Christian Guide to IVF

| Trying to Conceive guide |

Our focus on this page is In-Vitro Fertilization (IVF), for the broader discussion on other ways to support conception and have a healthy pregnancy, please see our page Trying to Conceive. Most of these other methods are not as difficult to navigate while protecting the lives conceived in the process as IVF, and many of them offer a very high chance of success depending on your situation. If you are considering IVF, we would encourage you to explore some of the methods mentioned on this other page first.

Background

As I mentioned in our post for Father’s Day, Monica and I had a fertility scare early in our marriage which led me to research IVF, among other infertility treatments. In researching IVF, I found that the typical process of IVF posses some meaningful risks to the embryos conceived in the process. This is important because we have found that both science and the Bible affirm that fertilization (conception) marks the beginning of a person’s life. You can see some discussion of this in our post for Mother’s Day; we have more research on this topic that we hope to release over time.

Because the IVF process often encourages us to disregard the significance of conception, navigating this process as a Christian is very difficult. This guide is meant to help couples considering IVF to make informed decisions about:

  • Whether to do IVF,
  • The kind of IVF they’ll do, and
  • The decisions they will make along the way.

In particular, the goal is to guide you through IVF so as to protect the lives conceived in the process. Because I’m not a reproductive endocrinologist, I promise to reference studies when appropriate.  My goal is to help you make informed decisions along the way that protect the lives of our children conceived in the process.

The Typical IVF Process

Before discussing the typical IVF process, I briefly want to mention that there is another approach to IVF that is far simpler to navigate while protecting the children conceived in the process.  I will discuss that method toward the end of this guide but let me start with an overview of the more typical approach to IVF.

As an overview, the standard In-Vitro Fertilization (IVF) process involves the following steps:

  1. Harvest: The wife’s eggs and the husband’s sperm are harvested.
  2. Conception/Growth: The eggs are fertilized with the sperm such that multiple conceptions occur, these conceived children are then allowed to grow and develop in a controlled environment at the clinic.
  3. Implantation/Freezing: Some of these conceived children (embryos) are then chosen to be implanted in the mother’s womb. The ones that are not chosen to be implanted are frozen to later be thawed and implanted in another cycle of IVF.
  4. Selective Reduction: In some cases, the number of children in the womb after implantation may be reduced using a procedure such as Dilation and Curettage (D&C).
  5. Frozen Embryos: After going through the first cycle of IVF, the couple may then choose to thaw and implant another frozen embryo in a second (or third etc.) cycle of IVF. The couple might eventually decide that they do not want to do another cycle of IVF. If there are any frozen embryos at this point, they must decide what to do with these children.

Since we know that fertilization (conception) marks the beginning of a person’s life (we will discuss this more thoroughly in the future but see a brief overview in our Mother’s Day post).  Because of this, whenever multiple eggs are fertilized, multiple children are conceived.  Accordingly, this typical approach to IVF can be very difficult to navigate so as to protect the lives conceived in the process.  There is a more recent approach to IVF that I mentioned before which uses frozen eggs (i.e. prior to conception) rather than frozen embryos (i.e. after conception).  It does not begin by conceiving multiple children. This makes it a far easier approach to navigate and is overall safer for the children conceived in the process. At the end of this guide I will discuss this option further, but for those couples who are planning to do (or are already doing) the more typical version of IVF, I will talk through this process first.

In discussing this approach to IVF, we will focus on identifying where it might encourage us to disregard our responsibility to the lives conceived in the process. We will then talk about how to navigate these situations so as to protect these lives. This isn’t meant to be a list of rules to follow but a guide to encourage us to honor God with our choices. As I will mention throughout and emphasize at the end, morality is always a matter of the heart. If our heart is in the right place, the decisions that flow from that will be good.

We will start by talking about selective reduction including what it is and what are its implications for the child who is selectively reduced.  Then we will discuss the decisions that the couple must make along the way regarding implantation and fertilization (conception).  We’ll bring it home by talking about how the right approach along the way can save us from having frozen embryos once we’re done with IVF.  We’ll also discuss what couples can do if they do find themselves there, with frozen embryos. As I mentioned earlier, after we discuss this approach to IVF, we’ll talk about another approach to IVF that is easier to navigate and is safer for the children conceived in the process.

Selective Reduction

First, I would like to address selective reduction.  Allow me to give a little context for this step.  It is not always a part of the IVF process.  If the couple chooses to implant more than one embryo at a given time, then it’s possible that mom may have a multiple-pregnancy (i.e. twins, triplets, etc.).  Multiples have a higher risk for miscarriage and carry an increased risk for the mother as well.  Because of this, a doctor might suggest selective reduction. To put it simply, selective reduction uses the same procedure as an abortion (i.e. a Dilation and Curettage) with the same intended effect (to remove the baby from the womb). Because it operates after conception to take the life of a conceived child, selective reduction simply cannot be an option.  Thankfully, navigating this issue isn’t difficult.

The good news is that it’s easy to avoid selective reduction in the IVF process.  At the onset, simply let your doctor know that selective reduction is not an option for you, and they should respect that.  As we’ve mentioned, when we acknowledge that the baby’s life begins at conception and believe that we have a responsibility to protect each life from the moment they are conceived, then the decisions that flow from that will help us navigate the issues in IVF, including this one.  When deciding how many children to thaw and implant in a given cycle of IVF, we would do so with the hope and prayer that each of these children survive implantation.  For example, we might choose to only thaw and implant one (or, perhaps two in the case of twins) so that there isn’t any undue risk on the mother or the children when implantation is successful (prayerfully).  As a result, there’s no need for selective reduction.

Implantation

IVF clinics have several ways to estimate the risk of birth defects for an embryo or the risk that an embryo will not survive implantation.  This can be done with morphology ratings or a pre-implantation genetic screening.  Some clinics may suggest that the embryos with a lower chance of survival or a higher risk of birth defects should not be implanted for these reasons.  However, let’s not forget that child is already alive, and they deserve every chance to continue that life.  Choosing not to implant a child because they may not survive or because there is a risk of birth defects carries the same implications as selective reduction, taking the life of a child after conception. These risks are only that, risks.  We must provide each conceived child the best chance to survive while we hope and pray that the child survives, and the pregnancy is healthy. Whenever we thaw an embryo in IVF, it must be with the intention to implant that embryo. Just as we said with selective reduction, we might choose to only thaw one (or, perhaps two in the case of twins) so that we are able to implant each child that’s thawed without undue risk for mom or baby when that implantation is successful.

Fertilization (Conception)

As a brief aside, I’d like to emphasize I’m talking about the typical approach to IVF here. I mentioned earlier that there is another approach to IVF that doesn’t have this same issue and that is overall safer for the baby.  I will discuss that method below and focus on the more typical IVF method here.

Perhaps the most difficult issue to navigate comes from the more general context of the typical IVF process. You may recall that this process begins by fertilizing multiple eggs. Since fertilization (conception) marks the beginning of the baby’s life, several lives are conceived right at the beginning of the process. As a result, the IVF process is hazardous, full of opportunities to disregard the value of each of these precious little lives. However, as with every matter of morality, we win the battle in our hearts first.  When we acknowledge that the baby’s life begins at conception and believe that we have a responsibility to protect each life from the moment they are conceived, then the decisions that flow from that will help us navigate this issue.  All our hope, prayer, and effort must go into ensuring that each and every child conceived in the process of IVF is born healthy. While we cannot control the outcome, we must do what’s within our power to do.

Because there is a substantial cost to each IVF cycle, an IVF clinic will often encourage couples to fertilize as many as 15 eggs at the start of the process, conceiving 15 children. The reason this number is so high is that they estimate how many will survive thawing, how many will implant, and how many will ultimately be born.  While I can understand the logic of trying to be efficient with the incredible amount of time and money that goes into IVF, that isn’t our only goal. When deciding how many eggs to fertilize, we must do so with the hope and prayer that each of these children survives the process and is born healthy.  So, if we start by conceiving 15 children, then our hope, prayer, and plan must be to safely have and raise all 15. Even if you’re a fan of big families, this number is probably more than any couple plans to have.  For most couples, they would likely choose to fertilize a fewer number of eggs in an IVF cycle. For example, if you would be happy to have five kids then have five, that is, conceive five.  If you’d be happy to have three kids, then conceive three (fertilize three eggs).  While this may be less efficient from the standpoint of cost and time, our aim is to be considerably more careful with the more precious treasure – the children conceived in the process.

Taking the right approach in this step will also prevent the situation in which many couples find themselves once they have completed their IVF cycles and must decide what to do with the remaining children that are still frozen.  Let’s discuss that situation further.

Frozen Embryos

As we discussed in the previous section, in this approach to IVF, a couple is often encouraged to conceive as many as 15 children at the start of the process. Since most couples don’t intend to raise 15 children, this means that, once they are done, they must often decide what will happen to those children who are still frozen.  As we discussed in the last section, if we have the intention and hope that every child conceived in the process is ultimately born healthy, this situation can be avoided.  For example, if we were happy to raise four children then we would start the process by conceiving four with the hope that all four are born healthy. So, if the first three pregnancies are healthy and there is still one frozen embryo left to implant, we are ready, excited even, to have that fourth child. This dilemma would never be an issue because we always intended and desired to raise every child we conceived. For those who find themselves in this situation though, with more conceived children frozen than they want to raise I’d like to talk about this further.

If the couple does not choose to implant the child in another cycle of IVF, they have the option to give the frozen embryo to another infertile couple (known as embryo adoption). Again, we must do so with the right heart that recognizes each of the frozen embryos for what they are – our son or daughter.  Essentially, our guiding principle in making this decision should be to make it with the same sense of responsibility you’d feel for any other child.  If you choose to put one up for adoption (i.e. through “donation” to an infertile couple), understand the process and feel convinced that your child has the best chance at survival. We must ensure that they will be implanted, will not be “selectively reduced”, and will, hopefully, have a healthy pregnancy and a happy life.  Admittedly that is a difficult task, but it is exactly what we would do before allowing any of our children to be adopted and this situation is not an exception to that.

If the couple doesn’t want to put the baby embryo up for adoption, they might choose to move forward with implantation. While we might end up with more children than we originally intended, we can take courage from what Solomon said in Psalms 127, “Behold, children are a heritage from the Lord, the fruit of the womb a reward. Like arrows in the hand of a warrior are the children of one’s youth. Blessed is the man who fills his quiver with them! He shall not be put to shame when he speaks with his enemies in the gate.” (Psalms 127:3-5). Of course, it’s important to be mindful of how many are implanted at a time so that we don’t risk the life/health of mom or baby.

Some clinics will present couples with a third option, to allow the conceived children to thaw, ending their life. An article from Parenting magazine discussed this option and the effects that it had on parents. In this article, a professor of obstetrics at Duke University acknowledged that life begins at conception when she said, “When you’re pouring your money, your heart, and your soul into creating an embryo and creating a life, the last thing you want to think about is how you’re going to dispose of it.”  A study cited in the article found that one in five couples (20%) who do not want to have any more children still decide to keep their remaining embryos frozen indefinitely despite the costs of doing so. This article is filled with this kind of confusion, including parents holding ceremonies to show their respects when they thaw the child or saying they feel a loss but being unwilling to call it grief.  For those who find themselves in this situation, I long to help you prevent the pain and confusion that ignoring conception’s significance here causes in our souls. Let’s give each child the best chance at a happy and healthy life, choosing to implant them or allow them to be adopted.

We want to acknowledge those couples who have been in this situation and may have chosen differently. Please know that any weight of shame or guilt is not yours to bear; there is “no condemnation for those who are in Christ Jesus” (Romans 8:1). As we discussed in our post for Mother’s Day, knowing that it was real can allow us to take time to grieve and find comfort. Having lost two children to miscarriage, we know how difficult this process can be and how hard it is to find comfort.  The question on my mind the most was, will I ever see them again?  I found comfort in what David said in about his baby boy who passed, “I shall go to him, but he will not return to me.” (2 Samuel 12:23) We will see them again, each and every one. Until that day, we can take comfort that God is caring for them.

The Heart of the Matter

While I don’t believe that it’s impossible to navigate these issues and reject these opportunities to disregard each embryo as a precious child, it is a challenging situation where we must be vigilant to check our heart motivation behind each decision we make in the process.  We must value each life we chose to bring into this world at conception as a precious child in need of our protection to survive. In the natural process of becoming pregnant we are not given a choice to implant after conception, but this approach to IVF allows us to conceive a child and then choose not to implant that child.  Because of conception’s significance, each child conceived through IVF must ultimately be implanted so as to give that child the best chance of survival (even if that implantation is with an adoptive mother).  To put it simply, a decision to conceive must be viewed as a decision to implant.

Beyond this maxim, it’s important to remember that there are many risks associated with IVF to the conceived child from low survival rates for thawed embryos to low successful implantation rates to low birth rates.  Some couples may decide that IVF is not an option for them because it poses too great a risk to the children conceived in the process regardless of the decisions they can make along the way. Making this decision and navigating these risks is an issue of the heart.  In our hearts we must value and seek to protect each embryo in the same way that we value any other child. Every analysis of the risks involved in IVF must be consistent with that perspective.

A Safer IVF (Utilizing Egg Freezing)

I would like to take a moment to discuss a more recent approach to IVF that is not as common but is far easier to navigate and is also a bit safer for the children conceived in the process. Through a process called egg freezing, this approach to IVF does not rely on frozen embryos (e.g. after fertilization) but on frozen ovum (eggs prior to conception). As a result, the process for this approach to IVF is different than the standard process outlined above.  Here is a brief overview of this process:

  1. Harvest/Freezing: The wife’s eggs are harvested but are not fertilized (i.e. conception does not occur at this stage).  These unfertilized eggs are then frozen, often through a process called vitrification.
  2. Thaw/Examination: A small number of unfertilized eggs are thawed and examined. The egg that appears the healthiest (i.e. have an excellent morphology) is then selected for fertilization (conception).
  3. Conception/Implantation: The thawed egg that is selected is then fertilized with the husband’s sperm and the conceived child is then implanted.

It is important to emphasize that the eggs are frozen prior to conception.  The cells that are frozen are called oocytes (or ovum) and are the female equivalent of sperm. Unlike choosing not to implant a thawed embryo (i.e. after fertilization), choosing not to use a thawed oocyte does not end a life, because it is prior to fertilization (conception) and thus prior to the beginning of the child’s life.  So, when the couple has decided that they are done with IVF, any remaining frozen eggs can be thawed and disposed of.

One of the primary benefits of this approach is that conception does not occur until you are ready to implant each egg that is fertilized.  As a result, there is a very immediate plan for implantation for each child that is conceived.  The hazards of the typical approach to IVF are in large part a by-product of separating the decision to conceive and the decision to implant. Freezing the eggs prior to conception reduces that separation. 

Further, with egg freezing, since the eggs are frozen and thawed prior to fertilization (conception), this approach also eliminates the thaw survival risk for embryos. In the typical IVF process, there is a risk that when one of the baby embryos is thawed, they do not survive the process. While the frozen egg (oocyte) may not be viable after being thawed, this does not present a risk to a child’s life because it is prior to conception. Overall, that makes this method safer for the babies conceived in the process by avoiding the thaw survival risk.

As for the effectiveness of this method of IVF, studies (see footnotes 2 through 6) have shown that oocyte vitrification is just as likely to produce healthy pregnancies as fresh embryo transfers like those used in the initial cycle of typical IVF. The only challenge with IVF using egg freezing is that it is less widely available.  However, because it is simpler for the couple to navigate, eliminates the possibility of having frozen embryos at the end of the process, and is safer for the babies that are conceived, I would encourage the couple considering IVF to find a clinic that offers the option to do IVF with egg freezing even if some travel is required.

Former IVF Couples

So far, we’ve focused our comments and advice to those couples who are considering or may in the future consider IVF due to fertility challenges. I would like to take some time to acknowledge that there are undoubtedly some couples reading this who have done IVF in the past.  It’s absolutely possible that, in reading this, you feel comfortable that your decisions in IVF were made with the right heart.

It’s also possible that as you read this you learned something new that might communicate a sense of guilt or condemnation. Please know our desire couldn’t possibly be further from this. If you have been through IVF and have found yourself reluctant to implant an embryo at the end of the process, please understand that I know this is a difficult topic to even consider. Please know that any weight of condemnation is not yours to bear.

God’s unreserved love and acceptance of us can help us to release this weight. That weight has already been borne for you by Jesus on the cross and God has only love for you. Like we discussed in our post on Mother’s Day, I hope that knowing it was real might allow you to grieve and find comfort. We’ve found comfort in knowing that God is caring for the children we lost and that one day we will see them again. Please know that you are loved.

If you are in the IVF process now and find yourself with more children than you were planning to have, God is ready to strengthen you through the challenges. He sees you as capable, having entrusted them to you. I long to save you from the pain that ignoring conception’s significance will bring.

[1] Beil, L. (2009, August 20). What is the fate of leftover frozen embryos? Parenting. Retrieved from https://www.today.com/parents/what-fate-leftover-frozen-embryos-wbna32489239

[2] Gunnala V, Schattman G. Oocyte vitrification for elective fertility preservation: the past, present, and future. Curr Opin Obstet Gynecol. 2017;29(1):59‐63.

[3] Cobo, A., Serra, V., Garrido, N., Olmo, I., Pellicer, A., & Remohi, J. (2014, October). Obstetric and perinatal outcome of babies born from vitrified oocytes. Fertility and Sterility, 102(4), 1006-1015.

[4] Wood M. Vitrification of oocytes. The Obstetrician & Gynaecologist 2012;14:45–49

[5] Cobo, A., & Diaz, C. (2011, August). Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials. Fertility and Sterility, 96(2), 277-285.

[6] Trokoudes, K., Pavlides, C., & Zhang, X. (2011, May). Comparison outcome of fresh and vitrified donor oocytes in an egg-sharing donation program. Fertility and Sterility, 95(6), 1996-2000.