people affected.
    .
• Intrauterine Insemination (IUI)
  • A woman often receives hormone treatments to stimulate egg production.
  • A man’s sperm is “washed” so that the most motile sperm can be separated from the fluid and other sperm.
  • His best sperm is injected into her uterus, from which sperm hopefully will swim into her fallopian tube to fertilize an egg.
  • Intracervical Insemination (ICI) is a similar (cheaper) process that can be done at home–his sperm (unwashed) is injected at the entrance of her cervix in the hope that it will then move to her uterus and beyond.
  • Regarding Boundary 1: Children must be created as the biological fruit of two married people; so neither donor sperm nor donor eggs can be used.
  • Using technology doesn’t make the process wrong.
  • The benefits and burdens of IUI vs. other options, for the couple in view, must be identified to determine if IUI, ICI, or another option offers the greatest balance of benefit over burden.        
    
    
• In Vitro Fertilization (IVF)
  • The Process
    • A woman takes hormones (typically by injection) to stimulate a large production of eggs.
    • Some egg(s) are moved from her body to a lab dish and mixed with a man’s sperm to encourage fertilization.
    • Intracytoplasmic sperm injection (ICSI) may be used to inject individual sperm into individual eggs.
    • One or more resulting embryos are transferred to the woman’s uterus. 
  • Boundary 1: Marriage and Childbearing
    • Using donor eggs or sperm is wrong because two unmarried people are having a child together.
    • It’s doubly wrong if the husband-child and wife-child relationships are intentionally being created unequally.
    • That’s different from redemptively entering into unequal relationships with already existing children (e.g., in second marriages).
  • Boundary 2: Human Lives
    • Preimplantation genetic testing of embryos is wrong if done for the purpose of discarding embryos with unwanted traits.
    • Freezing embryos is wrong since only about 75% (some local clinics) to 95% (top university health centers) of embryos survive the process.
    • “Selective reduction” is wrong because it involves removing/killing embryos or fetuses if more than are wanted are implanted in the woman’s uterus.
  • Ethical IVF
    • Only one or two embryos should be transferred into the woman.
    • One is usually safest for mother and child; however, other factors such as age and the risks of future IVF attempts should be discussed with the doctor.
    • Only the number of embryos currently being transferred into the woman should be created.
    • Since it’s not OK to freeze embryos, extra eggs shouldn’t be fertilized–but they can be frozen so that future IVF attempts won’t require the woman to produce more eggs.
    • IVF Technology redemptively helps to fulfill God’s original purposes: If it’s wrong to conceive a child with a neighbor, then using technology to bring the sperm and egg together doesn’t change that; and if it’s right for a married couple to bring their own sperm and egg together, then using technology to do it doesn’t change that.
  • Lower Risk/Cost Versions
    • Minimal Stimulation IVF (Mini IVF) uses lower doses of ovulation hormones and yields fewer eggs, thereby reducing risk and cost (e.g., Fertility Centers of Illinois–fcionline.com).
    • INVOcell combines sperm and eggs in a device placed in the woman’s vagina, thereby potentially saving lab costs and giving the woman’s body greater influence on the conception process (e.g., Pinnacle Fertility–pinnaclefertility.com)
      
      
• Surrogate Motherhood
  • A woman carries a child to term for someone else to raise.
  • Genetic/traditional surrogacy
    • The surrogate is impregnated by the father’s sperm
    • This violates Boundary 1: God requires that children be created as the biological fruit of two married people.
    • Old Testament examples involve surrogates becoming second wives to the man: e.g., Hagar with Abraham (Genesis 16:3) and Bilhah with Jacob (Genesis 30:4).
    • In these cases, surrogacy is portrayed as manipulation and doesn’t produce the heirs God intends.
  • Gestational surrogacy
    • A couple’s IVF-conceived child is transferred to a surrogate’s uterus.
    • This is unwise: Although the surrogate hasn’t taken the mother’s place genetically, she has done so biologically as the source of virtually all the material that becomes the newborn’s body.
    • By God’s design, it’s difficult for a woman who has endured an entire pregnancy to give up a child, potentially leading to complex relationship problems.
  • Commercial surrogacy
    • Surrogacy is usually (but not always) done for a price.
    • This is wrong: It amounts to selling and buying babies, reducing them to property.
    • Impoverished surrogate women are often exploited in the process.
    • Organs cannot be sold or bought in the U.S., for similar reasons.
  • Rescue surrogacy
    • A woman carries to term an unwanted embryo for someone else to adopt.
    • This is admirable because it saves the life of an abandoned child–no Boundaries of creation are violated since no child is being created.
    • The surrogate mother receives an embryonic child as a gift (ethically it’s an adoption; legally it’s a donation).
    • If the mother plans to raise the child, this is “embryo adoption” (see below); if not, it’s a form of surrogacy.

Alternatives to Creating a Baby

Just because a way to create a baby exists doesn’t mean it’s what God wants for a particular person to do. Being careful not to presume upon God, “instead, you ought to say, ‘If it is the Lord’s will, we will live and do this or that'” (James 4:15). See “The Importance of Prayer” below.

• Adoption
  • The key figures in the Bible were adopted by their earthly fathers: In the Old Testament, Moses; in the New Testament, Jesus.
  • The same was true for many others in the Bible:  For example, Esther, and Samuel.
  • Adoption is the model for our relationship with God:  Because God has adopted us, “God sent the Spirit of his Son into our hearts, the Spirit who calls out “’ Abba, Father’” (Galatians 4:5-6).
  • We also know what it’s like to long for the adoption process to be completed: “We wait eagerly for our adoption as children, the redemption of our bodies” (Romans 8:23).
• Embryo Adoption
  • A couple can go through the entire pregnancy and birthing process.
  • It enables a couple to rescue a frozen embryo who would otherwise be left to die.
  • There are likely over 1 million frozen embryos in the United States alone (all of whom are not available for adoption).
  • Embryo adoption ministries
    • The National Embryo Donation Center: embryodonation.org.
    • Snowflakes Embryo Adoption & Donation: nightlight.org/snowflakes.
• Post-Birth Adoption
  • Adoption of an already-born child can also rescue a child in need of a family.
  • Nearly 150,000 children in the U.S. alone are available for adoption as newborns or as children in foster care.
  • Post-birth adoption support organizations
    • Information and financial aid (grants of $8,000-$12.000): Show Hope (showhope.org).
    • Personal guidance: Faithful Adoption Consultants (faithfuladoptionconsultants.com).
  • Post-birth adoption ministries
    • United States adoptions: Lifetime Christian Adoption (lifetimechristianadoption.com).
    • International adoptions: Nightlight Christian Adoptions (nightlight.org).
• Forgoing Children
  • God specially directs some people not to have children.
  • What Paul explains regarding having a spouse is relevant to having children as well: Not having them leaves one free to serve the Lord in ways that others are unable to do (1 Corinthians 7:32-35).
  • Jesus also commends “those who choose to live like eunuchs [i.e., without reproducing] for the sake of the kingdom of heaven. The one who can accept this should accept it” (Matthew 19:12).

The Importance of Prayer

• So much of faithful medical decision-making involves judgment–for example:
  • recognizing how likely proposed procedures are to accomplish what they promise;
  • recognizing what procedures involve unacceptable risks to the mother or to embryos;
  • discerning whether the couple adopting a child as an embryo is what God intends;
  • discerning whether the couple adopting an already-born child is what God intends;
  • discerning if God’s purposes for the couple do not include child-bearing or child-raising.
• Godly decisions depend on the prayers of both the infertile person and their supporters.
  • God can, but need not, work through technology. Prayer demonstrates that we are trusting in God, not technology: “Some trust in chariots…but we trust in the name of the Lord our God” (Psalm 20:7). It took time, but Sarah came to trust God (Hebrews 11:11).
  •  Sometimes God wants to overcome infertility as an answer to the prayers of the person who is infertile, as in the cases of Rachel (Genesis 30:22) and Hannah (1 Samuel 1:27).
  • At other times God answers the prayers of the spouse of one who is infertile, as in the cases of the spouses of Rebekah (Genesis 25:21) and Elizabeth (Luke 1:13).
  • Yet God may also respond to the prayers of one outside the family of the infertile person—for example, Abraham’s prayers for Abimelek’s infertile family (Genesis 20:17).
  • “Be joyful in hope, patient in affliction, faithful in prayer” (Romans 12:12).

For Further Information

Books

• Basic Questions on Sexuality and Reproductive Technology: When Is It Right to Intervene? (Gary P. Stewart et al., Kregel Publishing Company).
  • A team of Christian leaders provides practical responses to common questions about medical treatment decisions at the beginning of life.

• Why the Church Needs Bioethics: A Guide to Wise Engagement with Life’s Challenges (John F. Kilner, ed., Zondervan, especially Part One)
  • Interacting with a real beginning-of-life situation, several Christian leaders explain wonderful resources the church has available to help families with tough decisions. 

Videos

• “A Biblical Ethics for Today’s Reproductive Technologies” https://www.youtube.com/watch?v=V9gX-40_3C4
  • Author and teacher Scott Rae gives a 30-minute overview of how Christians can wisely approach the use of reproductive technologies in the face of infertility. 

• “Anonymous Father’s Day” https://www.youtube.com/watch?v=fFd94VE–8g
  • The Center for Bioethics and Culture Network presents a 43-minute documentary on the growing practice of people using donor sperm (or eggs) to produce the child they want.

Websites

• The Center for Bioethics & Human Dignity: www.cbhd.org
  • Articles and more from a Christian perspective on a wide range of ethical challenges in health care and biotechnology, including beginning-of-life treatment decisions.

• Christian Medical & Dental Associations: www.cmda.org
  • Position statements and issue overviews from a Christian perspective on many health-related topics, including beginning-of-life decisions