In Vitro Fertilization
Procreation Ethics Series
by Paul Jersild
[1] The expression "test-tube babies" has become familiar to most
Americans since the birth of Louise Brown in 1978. It is a popular
expression for in vitro fertilization (IVF), which literally means
fertilization "in glass," or in a dish outside the mother's womb.
This is the way in which Louise was conceived, and now some seven
years later the world has witnessed hundreds more births through
I'VE It is a procedure which is apparently becoming routine as a
way in which infertile couples can have their own children.
[2] What exactly occurs in this laboratory procedure in which
new life comes into being? What kind of theological and moral
questions does it raise for the Christian? Ought we agree that it
is a gift from God made possible by the breathtaking advances in
medical technology? Or should we be having second thoughts about a
procedure which circumvents the natural way of procreation?
[3] In the pages that follow, we will briefly describe IVF as a
medical procedure and then consider theological and moral issues
which it raises. IVF is but one of many medical procedures which
today are challenging us to rethink the morality of medical care,
particularly at the beginning and the end of life.
Why IVF?
[4] The National Center for Health Statistics has reported
that one of every ten American couples is incapable of bearing
children. About 4.3 million women of child-bearing age appear to be
infertile for one reason or another, and at least two million of
them desire children. IVF is a possible answer for women who are in
this predicament.
[5] There are various reasons for a couple's infertility. IVF is
an option in meeting the following problems:
- When a woman's Fallopian tubes (which bear the egg from the
ovary to the uterus) are damaged or blocked, and tubal surgery is
unsuccessful. This is the common reason for IVF.
- When the number, movement, or structure of the husband's sperm
is abnormal and fails to respond to treatment. In the controlled
environment of IVF some of these problems can be overcome.
- When the reason for infertility is unknown (accounting for
approximately 10 percent of infertility cases). There may be
undetected abnormalities in the eggs or sperm, or other factors
which inhibit fertilization.
IVF as a Medical Procedure
[6] IVF involves a surgical procedure called laparoscopy. At the
proper time in the woman's egg-producing cycle, an incision is made
in her abdominal wall and a forceps is used to secure the ovaries.
A laparoscope, or small telescope with a light, is used to give the
physician a picture of the internal organs and the collection of
eggs from the ovaries. With a long, hollow needle, one or more egg
follicles in the ovaries are gently punctured and the eggs drawn
into a collecting tube. The eggs remain in their follicular fluid
and relatively little damage occurs. Only about 10 percent of the
eggs are lost in this procedure.
[7] The eggs are often allowed to mature for five to six hours
and are then inseminated. Twelve to twenty-three hours later one
can see with a micro- scope the fertilization taking place. After
approximately forty to sixty hours, a four- or eight-cell embryo
has developed; it is time now to implant the embryo in the woman's
uterus. This stage in the IVF procedure is described as "embryo
transfer" (ET).
[8] A transparent plastic tube is used to transfer the embryo
through the vagina and cervix into the uterus. This is a relatively
simple procedure, taking but a few minutes and requiring no
anesthetic. The chances of a successful pregnancy are not good,
however. At the Eastern Virginia Medical School in Norfolk, where
IVF was first successfully performed in the United States, the rate
of success has been just 10 percent when one embryo is transferred.
If three embryos are implanted, the possibility of having a baby is
increased to approximately 50 percent.
[9] Variations in the Procedure What we have just described is
the usual case of IVF involving the egg and sperm of a married
couple. Some couples, however, confront situations which are
leading to variations in the usual procedure. These variations
have, in turn, raised additional theological and moral
questions.
[10] For example, there are cases in which a woman has no
functional ovaries. In such cases the egg of another woman can be
used. This would be the female version of AID (artificial
insemination by donor) in which another male's sperm is used when
the husband's sperm is defective. A further variation of this
practice, just recently proposed, actually avoids IVF; its
particular appeal is that it makes surgery (laparoscopy)
unnecessary. Woman A is artificially inseminated with the sperm of
woman B's husband; at the proper time the fertilized egg is flushed
from her uterine cavity and implanted in the uterus of woman B.
This is called an ovum (egg) transfer. Also possible is embryo
adoption, in which neither the sperm nor the egg are from the
couple, but she bears the child.
[11] Another variation which has received considerable publicity
is proposed when a woman is unable to bear her own child. In this
procedure the embryo resulting from her own egg and her husband's
sperm is transferred to the uterus of another woman who serves as a
"surrogate mother," or substitute bearer of the child. However,
there can be considerable legal problems involved in this
procedure.
[12] The practice of freezing embryos has become common in the
IVF procedure, but it has also raised objections. Should the woman
be feverish at the time of embryo transfer, or should problems
arise in passing a catheter through the neck of the womb, the
embryo can be stored and transferred at a later time if it is
frozen. Freeze-storing is also done when two or more eggs have been
fertilized. This enables the woman to receive an ET at a later time
without submitting to another laparoscopy, should the first ET fail
in producing a successful pregnancy. Those embryos not preserved
are disposed of according to the wishes of the parents.
Theological Considerations
[13] What help can we receive from the Bible on this subject? While
the Bible is authoritative for us, we must be careful how we
understand that authority. For example, some Christians believe
that every social issue can be resolved by referring to appropriate
verses. Unfortunately this often results in an irresponsible use of
Scripture. The world of advanced medical technology raises issues
which the biblical writers never addressed, nor even imagined.
Scripture is important in providing us with a variety of moral
paradigms and a basic moral orientation as we address issues of
this kind, but even here Christians will disagree over what
specific principles one should infer from the biblical witness.
[14] There are those who find scriptural support for the idea of
a "natural order," that is, divine sanction of the natural way in
which procreation occurs, and that it should not be subverted by
such procedures as I'VE There is a divine wisdom in linking the
loving embrace of husband and wife with the act of procreation.
Anything that threatens this unity of love and life threatens to
undo a God-given order.
[15] Others maintain that the Scriptures do not testify to a God
who is the master designer of a static order, but to a God of
history who continually summons human beings to be co-workers in
fashioning a more humane order. If medical science and technology
enable childless couples to realize the blessings of parenthood we
should rejoice that such advances are possible, and recognize that
we are fulfilling our God-given role in gaining dominion over the
world (Genesis 1:28).
[16] A third theological orientation leads neither to a
categorical "yes" or "no" to IVF, but questions whether IVF should
have a high priority. This view asks, "Why have children?" in an
effort to determine the implications of the Christian message for
IVF. It concludes that the responsibility of parents before God is
centered not in child-bearing but in child-rearing. Here is where
faith, hope, and love are daily exercised and where one's parental
stewardship to God and community is carried out. Because the
experience of pregnancy is not essential to child-rearing, and
because IVF may constitute a considerable demand on our medical
resources (a moral argument), adoption should be regarded very
seriously as an inviting alternative to IVF.
Moral Arguments Opposing IVF
[17] The moral concern most often raised about IVF is whether it
dehumanizes procreation. The point is made that introducing human
manipulation brings the techniques of cattle breeding into the
human realm, turning procreation into reproduction. Images from
Aldous Huxley's Brave New World come to mind, in which
factories are busily producing human specimens to suit the desires
of a consumer society; It is argued further that human manipulation
tends to make us view the embryo as a means towards the happiness
of the t parents rather than an end in itself. This is a pragmatic
attitude which loses the I sense of ultimate worth in new life.
[18] Another primary moral concern is the destruction of new
life that occurs , whenever an embryo is disposed of instead of
being implanted in the womb. Many Christians would regard this as
abortion. The practice of freeze-storing is also regarded as
particularly dehumanizing. A stored embryo becomes an object which
is "shelved," to be used at our convenience. A further concern is
whether we are fully aware of the risk of abnormalities to the
future child.
[19] Many moral concerns about IVF are directed at anticipated
abuses. For example, will its use be restricted to married couples,
or to anyone who desires a child in this manner? Will there not be
single persons who insist upon parenting as a right, and request
the services of sperm, ova, or embryo banks for themselves?
[20] A scientific advance is usually a two-edged sword that must
be utilized carefully on the basis of an enlightened public
morality. Many are fearful that we do not have a sufficient moral
consensus to maintain the necessary restrictions on I'VE Not every
scientific and technological achievement we are capable of is
something that ought to be implemented.
Moral Arguments Supporting IVF
[21] The overriding value that would justify IVF for many
Christians is that it makes parenthood possible for couples who
otherwise could not have their own child. Thus it is a
"life-serving" procedure which may well result in great blessing
for those families. The fact that there is human manipulation is
not seen as morally objectionable when it is intended to enhance
family life.
[22] It is argued, furthermore, that possible abuse of any
practice which serves a good purpose is insufficient reason for
discontinuing its use. To be sure, we must exercise the necessary
restrictions that would safeguard the proper use of IVF but
whatever the risks at this point, the good it accomplishes amply
justifies its practice.
[23] Christians will disagree over the seriousness of embryo
disposal. Those who find it necessary to justify abortion under
certain circumstances will probably conclude that the loss of a
limited number of embryos is acceptable when the purpose is to help
a woman bring new life into the world. Others would insist that
every embryo produced in vitro ought to be implanted in the
womb.
Conclusion
[24] How does one weigh the value of a couple gaining their
long-desired child through IVF against the possible dehumanizing
effects of human manipulation in the procreative process? It is not
only a matter of competing values, but also a question of what is
likely to happen in the future - and no one knows for sure. This is
but one of the dilemmas posed by IVF and it is no wonder that
Christians will disagree as they attempt to determine what weight
should be given to these opposing factors.
[25] Since the practice of IVF has already been established and
is clearly growing, it is not likely that it will be prohibited
unless future developments clearly show that the procedure is
detrimental to the child. But most people would probably agree that
it should at least be strictly regulated. One possibility, for
example, would be to restrict it to cases where an infertile,
married woman is enabled to bear a child of her own lineage and
that of her husband.
[26] All variations which simply enable a couple to have a child
- of whatever parentage - would be prohibited. This would mean that
ova and sperm banks and surrogate wombs would not be utilized in
IVF nor would the procedure serve the single person or a
non-married couple.
[27] Christian couples with the problem of infertility may find
themselves considering IVF. They deserve the support and guidance
of their church in arriving at a decision. Clergy should help them
to examine carefully their motives in desiring IVF and to assess
their stability as a couple and their emotional resiliency in view
of the fact that this procedure is no guarantee of success. The end
result may leave them in greater despair than before. In making up
their minds they will want to give serious consideration to other
alternatives, such as adoption.
[28] The above discussion does not exhaust the factors which
people will find important in evaluating IVF but it does point to
some major considerations. A continuing discussion of IVF on the
part of the church and the larger society is necessary if those
values important to us are going to influence the public policies
that emerge.