In-Vitro Fertilization: Study Material and Guidelines
A Study Paper of the Lutheran Council in the U.S.A.
The standing committee of the Division of Theological Studies of
the Lutheran Council in the U.S.A. has requested and received
authorization from the member churches of the council to publish
the following report prepared by the consultation of lawyers,
physicians, and theologians which it commissioned to study in-vitro
fertilization (IVF). On the basis of its review of this document,
the division has concluded that this study makes a worthy
contribution to the ongoing dialogue on this issue. It therefore
commends this report to the churches for study and discussion.
As it releases this document, the division calls attention to
its basic format. The report first defines the procedure of
in-vitro fertilization. This is followed by a discussion of its
medical, legal, and theological aspects. The report then presents
the moral arguments which are most frequently used both to approve
and to reject IVF The conclusions of the consultation itself
regarding in-vitro fertilization are not represented until the
final section of the report under the heading "Guidelines for
Christian Counsel and Pastoral Care' The consultation was unanimous
in concluding that IVF "does not in and of itself violate the will
of God as reflected in the Bible" At the same time, these
guidelines also reveal differing viewpoints held by consultation
participants regarding the restrictions which should govern the
implementation of this procedure.
The standing committee of the Division of Theological Studies
hopes that this report will be helpful to all those who struggle
with decisions and concerns relating to in-vitro fertilization.
The standing committee of the Division of Theological Studies,
Lutheran Council in the U.S.A., commissioned a study of "in-vitro
fertilization" (IVF) in March 1980. The committee agreed that the
topic IVF should be examined as a case study in order to determine
whether there are any specifically Lutheran approaches that could
be applied to it or ethical problems of a similar kind.
Furthermore, the committee felt that the church has an obligation
to deal with such issues before they are decided for us by society
And it is clear that IVF has important implications for our whole
Nine Lutheran experts in the fields of medicine, law, and
theology were appointed to a study committee by the Lutheran
Council's member churches through their representatives on the
standing committee of the Division of Theological Studies. These
nine (later to become eight as one could not continue) were joined
by some members of the standing committee responsible for this
document. All participants represented the American Lutheran
Church, Lutheran Church in America, and Lutheran Church-Missouri
Synod and included:
- The Rev. Joseph A. Burgess, executive-director, Division of
Theological Studies, Lutheran Council in the U.S.A., New York
- Dr. R. John Buuck, president, Concordia College,
- Professor Arlen C. Christenson, law faculty, University of
- Ms. Carol Grant, attorney, Meshbesher, Singer & Spence,
- Dr. Fred J. Hofmeister, gynecologist-obstetrician,
- The Rev. Paul Jersild, dean, Wartburg Theological Seminary,
- The Rev. Lowell H. Mays, director of the Department of Human
Ecology of Madison General Hospital and member of the Department of
Medicine and Human Oncology faculties of the University of
Wisconsin Medical School, Madison.
- The Rev. Samuel H. Nafzger, executive secretary, Commission of
Theology and Church Relations, Lutheran Church-Missouri Synod,
- Dr. Warren Olson, Department of Psychiatry University of
Wisconsin Center for Health Sciences, Madison.
- The Rev. Robert P Roth, Department of Systematic Theology,
Luther Northwestern Theological Seminary, Saint Paul.
- Dr. James H. Thomsen, Department of Medicine, University of
Wisconsin Center for Health Sciences, Madison.
Beginning in September 1981, seven meetings were held over the
next two-year period in Madison, Wis. In trying to "set the stage"
for consideration of the subject, the study committee recognized
that the medical, legal, and theological disciplines involve
different world views, thought processes, and jargon. The
problem-solving method of each discipline was explored before the
committee attempted to do any problem-solving of its own; the
doctors, lawyers, and theologians found some common ground upon
which they could build their thinking and reflections for the
church. All committee members read a large amount of literature and
viewed the latest films about IVF, including a videotape of the
actual clinical laboratory procedure ("Nova:' broadcast originally
January 17,1982, on PBS). The physicians on the committee described
how IVF is done; the lawyers reported on the legal status of IVF;
and the theologians delineated the moral issues presented by IVF An
effort was made to suspend judgment about these moral issues while
additional information was gathered. The study committee heard
tapes of an interview by one committee member with Drs. Howard and
Georgeanna Jones, co-directors of the nation's first IVF clinic in
Norfolk, Va. It heard the pleas of two infertile couples who
expressed anguish over their childlessness while being interviewed.
The committee also sought opinions from interested individuals who
are strongly in favor of the process as well as from those who are
strongly opposed to it.
During the two-year study the participants were often reminded
of the rapidity of change in social attitudes toward developments
on the scientific and technological frontier. They witnessed the
change of IVF from an experimental to a therapeutic process, a more
routine medical practice, and a realistic and available alternative
for infertile couples. New clinics are opening up all over the
world. As one committee member put it:
"I first became curious about IVF in 1972, when 1 heard a
gynecologist speak on the subject. I had the feeling that others
who heard the presentation leaned back, yawned, and dismissed IVF
as a remote possibility, futuristic, or science fiction. I put the
subject on the 'back burner.' In 19811 was in Norfolk. I learned
that the medical school there had the most active IVF clinic in the
western hemisphere and certainly in America. A friend invited me to
tour the clinic and talk to some people involved in the clinical
research and my curiosity was heightened. The Lutheran Council in
the U.S.A. took that which was on the `back burner' and put it `front
and center.' Our LCU.S.A. committee has forced me to do some serious
thinking about LYE Even while the committee met, there were
numerous scientific changes which altered the picture and therefore
my thinking. Because of the rapidity of technological changes,
attitudes which I had concerning IVF had to be readjusted."
Finally, committee members began articulating some tentative
conclusions. While there was agreement that IVF in and of itself is
not contrary to Christian values, there was disagreement about some
of the issues associated with this process. This disagreement was
not suppressed for the purpose of formulating rules to govern
Lutherans contemplating IVF There is always a temptation to create
a synthetic stand on an issue when it involves many different
theological points of view. In some ways, it would be comfortable
to have the church dictate in every situation what is acceptable
and what is not. But it is not in our Lutheran tradition to
establish hard and fast rules to govern each facet of human
behavior. As stated by one of the theologians on the committee:
"Lutherans seek to achieve consensus, but the gospel must be
wrestled with, and uniformity may not be necessary or desirable in
order to be faithful to the gospel. Unity and diversity
are automatically presumed in any theological discussion."
The committee, therefore, decided to summarize its research, to
define areas of agreement and disagreement, and to describe the
reasoning used to justify the various positions set forth. It is
hoped that this material will be helpful to clergy who counsel
couples who suffer from infertility, to couples who want the
church's input as they try to resolve the plight of infertility,
and to professionals who look to the church for guidance in
exercising their baptismal vocations.
A special word of thanks is due the Sichert Lutheran Foundation,
Inc., Wauwatosa, Wis., whose grant enabled the Division of
Theological Studies to conduct a more thorough study than might
otherwise have been possible through Lutheran Council funds
Definitions and Historical Background
On July 25, 1978, the birth of the first "test-tube" baby was
announced. The label "test-tube" baby was a misnomer, since Louise
Brown was actually conceived in a laboratory dish (not a test tube)
through a process called in-vitro fertilization (IVF). "In-vitro"
is derived from Latin and means "in glass." So IVF refers to the
fertilization of an egg outside the living body in an artificial
environment, such as a glass container.
IVF now fascinates the public. Scientists, however, have been
interested in the process since 1878 when a German named W. Schrenk
unsuccessfully attempted to fertilize rabbit eggs in a laboratory
dish. In 1934 Gregory Pincus reported that he had used rabbit eggs
to accomplish what Schrenk had not been able to do. In 1944 Dr.
John Rock of Harvard University mixed eggs from female cadavers
with sperm and reportedly observed fertilized eggs divide.
Dr. Landrum Shettles of Columbia University wrote in 1953 that
he had used some of Dr. Rock's techniques and had induced
fertilized human eggs to grow into a solid mass of cells.
Some people were skeptical about the claimed success of IVF Dr.
M.C. Chang of the Worcester Foundation of Experimental Biology in
Massachusetts was especially concerned, believing that fertilized
eggs which gave the appearance of early embryological development
were actually deteriorating. Chang removed sperm from a male rabbit
and an unfertilized egg from a female rabbit. He combined the egg
and sperm in vitro and then inserted the egg into the womb of a
second female rabbit (which had been segregated from male rabbits).
The second female rabbit became pregnant, proving that IVF had
Following Chang's success, interest in IVF with humans was
quickly renewed. In 1961 an Italian doctor named Daniele Petrucci
claimed the successful accomplishment of IVF with human egg and
sperm, resulting in the development of an embryo. A heartbeat was
detectable in the embryo, which was destroyed after 29 days due to
tissue malformation. When the Vatican learned of Dr. Petrucci's
research, he was pressured into discontinuing it. An editorial in
L'Osservatore Romano announced that IVF violated God's natural
The success of Dr. Petrucci prompted researchers in other parts
of the world to continue investigating LYE Physicians in Melbourne,
Australia, were the first successfully to implant eggs fertilized
in vitro to bring about a human pregnancy The pregnancy, however,
lasted only a short period of time. Meanwhile, Drs. Robert Edwards
and Patrick Steptoe of Cambridge University in England perfected
the IVF process by administering hormones to stimulate the
production of more than one egg per month and by using new tools
called laparoscopes to recover the eggs. As a result, a woman from
Bristol, England, became pregnant and gave birth.
The demand for IVF is growing. Since July 25,1978, numerous IVF
clinics have been established, and a growing number of test-tube
babies, including twins, have been born. For infertile couples who
can afford it, IVF will become a routine procedure in their attempt
to have a child.
Medical Aspects of IVF
The Medical Method
Medical researchers use the "scientific method" to solve
problems. First a hypothesis (what the researcher wants to prove)
is stated. Next experiments are conducted and facts are gathered to
support or disprove the hypothesis. Finally a conclusion is drawn,
based upon the experimental data. The scientific method asks what
is, not what ought to be. The method sounds objective, but even
facts may be viewed differently by different people. For example,
the question whether IVF is safe cannot be resolved by the
scientific method. What one person considers safe, another does
not. It is important to know the underlying factual basis of any
conclusion, even one drawn by a scientist.
Typical Conception Process
Every woman stores hundreds of microscopically small eggs in her
body. Once a month, an egg is released from a sac (ovary) in the
pelvic region. It then travels through a "fallopian" tube. During
sexual intercourse a man ejaculates sperm into a woman. The sperm
travel up the fallopian tube. If a sperm unites with an egg there,
conception occurs. The fertilized egg then implants into an organ
(uterus, or womb) at the end of the fallopian tube. The egg begins
to divide, and nine months later a baby is born.
Some women are born without fallopian tubes. Some have had the
tubes removed after an infection or an ectopic pregnancy (where the
fertilized egg begins to grow in the tiny tube, rather than the
elastic uterus, bursting the tube). Disease itself may destroy the
tubes. Some women are born with tubes that are too small. Others
have been sterilized by having their "tubes tied" and later have
tried to reverse the sterilization, but unsuccessfully. In all of
these cases the egg cannot travel to meet the sperm and be
fertilized. On the other hand, a man's sperm count may be too low
for conception to occur. Or sperm may be "rejected" by the mucus in
a woman's organs due to an immunity problem.
Details of the Procedure
IVF may solve many infertility problems because the egg is
fertilized with sperm in a laboratory dish. The egg does not have
to travel through a fallopian tube in order to be fertilized. IVF
also may eliminate infertility even when the cause is unknown.
Every month a woman typically produces one egg which may be
fertilized. When certain hormones are taken or birth control pills
are stopped, "superovulation" may occur, and many eggs may be
available for fertilization. The result could be a "litter" of
Even if a woman undergoing IVF has superovulated, a single egg
may be taken from her body using a technique called laparoscopy The
egg is removed by making small incisions in the abdominal wall. A
lighted viewing telescope (laparoscope), suction needle, and
forceps are passed through the incisions. The harvested egg is put
in a laboratory dish, where it "matures" or ripens. Fresh sperm is
added to the dish. The egg is then watched through a microscope. If
it has been fertilized and its cells properly divide, it is
carefully returned to the woman's body. She is told to lie
perfectly still for many hours. Her blood hormone levels are
measured for a number of weeks after the egg transfer to see if
there has been a successful pregnancy.
The chance of establishing pregnancy through IVF of an egg is currently around
10 percent. Several eggs may be removed from, and returned to, the body of a
woman who has superovulated in order to increase to 60 percent the chance that
pregnancy will result.
A variation of IVF requires a couple to have sexual intercourse just before
an egg is removed from the female's ovaries. The egg is implanted in her uterus,
and the couple has intercourse again. Conception takes place in the body, rather
than in a glass dish; but otherwise in-vivo ("in life") fertilization is like
Clinics in this country commonly set prerequisites for IVF These
are usually similar to the prerequisites at the first IVF clinic
established in the United States by Drs. Howard and Georgeanna
Jones and located in Norfolk, Va. At Norfolk patients meeting the
following criteria are accepted:
- The couple should have a stable marriage.
- The couple should be childless.
- The couple must be infertile due to an abnormality of the
fallopian tubes, low sperm count, the woman's mucus being hostile
to sperm, or unexplainable infertility.
- The woman's uterus must not be small, bifid (with two cavities),
or otherwise abnormal.
- The woman's hormone levels, menstrual cycle, and glandular
functions should be normal.
- The woman should be less than 35 years old to avoid the
increased probability of chromosome defects that occur during the
- The couple should be in general good health, like any couple who
plan to adopt a child.
- The couple must be able to pay the clinic and must be willing to
follow directions of the clinic's staff
Legal Aspects of IVF
The Legal Method
Many people think that there are laws which contain all the answers
to issues which arise about every subject. In fact, there are no
laws to resolve many disputes, especially disputes regarding
matters as new as IVF And even if there are laws which cover a
topic, they may be subject to different interpretations. Therefore
we can only suggest the probable or possible outcome of most IVF
In the United States there are three branches of government
(legislative, executive, and judicial). Legislators, administrative
agencies, and judges all have the power to create law, subject to
checks and balances. If legislators pass a law, for example, judges
may invalidate it on the ground that it is inconsistent with the
Constitution. What is more, we have parallel federal and state
legislatures, federal and state supreme courts, a president, and
governors. Each system deals with different governmental
Executive agency administrators and legislators make broad
policy decisions after soliciting testimony and investigating
issues. Special-interest groups participate heavily in this process
and have a major impact on legislation and administrative rules.
Judges and juries, on the other hand, are supposed to consider only
one case at a time and decide that case consistently with past
decisions in similar cases (precedent).
However, no two cases are exactly alike. There is a lot of room
for argument about whether one case is sufficiently similar to
another so that the same rule should be applied. Since there are
many judges in this country, there may have been different
decisions in cases that are alike, and lawyers argue that their
position is supported by the weight of authority in addition to
arguing that their position is just.
How do these lawmakers decide what the law should be? It is
possible to identify several different ways legal decision-makers
decide. First, decisions are often made implicitly, without
recognizing that they are being made or explaining how or why. A
court must, in every case, decide whether or not the case before it
is governed by a particular rule. In doing so it is making law by
deciding the parameters of the rule. Often this is done without
much thought or any consideration of method. Legislators, of
course, are under no compulsion to rationalize their decisions.
They may decide on the basis of their own present knowledge and
values, the views of their constituents, the pressure from
organized groups, or for any reason or no reason.
Second, legal decision-makers sometimes use a method akin to the
"scientific method" used by physicians and scientists.
Legislatures, administrative agencies, and courts will seek data on
the impact of alternative rules of law and adopt the rules which
seem best. The U.S. Supreme Court, for example, when it decided
that "separate but equal" education systems segregated by race were
"inherently unequal:' based this decision in large part upon
sociological and psychological data.
Third, lawmakers sometimes simply follow precedents or the
"weight of authority." Courts are prone at least to explain their
decisions in these terms. As we have seen, however, this approach
seldom actually explains the reason for the decision since it does
not examine whether or not the present case is or is not
sufficiently similar to the precedent to be governed by it.
Fourth, legal decision-makers sometimes make decisions using a
method that appears similar to theological exegesis. A court may
seek, through a variety of techniques, to determine the "intent" or
"will" of the legislation as expressed in a law or the "founding
fathers" as expressed in the Constitution. This process is much
like a theologian's search for the will of God as expressed in the
Decisions about the laws are made by several institutions using
various articulated and unarticulated methods of decision making.
For this reason statements about what the law is can seldom be made
in absolute terms. It is necessary to speak in terms of
probabilities. Readers of the following discussion should have this
IVF Is Not Illegal
The law does not specifically prohibit LYE Inmost states there are
laws prohibiting fetal experimentation, and IVF opponents could
argue that these laws cover IVF The argument probably will be
rejected, for it is clear that these laws were intended to cover
experimentation with fetuses that had matured beyond the test-tube
stage. In 1980 an Illinois law encouraged the prosecution of
doctors for child abuse if the "life" of any fertilized egg was
endangered. The law has temporarily halted the use of IVF in
Illinois, but the law is being challenged as unconstitutional.
A blanket prohibition of IVF appears to be unconstitutional
because the right of privacy and the right to decide whether to
have a child are fundamental rights, and fundamental rights are
protected by the Constitution unless "compelling" reasons dictate
otherwise. Even the Illinois concern (over the "life" of any
fertilized egg) would not be considered "compelling" by the U.S.
Supreme Court, which has held that the destruction of fertilized
eggs is not against the law. Thus the decision to abort a fetus
during the first three months of pregnancy is to be a decision by
the mother and her physician. During the second trimester a state
may regulate the abortion procedure only to ensure maternal health.
During the final trimester a state may prohibit abortion, but only
when it is necessary to preserve the mother's health. The Court,
after considering religious views, concluded that we cannot be
certain when life begins, but that there is strong medical,
philosophical, and theological support for the view that conception
is a process over time rather than an event. The interest in
potential human life is important, the Court added, and at some
point outweighs the woman's privacy. During the first few months of
pregnancy, however, what to do with fertilized eggs must remain an
How It Is Done Affects Legal Status
Of course, IVF can be carried out in many situations. As these
situations become less conventional, legal barriers are of greater
If IVF is not necessary to conceive but is desired to screen for
genetic defects or even to control the timing of a pregnancy the
right to IVF seems less fundamental; but it would probably be
protected by the Constitution, much as the right to abortion is
protected regardless of motivation.
If an IVF husband is sterile so that donor sperm must be used to
fertilize the wife's egg, the wife still has certain childbearing
rights, probably protected by the Constitution. What she seeks to
do with the approval of her husband is not too different from
artificial insemination, a procedure that is widely available
When a donor egg rather than donor sperm is required, the
husband's childbearing rights probably would justify IVF under the
If both donor sperm and donor egg were required, however, the
courts might not acknowledge a fundamental right to IVF Adoption,
even through IVF, is more a privilege than a right.
Some states have laws prohibiting payment to a biological parent
in connection with the adoption of a child. In these states a
contract hiring a surrogate mother probably is void. Whether laws
which outlaw surrogate motherhood are constitutional is another
question. It can be argued that if the use of a surrogate mother is
the only way a couple can have their own child, that method must be
protected. On the other hand, courts might hesitate to extend
principles that have their origin in the privacy of two-person
intercourse, If the use of a surrogate mother is unnecessary, of
course, the courts will be less receptive to the idea.
It might be argued that an interest in preserving the integrity
of the family would justify laws limiting IVF to married couples.
But the law presently holds that even single people have some right
to be free from governmental interference with procreative
decisions. It is possible that limiting the use of IVF to married
women would be considered unconstitutional.
One of the few governmental interests that is considered
"compelling" is the interest in protecting future generations from
genetic abnormalities. There are a few laws which prohibit men with
venereal disease and other genetic defects from becoming sperm bank
donors. These laws would apply if sperm were donated to a couple
using IVF The laws also suggest that states may constitutionally
deny ) access to IVF by persons with hereditary and communicable
Before any constitutional challenge can be made, the legislature
must pass a law prohibiting IVF or prohibiting it under certain
circumstances. So far there are few or no legal restrictions
governing IVF, and almost anything is possible. If legal barriers
are erected, they may or may not be invalidated, as indicated
While the government may not easily prohibit access to IVF, it may
reasonably regulate IVF to promote the public welfare. To protect
future generations from genetic defects, a law may be passed which
would require the destruction of eggs developing abnormally, for
example. The Department of Health and Human Services, an executive
administrative agency, has already issued some regulations which
affect all research programs involving humans. These regulations
require that the institution involved study potential risks and
benefits of research, the rights and personal welfare of proposed
subjects, and the need for their informed consent. If an experiment
exposes human subjects to possible physical, psychological, or
social injury, an independent review committee must find that the
risks are outweighed by the benefits to the subject and by the
knowledge to be gained. All subjects must give informed
Recognizing that fetal research has saved thoU.S.A.nds of lives,
DHHS has approved research involving fetuses less than 20 weeks old
where the parents have consented, and an ethical advisory/medical
institution review board monitors the procedure. Risk to the fetus
and pregnant woman must be the least possible, consistent with the
objectives of the research. No money or other inducement may be
offered to terminate pregnancy for the purpose of the activity
These rules supplement laws restricting fetal research in some
Similarly, IVF research is considered vital and may be conducted
with DHHS involvement as long as embryo transfer is attempted only
with married couples upon their informed consent. There are no
rules which govern research with un-implanted fertilized eggs.
Research with implanted fertilized eggs that cannot survive outside
the womb may be conducted to obtain "important biomedical knowledge
which cannot be obtained by other means." The federal government
through DHHS may fund IVF programs and provide Medicaid
reimbursement for IVF, but only if the safety of the technique is
demonstrated (as with animal studies) and the legal
responsibilities of parties are clarified.
If donor sperm is used to accomplish IVF, some states have laws
which require the husband rather than the sperm donor to support
the child, as long as the husband accepted the procedure. The
husband probably would be granted reciprocal parental rights in the
event of a custody battle at the time of a divorce or for
inheritance purposes. If the husband does not know about or consent
to artificial insemination, the situation is murky Only six states
have expressly severed any obligation between the sperm donor and
If a donor egg is used to accomplish IVF, the wife who did not
contribute the egg probably would be treated like a natural parent
for legal purposes just as the husband would be treated in the case
of "donor sperm."
An incredible number of legal questions may arise in the
surrogate mother situation. How can anybody ensure that the
surrogate mother conduct the proper health maintenance during
pregnancy? Can a surrogate mother be forced to give up a child
after birth? Can she exercise parental rights? Does she have any
obligation to support a defective child? These questions and others
may be discussed by contract before conception. Anyone considering
involvement with a surrogate mother, however, should be aware that
it is almost impossible to resolve these issues by contract; and
even contract rights may be almost impossible to enforce.
Every person has a legal duty to exercise reasonable care to avoid
hurting others. Failure to exercise such care is negligence and
subjects the careless person to a lawsuit.
Parents could sue on behalf of a child for injuries inflicted
before or during the IVF process, but only if the child is born
A surrogate mother could inflict injuries on an unborn child and
is legally obligated to use reasonable care to avoid such injuries.
In addition, she must obey contract restrictions (such as a
prohibition against smoking, drinking, and the use of drugs during
pregnancy), or she may be sued.
If a child is born dead or is capable of surviving outside the
womb but does not survive, a "wrongful death" lawsuit may be
Doctors have been sued for mis-diagnosing German measles and
failing to inform parents that amniocentesis was available to
detect genetic defects. Sperm banks have been sued for storing
sperm negligently. Parents have been sued by their own children for
failing to terminate a pregnancy after learning about a genetic
defect. If defective eggs or semen are negligently used or an
abnormally developing fertilized egg is not destroyed, an IVF child
could claim that he or she should not have been born at all and
start a "wrongful life" lawsuit against his parents or their
doctor. Only a few of these suits have been successful, yet the
wrongful life theory may be on the verge of legal acceptance.
When parents sue because a doctor's negligence led to the birth
of a deformed child, the lawsuit is called "wrongful birth." The
negligence may take the form of an unsuccessful abortion,
unsuccessful sterilization, or a failure to diagnose chromosomal
defects in a fetus. The parents may request compensation for the
cost of medical care and support during their child's lifetime as
well as for economic loss and physical and emotional suffering
arising from negligent procedures which led to the birth of a
deformed child, including negligent IVF procedures. In one case IVF
parents were awarded $50,000 for the pain and suffering caused by
the deliberate destruction of an un-implanted fertilized egg by a
member of the hospital staff if the parents had given informed
consent to this procedure, though, they would not have been able to
Informed consent represents the positive value that patients
should share in the medical decision-making process. In view of the
importance of informed consent, IVF doctors typically should
disclose to the IVF patient:
- The availability of effective alternatives to IVF (e.g.,
surgical reconstruction of the fallopian tubes).
- The discomforts and risks of laparoscopy and other segments of
the IVF process.
- That there may be risks to the child which scientists cannot
- The probability that IVF will not succeed the first time or
successive times that it is tried.
- What will happen to sperm, eggs, or fertilized eggs not used in
the transfer attempt.
Once the patient is thus informed, her consent may insulate the
doctor from lawsuits.
In any event, while potential parents may bring many kinds of
lawsuits, there are proof problems (e.g.. that a physician was
actually negligent, or that the negligence actually caused harm)
which may make winning a lawsuit difficult.
Theological Aspects of IVF
The Church and Social Issues
There are Lutherans who for various reasons would question the
appropriateness of the church's addressing the subject of IVF Some
would argue that the church's message relates to our eternal
destiny and cannot be expected to address the various social issues
which come and go. Others would reject this view as unduly limiting
the full meaning of the gospel, but they are nonetheless suspicious
of any attempt on the part of the church to take a stand on social
issues because it may lack the necessary knowledge and expertise
that is needed. Still others note that Lutherans disagree among
themselves on the proper response to many social issues.
This study committee recognizes the legitimacy of many concerns
which Christians have raised. At the same time, the church cannot
abdicate its responsibility to provide moral counsel and direction
to those who quite naturally would seek it. Particularly in the
area of biotechnology IVF is but one of many issues whose
implications for the social fabric of the world are tremendously
complex. if there is a word of moral wisdom to be offered in the
light of such developments, the church should be concerned that
such a word be spoken and heard. The church should make every
effort to use members who are well informed and morally sensitive
to help provide a responsible perspective on whatever subject is
being addressed. The fact that there will be those who disagree
with a stand taken by the church does not remove the responsibility
of the church to address any issue of moral consequence which
affects the lives of its people.
The Theological Method
When we address a moral issue such as IVF, the first requirement is
that we become fully informed about it. Ethical judgments on any
issue cannot be responsible without accurate information based on
careful study This was done by the study committee in the manner
described in the introduction.
In addition to gaining clarity concerning the facts of the
matter, we also bring certain moral and theological convictions to
the consideration of an issue. Since the Scriptures exercise
particular authority in the shaping of those convictions, it is
important to be clear on the appropriate use of the Bible in
seeking moral direction. Some use it as a moral handbook, expecting
to find ready-made and guaranteed answers to every problem we face.
While this leads to gross misuse of the Bible, it is true that we
as Lutherans do find imperatives in Scripture which exhort us to
responsible living and which we want to take seriously. But we
should resist the temptation to find in Scripture an answer or an
imperative which will speak directly to every current social issue.
Luther had an astute observation on this point: "Heretofore I have
held that where something was to be proved by Scriptures, the
Scriptures must really refer to the point at issue. I learn now
that it is enough to throw many passages together helter-skelter
whether they fit or not. If this be the way, then I can easily
prove from the Scriptures that beer is better than wine."
Sometimes two biblical passages seem contradictory. Lutherans
try to avoid both absolutizing and relativizing Scripture. The
truth of the gospel is that it embraces some compelling paradoxes
in reality. For example:
- Although we are saved by grace, we are required to make
appropriate choices based on faith.
- Although God's law is holy, it defines and therefore increases
- Although the kingdom of this earth is God's good creation,
because of the fall it is doomed, and we wait for a new
- Although we are sinners, we are at the same time saints.
- Although Christ is infinite as lord, he is capable of becoming
finite through the sacrament.
- Although we must wait for judgment and salvation, we are already
saved through baptism and our incorporation into the church.
- Although some use the historical-scientific method to criticize
Scripture, it is not history that reveals Christ, but Christ who
reveals himself through history.
When we acknowledge that we must live with paradoxes like these,
we will let Scripture speak as a living word to our situation.
When we talk about the use of Scripture in seeking moral
direction, we should also be aware that one never uses Scripture in
a vacuum. We come to it with certain theological orientations or
stances that have been shaped not only by the scriptural message
itself but by the larger theological and moral tradition of our
church, by the culture in which we have been raised, and by our
Consider the following stances, all found within Lutheranism
— As creatures bearing the image of God, we are to exercise our
creative and imaginative powers in every way that will bring
blessing and improvement to the human race. This may involve
risk-taking, but that is to be expected in a dynamic and changing
world. Scripture itself is not a static truth "above history" but
the living word of God which gives new insight and direction as the
times change. It reveals a changing world that is moving toward its
fulfillment through the redemptive and liberating work of God. That
work should liberate us in the use of our gifts and the world's
resources. Thus we should be willing to venture any scientific and
technological advance which promises a more humane environment.
— There is a divine order inherent to our lives and the world in
which we live. It can be recognized through our reason, for we are
creatures of God, as well as in the witness of Scripture. This is
the concept of "natural law:' which identifies specific structures
that we disregard only at our peril. For example, any attempt to
tamper with procreation, regardless of good intentions, puts us in
danger of transgressing boundaries which are meant to protect us.
Science and technology are not unmitigated blessings but rather
tempt us to play God in setting aside the limitations which are to
govern our lives.
— The Holy Scripture is the normative authority for moral
decisions. To be sure, a proper distinction must be made in its
content between law and gospel. While not a moral handbook, the
Scripture presents God's immutable will in the form of the moral
law. This law encompasses certain orders in creation which are
valid for all times and places. Where there is a clear direction in
God's written word regarding what is right and wrong, this settles
the matter. Recognizing, however, that many problems in life are
not directly addressed in Holy Scripture, one seeks in whatever
moral judgments one makes to remain faithful to the parameters of
God's law as presented in Scripture. This view is related to that
of natural law in its stress upon a moral order, but Scripture
receives greater emphasis than reason, and there is greater
caution, supported by an evangelical concern to avoid legalism,
about our ability to spell out all the implications of the moral
order for our concrete behavior.
As broadly described here, these stances may not be entirely
exclusive of each other, but each one clearly has implications for
a consideration of IVF The first is likely to favor it; the second
to reject it. The third may or may not accept it, depending on how
it is prone to read certain passages in Scripture or what
implications it finds in the notion of a moral order. Even when
people agree on the facts concerning a given issue, they may still
disagree in their moral judgment of it because of differing
theological understandings and moral priorities they bring to
One final word should be addressed to the witness of the
Lutheran Confessional writings. It should be clear that they cannot
be used as a moral handbook any more than can the Bible. We cannot
turn to a chapter or verse for the answer to the questions posed by
IVF In regard to questions of morality, the Lutheran heritage we
share acknowledges that we have our God-given endowments of reason
and moral discernment and that we are to use them responsibly. We
make a critical distinction between law and gospel, which means
that the answers we give to moral questions do not bring us
salvation. That is God's gracious work. Thus we may "sin boldly" in
earnestly trying to be responsible, even if we discover in the
process that we may not have acted responsibly. Because moral
decisions are often filled with ambiguity, it is well for us to
remember that God's grace is sufficient and that we can only trust
in his forgiving mercy With this understanding we can address
current moral issues in a spirit of both confidence and
Moral Arguments Against IVF
The following moral arguments against IVF are intended to
make the strongest case. Obviously persons will give different
weight to various arguments, and not everyone opposing IVF will
necessarily hold to every argument cited.
Pope Pius XII opposed artificial insemination on the ground that it
reduces the sanctity of the family to nothing more than a
laboratory exercise. Some people use the same line of reasoning to
Scripture says that two will become one flesh through the
marriage union. Helmut Thielicke, a Lutheran theologian from
Germany, has observed that it is through this union that a couple
is to be "fruitful and multiply." New life should be created during
a loving embrace between husband and wife. Love and life go
together. This is the natural order or natural law, which has been
designed by God, and humans must respect it.
When a physician uses artificial means to bring about
fertilization, a third party violates the "two-in-one-flesh"
concept. A laboratory has been substituted for a natural
environment. To use such a setting for the conception of life is
dehumanizing. It places more emphasis on procedures and products
than on children, parents, and families. The process could lower
appreciation of human life to a point where it would simply be a
commodity which can be purchased, like any other material item.
Destruction of Embryonic Life
Experimentation was required to develop IVF In the process
fertilized eggs have been destroyed. Most IVF clinics discard only
fertilized eggs which develop abnormally. But it would be possible
to fertilize several eggs with a view to selecting the most
"promising" egg and discarding other healthy eggs. The sex of a
child might someday be selected in this way. Many people would
regard it as "mini-abortion:' believing that human life begins at
conception and that each embryonic cell is endowed with a complete
set of chromosomes, all of the genetic information necessary for
the full and complete development of a new person. The premeditated
termination of embryonic life, whether in vitro or elsewhere,
constitutes a questionable, if not unacceptable, treatment of
Adoption as an Alternative
Must we assume that having one's own child is an absolute good
which should not be denied anyone? Is it not more noble and more
rewarding to adopt a child rather than to have one's own? Two
hundred thoU.S.A.nd American children wait to be adopted. No childless
couple can be told that adoption is a moral obligation, but
adoption does constitute an option which should be recommended. It
is rewarding for the couple, gives a new future to the child, and
makes a significant contribution to the welfare of society.
A remarkable ability to manipulate the environment encourages a low
tolerance level for any kind of suffering or frustration. There are
negatives which we reject as unacceptable; we ordinarily assume
that whatever is required to avoid suffering should be obtained.
But Christians recognize that suffering is not an unmitigated evil
which must be avoided at all costs. The suffering of childless
couples may be edifying in the sense that they will be better for
having taken up some of the reality of what it means to be human.
Suffering is consistent with the Christian experience. Jesus
suffered to redeem humankind, and Christians understand that their
own suffering can be a sharing in the suffering of Christ.
This does not mean that we are to seek out suffering, but it
does mean that we should put into perspective our disappointments
and not be driven to remove them, whatever the cost. Sorrow may
bring strength, and the Christian community may assist those who
suffer and ease their burdens.
An IVF attempt now costs approximately $4,000. Depending upon how
many fertilized eggs are returned to the mother, an attempt will be
successful 10-60 percent of the time, according to reports at the
time of writing. If an attempt is unsuccessful, the procedure can
be tried again and again.
How many clinics, how many medical practitioners, how much staff
assistance, and how many dollars are required to give even
one-fourth of America's infertile women a chance to bear a child?
Should not these resources be devoted to eliminating disease and
starvation in those already born? Basic human health needs are
going unmet. When people in the world are dying because they don't
have the "basics:' such as food, clothing and medicine, it seems
frivolous to devote resources to IVF The significance of needs
beyond the basics heart surgery, brain surgery, emergency and
critical care ) still dwarfs the need for IVF Christians need to
ask if continuing to provide those who "have" with even more is
right, when the plight of those who "have not" is so compelling.
Considering the alternatives, procreation should be seen as a
privilege and not a right.
The Limits of Creaturely Freedom
What we can do and what we ought to do are not always the same,
although there will always be intense pressure to do what we are
able to do.
This pressure will sometimes arise from simple curiosity. The
urge to know is part of human nature. But we must never forget that
our natural curiosity becomes a vice when it is motivated by a
desire for mastery and control of the world rather than an
opportunity to exercise the dominion of stewardship granted to us
by God. Because we are limited creatures responsible to our
creator, it is necessary for us to grant that sometimes Christians
ought not to do all that they can do. Technology is not something
which has to be used. It can become a thirst which recognizes no
Pressure to do what is possible arises not only from curiosity
but also from the desire to benefit others. Even this praiseworthy
motive, however, does not justify any and every deed. The desire to
benefit others may be misguided. Who decides what benefits others?
What if the decision is wrong? There are also bad means to good
ends. The positive duty to help others must be carried out within
the limits of God's will as originally placed in the human heart
and revealed in Holy Scripture. Because we are creatures, there are
limits on the means we can adopt to attempt to bring about good
results. To imagine that we ought to do whatever is necessary to
achieve even praiseworthy aims is to begin to think of ourselves as
gods, as world creators, as those responsible for delivering the
ultimate and final blow against evil and for good. But human beings
are not responsible in this way. Only God is.
The limits of our creaturely freedom must be taken into account
in considering the morality of IVF We are bodily creatures who are
capable of giving birth to children through a physical act of
giving and receiving. It has always been possible in our freedom to
transcend that physical act, as for example in choosing to live a
celibate life devoted to the undivided love of God. Such an
exercise of freedom transcends biological nature without dissolving
it. But it is now possible through the use of IVF to transcend the
sexual act and produce a child in the laboratory. Here we transcend
an old limit and manifest freedom, but we do so in a way which
serves to devalue the significance of the body for our person and
acts. Such an exercise of freedom must finally prove
self-destructive. Indeed, this might be said to be the glory of the
creature created in God's image: the freedom to destroy ourselves
by refusing to accept God's limits to that freedom.
Christians, governed by the first article of the Apostles'
Creed, must be willing to be creatures. This means that we must be
willing at times not to do what we can do. It is for this reason
that IVF should be rejected as a way of overcoming
Hazards to Women
The desire to have a child of one's own is a deep-seated human
desire and is for many women so intense that infertility causes
tremendous pain, frustration, and distress. The elimination of such
anguish is a worthy goal. Yet, much as one might sympathize with
the plight of infertile women, compassion should not lead to the
endorsement of a procedure which not only involves moral
difficulties, but also subjects women to potential physical harm
and a high risk of exploitation.
Health hazards to women are present during a variety of stages
in the IVF process. Superovulation, the production of more than one
egg for fertilization, is often encouraged by the administration of
hormones, a therapy which may produce ovarian cysts. Risk is more
immediate during the removal of eggs by means of laparoscopy, a
surgical procedure which requires a general anesthetic. There also
exists a risk of damage to the uterus during embryo transfer. New
techniques have been developed to monitor a pregnancy; they
probably will be used when a pregnancy has resulted from IVF, and
questions regarding the safety of these techniques have been
While the medical complications of IVF are troublesome, so is
the fact that infertile women are vulnerable and subject to
exploitation from a variety of sources:
- By Physicians
As previously noted, IVF clinics often destroy fertilized eggs that
are developing abnormally and/or require a woman to have an
abortion if the fetus is developing abnormally In either case, for
many this is an unacceptable practice even though this is a
requirement for IVF A woman who wants her own child may consider
this mini-abortion, but may be forced to accept it in order to be
eligible for IVF One can imagine a requirement that "extra"
fertilized eggs be frozen or used for research, although that
requirement would be illegal in many states.
- By Scientists
The anguish of infertile women is being used to seek and justify
massive sums of money for IVF clinics at a time when funds for
general research are limited. However, few such women will be
helped, since the criteria for admission to a clinic are so
- By the IVF Procedure Itself
The technology and language of IVF is such that a woman is led to
view her developing child as an embryo or fetus, terms which do not
imply a relationship. Moreover, bonding between mother and child is
now believed to begin in the womb. Laboratory conception, the
invasive technology used for monitoring an IVF pregnancy, the
tentative nature of that pregnancy, and the emotional anxiety of a
woman whose child has been conceived through IVF could have a
serious impact on the bonding process.
- By the Male Partner
An infertile woman may be subjected to undue coercion, however
subtle or unintended, from a marriage partner with a need for a
child of his "own flesh."
- By the Woman (Self-Exploitation)
The anguish which leads a woman to say, "I will do anything to give
birth to a child:' can also lead her to undertake a host of
impositions and disruptions to her life which are unwise. Personal
heartache may cause her to accept otherwise unacceptable costs and
the emotional stress of a laboratory pregnancy as well as
psychological trauma if IVF fails. She may view herself as a
patient, when she is, in fact, a subject for experimental
technology in that infertility is not a disease or illness in the
usual sense. She may undergo IVF even if she believes it violates
her bodily integrity.
Hazards to Children
Many rights are involved in the decision to have a baby. For too
long the rights of the innocent, the unborn, and the incompetent
have been overlooked. People contemplating IVF must consider risks
to a child so conceived.
Unfortunately, the range of risks cannot be identified with
certainty, due to the absence of any long-range studies about the
process. Some researchers maintain that there is no problem, but
base their opinions on the results of animal experimentation.
Others, who claim that the danger of increased birth defects is not
high, base their conclusions on the health of those children who
have been born after IVF The "sample" of IVF children is far too
small to permit those conclusions! And it ignores the possibility
of delayed reactions. Decades are required to resolve these
concerns; IVF children must be observed. Their physical condition,
especially during the reproductive years, and the physical
condition of their offspring must be studied. Therapies long
thought to be safe, such as thalidomide and diethylstibesterol,
have been discovered to be unsafe. People have begun to ask
questions about amniocentesis; yet this procedure is minor compared
to the chemical and surgical intrusions required by IVF Its effect
on emotional, mental, and social well-being is even more
Problems will undoubtedly multiply if an IVF child is conceived
out of marriage, in a surrogate womb, or with the aid of an unknown
male sperm donor, even a deceased sperm and/or egg donor. We are
now facing the problem that someday frozen embryos may be "banked."
What insecurities might emerge during critical times in the lives
of such children ) at puberty, for instance, or when they become
parents? What anxieties are built into children as a result of
"special" fertilization and gestation?
These fears do not seem unrealistic. Were there not risks, the
medical and scientific community would not go to such lengths to
secure immunity from lawsuits as a result of the IVF process. We
know that hormones may be administered to stimulate extra egg
production. Once fertilized, some of these eggs do develop
abnormally. When the abnormality is obvious, the egg is destroyed.
One can imagine a situation in which the mother is required to
consent to an abortion if an error is made during the IVF process.
Delivery by Caesarian section also increases the potential for harm
to IVF children. The issue of risk should be resolved before IVF is
practiced. We owe it to the children.
Certain means of conception arguably violate God's natural law
These techniques may never be used or realized, but deserve
discussion since they are compatible with IVF.
A woman with healthy eggs may have medical problems so that she
cannot carry a child in the womb. Such a woman and her husband can
engage in sexual intercourse so that conception occurs, but the
embryo will be transferred to a willing third party's womb. That
third party completes a normal pregnancy and is a surrogate or
substitute mother. The child she carries is returned to the couple
upon birth, if a woman with a defective womb also has defective
fallopian tubes, IVF may be necessary. The fertilized egg is then
transferred from the glass dish to the surrogate, rather than
Someday a surrogate womb may replace the surrogate mother. One
can imagine a mechanical device where a fertilized egg would be
nourished and develop over a nine-month period, and that egg could
be fertilized in vitro.
There are 15 sperm banks in the United States. Egg banks or even
embryo banks are possible. Third-party sperm or eggs may be used in
the IVF process if there is something wrong with a couple's sperm
or eggs. An embryo conceived through IVF can be preserved in an
embryo bank when an embryo conceived through natural processes is
Some people say that surrogate mothers, surrogate wombs, and
sperm, egg, or embryo banks discount the highly valued relationship
of husband and wife which, in turn, is part of the order of
creation. The artificial womb additionally may affect the
psychological growth of a child; there would be no interaction
between the developing embryo and the mother. The embryo bank
threatens to change spontaneous creation into a matter of choice.
The process could lower appreciation of human life to a point where
it is simply a commodity which can be purchased like any other
Moral Arguments for IVF
The following moral arguments for IVF are intended to make
the strongest case. Obviously persons will give different weight to
various arguments, and not everyone approving IVF will necessarily
hold to every argument cited.
Blessing of Human Creativity
Pagan tribes thought of their gods and goddesses as projections of
human nature. The Bible teaches, however, that we are created in
the image of God. This means we have powers of creativity, as God
does. We are also free to shape our destinies creatively, for our
welfare and for the glory of God. We have, in fact, been doing that
since the beginning of civilization, developing the arts, sciences,
and social order.
Medicine does not violate natural processes; it assists nature.
We are awed by what we learn about the cell, and we apply that
knowledge to cancer research. In one case the division of cells
destroys life, and in another case cellular division contributes to
the development of life. How can we help but be curious about this
phenomenon? The wonder of creation should not be stymied. The
church should not discourage us from being curious about the
marvelous experiences of our existence.
What humans make artificially is, of course, distinguishable
from what happens naturally, but the artificial is not necessarily
unnatural or against nature. Indeed, it is in the natural God-given
order of things for us to use imagination and intelligence to
improve our lot in life. Research is done so that we can follow
God's order to be fruitful, multiply, and subdue creation.
The Bible says that God put human beings in the Garden of Eden
to work in it and care for it. The only restriction was to avoid
eating from the tree of the knowledge of good and evil. The devil,
through a serpent, tempted Adam and Eve to disobey this
restriction. Adam and Eve freely chose to believe the serpent's
lie. There is nothing in the story that restricts us in our task of
working in the garden. The restriction concerns our relationship
with God, not our stewardship of creation. The restriction is on
how we relate to God, not on technology.
This theme is repeated in the New Testament. With the coming of
Jesus the veil of the temple was rent. No longer were the social,
political, and cultural restrictions of the Jews acceptable. All
precincts of the temple, for example, now were open to women and
Gentiles. No longer was anything secret or sacred in the sense of
being "off limits." There is no limit placed on the acquisition of
technical knowledge, but we must everlastingly decide whether to
use our knowledge for good or evil.
The Limits of Creaturely Freedom
There is no evidence that IVF was developed to satisfy idle
curiosity or for "mastery and control" purposes. It was developed
by people who wanted to help couples in distress. IVF clinical
standards prove that ethical concerns have not been disregarded.
Most clinics have a tremendous waiting list. In the end it is these
patients who must decide whether IVF is a blessing, for that
decision is not simply a matter of consensus. It is a matter of
God-given freedom of choice, to be exercised after looking to the
Bible for guidance.
If life is for God, there may be some kind of obligation to
produce life for him. Some people should not reproduce for a
variety of medical, psychological, and sociological reasons. But if
a woman can produce a healthy egg and she wants to have a child
with her husband, IVF should be regarded as a blessing.
The argument that love-making and baby-making should never be
separated is not persuasive. The use of the laboratory dish in
fertilization is no more depersonalizing than the use of forceps in
birth. In no way does clinical aid intrude on the mutual love and
one flesh union of marriage. To think otherwise would be to deny
the whole medical enterprise; we could use the same argument
against efforts to improve the law and order of society. Indeed,
the loving care of nurse and physician may strengthen the bond of
marriage since everyone involved in the IVF process is working
together to enlarge the Christian family.
Moral Status Counts
Doctors can remove one egg from a woman for fertilization. In most
clinics where several eggs are removed, the same number of
fertilized eggs is returned to the woman. There is no wastage.
Would the destruction of several cells, because they were
developing abnormally or for other reasons, be sinful? The Bible
says that we should not ask whether a cell is living, but whether
it has a moral status. We are fearfully and wonderfully made in the
womb, but we are also baptized. The church does not baptize the
unborn. Their moral status is clearly distinguished from that of a
child or an adult.
Lutherans do not idolize human eggs or sperm. Some argue that if
it is not wrong to destroy either an egg or sperm before they are
united, then it is not per se wrong to discard them after they are
united. The fertilized egg contains only a few cells. It has no
brain or nervous system. It cannot feel anything, and it is not
conscious in any way Such fertilized eggs are destroyed in nature
as well as in the clinical laboratory Every normal female between
puberty and menopause wastes an egg each month that she does not
get pregnant; after puberty every normal male wastes millions of
sperm in sexual intercourse in which contraceptives are used or in
which the woman is not fertile. In fact, IVF is less "wasteful" of
fertilized eggs than nature is. Researchers point out that
experimental study of abnormal fertilized eggs will help us to
understand chromosome defects, including cancer in young women and
genetic malformations. There are great benefits to be derived from
the study of a few-celled organism having no moral status.
Adoption as an Alternative
We cannot presume to say that adoption is better than IVF if
would-be parents yearn for a child of their own, an adoptive child
may be seen as a "second-class citizen." There are too few children
available for adoption now; they should be placed in the homes
where they are most wanted.
Jesus never hesitated to respond to suffering. if doctors have the
ability to relieve suffering, should they remain idle? There is an
abundance of suffering in every life. After using IVF to eliminate
the suffering of some childless couples, there will still be more
than enough suffering to "edify" those couples.
The anguish of infertility cannot be approved as "character
building" anyway. It is too deep to be appreciated by most people
without reproductive problems. It involves one of the most
important decisions in a lifetime. Many childless couples are
simply overwhelmed by suffering and cannot learn a thing from it.
They can never develop a philosophical appreciation of the
Benefits Outweigh Cost
Who is to say that the cost of IVF is not justified? A person who
is not enthusiastic about children? A parent who has been able to
fulfill his or her familial desires? Who is to say that the
emotional need to have a child is any less important - or part of
God's design - than physical needs?
Yet few people have the courage to donate all their money to
charity or the church. While such a vow of poverty might result in
the greatest good, it is rarely permitted by human nature. More
realistic is the process of using some material gifts to increase
personal happiness while sharing other gifts with those less
fortunate. A couple can achieve personal joy by using IVF and, at
the same time, can be extremely generous with their resources.
Hazards to Women: Speculative
Physicians say that IVF creates some small risks for women. There
is a slight possibility that the womb wall will be ruptured during
egg removal. Amniocentesis requires the introduction of a needle
through the abdominal wall into the sac which surrounds the fetus.
Some fluid in the sac is removed. It indicates the genetic status
of the fetus. The risks of amniocentesis are small, but the
benefits are great, for the procedure reveals whether or not a
fetus is developing abnormally. The greatest risk from IVF arises
in the need for general anesthesia. Even that risk is small and one
which most women are willing to take.
Alternatives to IVF create much more danger to women. For
example, new surgical techniques to unblock fallopian tubes carry a
risk of the egg developing outside in a dangerous ectopic (wrong
Birth control involves the long-term ingestion of hormones or
implantation of a device in the woman's body. There have been
problems with diaphragms, and the incidence of blood clots seems to
be higher among older women who smoke and use the pill. Still, the
benefits of birth control outweigh its risks for many women. The
latest research suggests that the pill may protect women from
breast cancer, a hitherto unknown finding. The benefits of IVF are
great; the risks are far more speculative than the risks of birth
control. With bio risks come bio blessings.
It is difficult to see how IVF subjects women to
- By Physicians
A woman may be disturbed about the destruction of fertilized eggs
that are developing abnormally, and such destruction may be
required by IVF clinic rules; but if an abnormally developing egg
is returned to the body, it probably will be aborted by nature's
- By Scientists
IVF is not nearly so profitable as other branches of medicine.
Money for more research is desirable so that new techniques can be
developed, and the criteria for admission to a clinic can be
- By the IVF Procedure Itself
There is no evidence that IVF couples view their developing
children any less personally than other couples.
- By the Male Partner
A new opportunity arises; two people must cooperate to take
advantage of the opportunity; and the opportunity involves more
inconvenience to one of the people than the other. Whenever such a
situation occurs, pressure to seize the opportunity may be exerted
on the inconvenienced person. The problem is not in the
opportunity, but in the situation. As in marriage, the people
required to cooperate must respect each other's feelings.
- By the Woman (Self-Exploitation)
The satisfaction of needs always involves a trade-off. Usually it
requires spending money. Sometimes it requires passing up a good
time. Or it may require some compromise of competing desires, If a
woman decides that she wants to accept the constraints of IVF in
order to have a child, she has made the right decision, for it is a
personal decision based on factors that no one but the woman
herself can appreciate. The law, for example, would not require a
woman to undergo an abortion if she originally agreed to accept
such a recommendation by her doctor, but then changed her mind.
Hazards to Children: Speculative
It is difficult to see what in the IVF process would encourage
birth defects. The hormones which may be used to stimulate extra
egg production are the same hormones already present in a woman's
body. The sperm and egg which unite in vitro are no different from
the sperm and egg which unite in vivo. Amniocentesis does not
disturb the fetus; it merely permits the removal of fluid from a
sac so that doctors can verify that the fetus is developing
normally. A woman's body usually rejects through miscarriage an egg
that is not developing normally, and the same thing would happen
with a defective egg fertilized in the laboratory. In fact, there
have been no IVF-related birth defects reported among several dozen
test-tube babies born throughout the world.
Color television sets may emit radiation dangerous to
those who sit too close. Microwave ovens may emit deadly
radiation, too. Yet at some point we must recognize that the risks
of a new product are too speculative to prevent the public from
enjoying its benefits. Once that decision has been made, the public
has a right to know about any latent or hidden risks; but the
decision whether to accept these risks is one that must be made
individually. The unborn cannot make decisions. Couples must make
conception decisions, and all couples want healthy children. They
have taken the advice of their doctors, who are convinced that it
is a reasonable medical certainty that IVF poses no identifiable
hazards to children.
"Parade of Horribles"
IVF, like all scientific breakthroughs, is subject to abuse. Perils
and difficulties, however, should not nullify a course of action
which has proved to be a blessing. Hypothetical dangers have not
invited the wrath of God. Adam and Eve's expulsion from the garden
of Eden, the subsequent flood, and the scattering of people from
Babel seem to indicate a kind of judgment against arrogance. But
the judgment is really against the abuse of God's gifts and not
against their proper use. Abusus non tollit usum: abuse does not
IVF opponents can arouse much passion and prejudice by confusing
IVF with "surrogate mothers:' "surrogate wombs:' and "embryo
banks." Some people believe that if a medical problem with the
fallopian tubes justifies fertilization in an environment outside
the natural mother (test tube), a medical problem with the womb
justifies gestation in an environment outside the natural mother
(surrogate mother). In any event, a surrogate mother can accept an
egg fertilized in the body of the natural mother, without using IVF
An argument against surrogate mothers is an argument against
surrogate mothers, not an argument against IVF Similarly, concerns
about the use of "donor sperm" or "donor eggs" are directed at
something other than the IVF process.
Sperm banks already are widely used by women whose husbands who
have a medical problem which makes conception impossible. But there
will be people who become upset if donor sperm is used to
We must always bear in mind the risks of research, but we should
never abandon it for fear that we are playing God. Here, with
Luther, we can sin bravely or boldly. Only when we think we can
create from nothing and redeem sinners do we play God. God requires
us to choose between good and evil. We cannot avoid this choice by
curtailing research or clinical practices which strengthen family
Guidelines for Christian Counsel and Pastoral Care
For two years the members of this study committee have examined
the legal, medical, and moral aspects of IVF As Lutherans we have
sought guidance and direction about this complex and sensitive
issue from the Holy Scriptures interpreted from a perspective which
carefully distinguishes law and gospel.
The committee has unanimously concluded that IVF does not in and
of itself violate the will of God as reflected in the Bible, when
the wife's egg and husband's sperm are used. All committee members
believe that marriage partners may in good conscience consider
using IVF to conceive and give birth to a child. We believe that
this procedure can in certain circumstances offer the blessings of
parenthood to would-be loving parents who suffer from infertility
for a variety of medical reasons. The creative intervention in
procreation required to accomplish IVF is consistent with the
biblical injunction to "be fruitful and multiply and have dominion
over the earth" (Genesis 1:28).
In coming to this conclusion, all members of the committee agree
that there are a number of important issues which must be
considered before making a decision to employ IVF Not all members
of the committee agree, however, on whether these issues are
decisive. Noting areas of disagreement, the committee offers the
following guidelines for Christian thought and pastoral
- 1. Some committee members hold that IVF is unobjectionable only
when it is carried out subject to two limitations:
a. Because the biblical injunction to be fruitful and multiply
was given by God to a man and a woman united in the one flesh union
of marriage (Genesis 1:28; 2:21-25), only the sperm and egg of a
man and woman united in marriage may be employed. Any use of donor
sperm or eggs involves the intrusion of a third party into this
one-flesh union and is contrary to the will of God. For the same
reason surrogate wombs must not be used.
b. Because the unborn are persons in God's sight from the time of
conception (Job 10:9-11; Psalm 41:5; 139:13-17; Jeremiah 1:5; Luke
1:41-44), all fertilized eggs must be returned to the womb of the
woman. Any experimentation with, destruction of, or storage of
unneeded or defective fertilized eggs fails to accord respect and
reverence for new life brought into being by God at the moment of
conception and is contrary to his will. The same considerations
preclude any agreement to permit the interruption of an IVF
pregnancy for any reason other than to prevent the death of the
Some participants believe that these factors, while deserving of
careful consideration, should not necessarily limit the use of IVF
They state their concerns as follows:
a. When properly motivated, the use of donor sperm or eggs, or
even surrogate wombs, does not violate the sanctity of marriage.
But the problems of donors and surrogates are not absolutely
insurmountable, and if all the sociological and legal complications
can be resolved, the contribution of a third party may strengthen
the Christian family.
b. While experimentation with, destruction of, or storage of
unneeded or defective fertilized eggs should not be done for
frivolous reasons, it may be justified by the need to avoid birth
defects or for other good reasons.
Between these positions there is a range of opinion about the
situations in which IVF is appropriate.
- Caution needs to be exercised so that couples use IVF to
fulfill God's will and not to fulfill a hedonistic
(pleasure-serving) or a narcissistic (self-serving) appetite.
- Infertile couples must confront and forthrightly deal with
the nature of human suffering. Parenthood is a gift of God, and
couples should remember that conception and parenting is a
For their part, pastors need to be aware that human suffering
(which may be quite different in regard to infertility compared to
other forms of suffering) needs to be dealt with forthrightly.
Human suffering is part of the human predicament, and therefore
pastoral ministry will be offered to support people with their
share of pain. Scriptural references to God's concern for the
childless may help people recognize God's desire that the gift and
heritage of children be enjoyed. Human frailty, however, may
interrupt this normal desire and consequently individuals, in
wrestling with their humanness, may need unique pastoral care.
- Before IVF is employed as the therapeutic remedy for
infertility, other alternatives (such as fallopian-tube surgery and
adoption) should be explored. This recommendation is not made
because of negative feelings about IVF, but because other
techniques might be or become simpler, cheaper, and more
- The strength of a marriage, the psychological balance of
husband and wife, and their ability to celebrate as well as to cope
with disappointment must be assessed.
- Infertile couples must be thoroughly informed before they
consent to participate in the IVF process.
- Couples must responsibly consider the financial obligation
which IVF entails. It would be unwise for a couple to deplete their
resources in order to have a child so that they would be unable
properly to care and provide for the offspring when born.
- Scientists and clinicians involved in infertility therapy
deserve counseling and support as they deal with the issues which
arise during the IVF process. They must remember that they have a
special role to play in assisting creation and should understand
that the process deserves respect and awe. They should offer
counsel to prospective users of IVF and safeguard against
- Research about infertility constitutes continued stewardship
of God's mysterious creation. It can diminish pain and suffering
and bring peace. Researchers ought to be reminded that they are
participating in God's creative processes and are responsible for
possible misuse of those processes.
- The Christian community has a responsibility to the
infertile. Through its liturgical life the care of the people of
God may extend not only to the joy of birth but also to the pain of
infertility and the celebration which may be shared within the
context of the body of Christ as conception takes place. It should
therefore not to be considered unusual if intercessions are made
for those who suffer the pain of infertility and childlessness as
they seek to fulfill God's will and also as some live with
handicaps. Prayers may be said, liturgical blessings sought, and
counsel from the Scriptures and the wisdom of the church applied
when persons wrestle with the struggles of creation. Pastors would
be wise also in the judicious use of occasional-service rites which
may support those who are childless as they too seek to fulfill
- Those who regard past decisions about IVF as contrary to
God's will should be reassured of the forgiveness acquired for the
sins of the world in Christ's suffering, death, and
- Counsel for clergy. The clergy of the Lutheran Church will
be sought by thoughtful Christians for spiritual advice on in-vitro
fertilization. An understanding of the issues involved in in-vitro
fertilization is essential to provide for competent pastoral
The clergy need to recognize that the pain of infertility for
some is greater than for others. Because the desire to be parents
is intense, many couples will go to great lengths in order to share
in the gift of parenthood. The clergy need to be mindful that they
may assist some couples in thinking through their financial
resources and their motives before engaging in IVF.
Pastors need to remember that IVF is not automatically a remedy
for infertility and therefore the stress of infertility may remain
in a marriage. Furthermore, pastoral ministry should help a couple
assess the strength of their relationship before they decide on IVF
as a remedial activity. Disappointment may be hard for a couple to
tolerate, and the marriage needs to be strong. On the positive
side, a similar kind of assessment needs to be made in order to
assist the couple in deciding whether their marriage is one into
which a child can be born and adequately cared for.
Pastoral care of medical scientists, clinicians involved in
infertility therapy, and those who support clinical intervention
should also be offered. Congregations whose members are researchers
and clinicians need to celebrate with those individuals the
vocation which such a priesthood involves and these individuals
deserve pastoral support as they assist in the building up of the
body of Christ and God's continuing creation. In addition,
researchers are often disappointed, and clergy need to be mindful
that research is not always steady progress. In every case the
clergy should be ready to offer counsel and support to those in
research and development.
Pastoral care should be offered not only to the female
undergoing IVF but also to the male who may have questions and
emotional concerns related to his involvement in the provision of
sperm. The pastor should be ready to be an advocate in behalf of
the patient when this is needed. At times it might be necessary for
the pastor to be in conversation with clinicians to help interpret
vocational questions, needs, and the human spirit to the clinician.
On the other hand, the clergy may also be a broker in the clinical
context, making sure that couples seeking IVF are adequately
informed and comprehend what they are being told.