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February 1st, 2019

Week 9: Infertility

Core Seminars -- Marriage Week 9 

Infertility

What if We Can’t Have Children? 

In last week’s marriage core seminar, we considered the blessing of having children. Yet it isn’t always so straightforward. Often, love and marriage don’t automatically lead to a baby in the carriage. So this week we want to consider the topic of infertility -- what if we can’t have children?

Now as we turn to this topic, I want to make sure we do this with appropriate sensitivity. Don’t look at this topic clinically, divorced of the people involved, but instead with an appreciation of the deep personal challenges that people are going through as they consider them.

Why should you care about this talk? If you are currently a married couple struggling with infertility, please let me suggest some guidelines for you to consider. If you are a married couple that has not thought about infertility before, or if you are serious dating or engaged, please see our discussion as principles to consider before you may or may not face this situation. And if you are in another category, please see this talk as a way that you can learn to mourn with those who mourn, as our church covenant calls us to do. Perhaps it can be a way for you to prepare yourself to handle a similar situation of hope deferred in the future.

Our goal this morning is to offer a Biblical framework as we consider the topic of infertility. We will approach the topic as follows:

  1. Biblical principles regarding childbirth and infertility
  2. Assisted Reproductive Technologies
  3. Adoption
  4. Final Considerations

We can’t address all the options on the table nor go in-depth on everything, but hopefully this will serve as a helpful starting point. At the same time, we plan to cover a lot of information so if you have further questions, please feel free to talk to me or one of the other elders.

1) Principles

            It’s helpful to trace childbirth through the Bible. Beginning in Genesis 1, God commands us to be fruitful, multiply, and fill the earth. His desire is for His glory to be displayed over the whole world by people, human beings who reflect His glory. So Adam and Eve are to have children and populate the world. Yet they sin.

            As a result, childbirth is cursed. More clearly, to the woman, God says, “I will greatly increase your pains in childbearing; with pain you will give birth to children.” Childbirth would become very difficult, which any mother here can attest. And at the same time, creation itself was subject to frustration: infertility happens, even from the very beginning.

            Infertility was a trial for God’s people. In 1 Samuel, we read that Hannah cried bitterly and would not eat because she didn’t have any children. And she was also mocked by her husband’s other wife.

There were 2 ways that the people of God dealt with infertility. One was by sinning and not trusting in God. For example, Abraham, though married to Sarah, had a child with his servant Hagar. And since Jacob and Rachel had difficulty having children, Rachel gave him her servant Bilhah as a concubine. Throughout its history, Israel also sacrificed to Asherah, the goddess of fertility.

The second way Israel dealt with infertility was by trusting God and crying out to Him. Genesis 25:21: “21 Isaac prayed to the LORD on behalf of his wife, because she was barren. The LORD answered his prayer, and his wife Rebekah became pregnant.”

Instead of following the nations and their fertility cults or trying to force a biological heir through having a concubine, Isaac prayed to the Lord. And we read that the Lord answered his prayer. He didn’t need to provide children, but in this instance He did.

            Then Jesus comes. Jesus clarifies the concept of the family of God from one of biological kinship to a spiritual one, even as he tells Nicodemus in John 3 that he must be born again. How will God be glorified in the whole world (per Genesis 1)? It will be through those who have been born again spiritually, through faith in Jesus. On the cross, Jesus pays the penalty for all who have ever repented from their sin and trusted in Him, underscoring this new importance of a family of faith. This is not to put down having biological children; certainly, Jesus welcomes little children and loves them. However, there are greater callings on those who are His people – they are called to believe in Him. Not only that, they are to make spiritual children, to share the gospel.

            Therefore, when considering infertility, we are to remember the overarching storyline of the Bible. God desires first to be glorified. All our considerations should therefore fall within this guiding principle. Having a child, for example, as much as it is a very good thing, is not an ultimate goal and cannot be something that is pursued at all costs; rather, we must think first about how we glorify God. And it’s important to remember that our identity as those in Christ is ultimately as a child of God -- we are not defined ultimately by secondary issues such as our gender or ethnicity or whether we have children or not. Regardless of whether you have children or not, you are complete in Jesus Christ.

            Therefore, we should, in any discussion about infertility, hold to a Biblical framework. To that end, here are a two principles we can distill:

1)   Life begins at conception:

There are a number of Scriptural passages that refer to life beginning at conception, one of which is Psalm 139:13-14.

“For you created my inmost being; you knit me together in my mother’s womb.

I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.

My frame was not hidden from you when I was made in the secret place, when I was woven together in the depths of the earth.

Your eyes saw my unformed body; all the days ordained for me were written in your book before one of them came to be.”

Since life begins at conception, and we know we should not murder, therefore, we should preserve and not kill life at all stages, from conception all the way to death.

2)   Heterosexual monogamous marriage is the only relationship ordained by Scripture for the creation of children.

As Genesis 2 states, “For this reason a man will leave his father and mother and be united to his wife, and they will become one flesh.” Marriage is a particular relationship ordained by God between a man and a woman. It is this relationship in which children are exclusively created. This link between marriage and childbirth is underscored in Malachi 2, when God denounces Israel for the rampant divorce taking place and instead desires children: “And what does the one God seek? Godly offspring. So be on your guard, and do not be unfaithful to the wife of your youth.”

Therefore, there is a God-ordained link between marriage and having children.

And yet, as we’ve discussed, couples may struggle with infertility. Now, before transitioning to application, are there any questions?

2) ARTs

There are multiple reasons that infertility may happen: 1) medical issues with the man (e.g., the sperm may not be of the right quality to fertilize an egg); 2) medical issues with the woman (e.g., she might not release an egg regularly); 3) other reasons that sometimes can’t be medically determined (e.g., there might be multiple miscarriages).

At this point, a couple may approach a clinic to explore assisted reproductive technology (ART) treatments. In what is to follow, I will assume you have a general understanding of how childbirth happens; even if you do, there are some good resources available (Taking Charge of your Fertility).

This is a complicated topic and the suggested course of treatment for any couple’s infertility will vary. Let me share with you a three common treatments.

  1. An initial stage could be hormone treatments if the wife has medical issues. This means that she may need to take some pills or inject herself regularly with particular hormones in order to stimulate regular releasing of eggs.
  2. In a situation where the husband’s sperm may have some issues, they may consider IUI (intrauterine insemination). What happens is that the fertility specialist takes sperm from the man and injects it into the woman’s uterus when she is ovulating. In this situation, the woman may also have been receiving hormone treatment in order to establish a regular releasing of eggs.
  3. Another type of treatment is IVF (in vitro fertilization). What happens here is that the fertilizing of an egg occurs not in the woman’s uterus but in a lab, after both egg and sperm have been collected from the wife and husband. Then, after the fertilized egg has developed into an embryo, it is implanted in the woman’s uterus. Since the success rate for this (i.e., the times that an implanted embryo is born) is quite low (25%-33%), and since the cost for a cycle of this treatment is very expensive ($12K/cycle), fertility specialists often recommend attempting to create multiple embryos (let’s say 5). Then, after they see how many embryos are created, they may implant 1-3 embryos at one time. The remainder would then typically be frozen for use in the future, if needed.

As you can see, this whole issue becomes quite complicated quite quickly. I’m generally using the term husband and wife, but you can see how this technology can easily break the Biblical link between Biblical marriage and childbirth. For example, a couple in which one party has clear medical issues preventing them from childbirth may work with a 3rd party to donate sperm or an egg or even to be a surrogate mother (which means that they work with another woman to have their baby).

Implications for ART

Given our 2 Biblical principles, here are 4 implications that the elders developed after spending time considering this issue:

  1. Any fertility treatments should preserve the parent-child relationship. Currently, if a couple finds out that one or both of them are infertile, they can look for someone else to donate a sperm or egg.

    As elders, as stated earlier, we believe that marriage is the only context for creating children. Bringing someone else’s genetic material into the mix of the marriage destroys the parent-child relationship. God intended for Him to be glorified in a marriage between 1 man and 1 woman. If one spouse is infertile, this is not just their problem, it is a shared situation by both the husband and the wife. At this point, it would be good to mention that men should not be sperm donors.
  2. Fertility treatments that involve the destruction of embryos must not be pursued. There are a number of ways this may happen. For example, there is the concept of ‘selective reduction’, which means that during a pregnancy with multiple embryos, a fertility specialist may abort one or more of the embryos. They may do this for reasons such as: potential genetic abnormalities seen in one of the embryos or just that there are too many embryos that are viable and the couple might not want to care for multiples, e.g., triplets.

    As elders, we see any such willful destruction of an embryo as the same as an abortion and the same as killing a child, which God’s commandments clearly forbid.
  3. Any fertility treatments must not involve the freezing of an embryo. You may recall that we discussed an earlier scenario where fertility specialists often encourage a couple to create more embryos than can be implanted at a time. Therefore, freezing an embryo is a pretty standard procedure.

    As elders, we believe that an embryo should not be frozen. Here are a few reasons:
  4. life is created so it will be born – placing life in stasis and on hold cheats that life of being what God created it to be, and takes away from the human dignity and respect that should naturally be given to any life;
  5. freezing an embryo is what we would see as the opposite of what 1 Timothy 5 describes as providing for our immediate family (1 Timothy 5:8: “If anyone does not provide for his relatives, and especially for his immediate family, he has denied the faith and is worse than an unbeliever.”) – instead, it’s using those embryos;
  6. Any fertility treatments must seek to preserve life. Specifically, couples who have created embryos have a moral obligation to give them the opportunity to be born. We believe that any embryo, including a frozen one, is a life, and thus deserves to be born. As with any such issues, this might not be an easy scenario and we are happy to be of help in thinking through how best to follow Scripture in this regard.

Application

This is difficult terrain. Let me just say that we as elders want to be part of the conversation to help you think through these issues, if you are thinking through using ART. Given the issues of life that are at stake, we believe it is important that you not regard these issues as merely private but invite others to be part of the conversation. Oftentimes, it can feel very isolating to struggle with infertility, especially in a church as fruitful as ours. But you are certainly not alone. Please let us help you bear your burdens.

Specifically, we would like to strongly encourage couples considering ART (such as IVF) to receive the following:

  • information on ART, particularly from a Christian perspective (we recognize that the fertility industry is one where people can easily be given one-sided information: all the benefits but none of the risks)
  • opportunity to consider issues involved through a few discussion questions; and
  • counseling from an elder to discuss their situation, including establishing ethical limits

What if you have already pursued these technologies and weren’t following the principles that we laid out? We don’t intend for this time to be a condemning one but rather one for discussing Scriptural principles. If there is something to be repented of, praise God that we have been saved by a Savior who has borne our sins. If there are ways you can be faithful with decisions going forward, please let us know and talk to others about how we can be of help to you.

Are there any questions?

3) Adoption

Another option that couples can consider is adoption. Adoption isn’t just an option for couples struggling with infertility -- it can be a wonderful ministry that any family undertakes -- but it is a way for a couple dealing with infertility to add to their family.

This is another big topic but let me help give some background and some parameters.

Background

Adoption is bringing a child into your family who is not biologically related to you yet raising him or her up as your child. 

Biblically, there is a beautiful parallel in how God has loved us in Christ. Though we by nature are His enemies, in His love He adopted us. In Ephesians 1:5, Paul writes that God “predestined us for adoption as sons through Jesus Christ, according to the purpose of His will.” J.I. Packer has a wonderful chapter in his book “Knowing God” particularly on adoption where he states that adoption is the highest privilege that we as Christians can enjoy. Justification is essential -- to be right before God, we need to be declared righteous. However, in adoption, God has brought us into His family -- and so we read incredible passages such as Hebrews 2:11 (Jesus isn’t ashamed to call us brothers) and Romans 8:16-17: “The Spirit himself bears witness with our spirit that we are children of God, 17 and if children, then heirs—heirs of God and fellow heirs with Christ, provided we suffer with him in order that we may also be glorified with him.” 

As we consider adoption, here are a couple issues to keep in mind:

  1. Motivation -- at the end of the day, the motivation for adoption should be to love a child. It can be easy to have a hero complex thinking that you’re saving a child. But that will only sustain you so long. At the end of the day, you need to love the child as your own and not as a project.
  2. Biological tie -- can you love a child who is not biologically related to you? Yes. This issue is often one that prevents couples from considering adoption but it is good to talk through and distinguish between what can be a good thing (biological relatedness) yet not idolize it. 

With adoption, there are several factors to consider, such as domestic or international adoption, what age range of a child, even if you’d be willing to consider adopting just one child or multiple children at once. And you could consider whether the Lord would have you open your home to a child with special needs, of which there is a big range. The process for pursuing adoption can vary but it involves submitting paperwork to an adoption agency, getting approval from a social workers, and getting finances in order. 

What are costs? Domestic adoption can be $10-$20K if through an adoption agency; $1K (not recommended) if private adoption; free if through foster care (older child, special needs, abused). International adoption can be anywhere from $10K-$50K, given international fees and travel. There can be some grants available and there is currently a $13K federal tax credit which helps offset the cost. 

For more information, there is a CHBC Google group. 

The adoption process is not easy. Social workers and state associations can make it hard for Christians to adopt, particularly when dealing with issues of corporal punishment. Finances are not easy. But it is doable. If you are thinking through adoption, please let others and the elders know. We would be happy to be of assistance as you consider this path. 

Any questions? 

4) Final Considerations

As a congregation, pray for each other. Listen to one another. How should you talk to one another about this? Let me encourage you, if you are struggling with infertility to share with others what you’re thinking. Don’t talk just with those who are in similar positions as you; involve others as well.

If you’re not struggling with infertility, I’m not saying you should go and ask a couple if they’re struggling with infertility. That is not wise. And don’t assume that just because someone who doesn’t have kids, they don’t want them. There may be a number of reasons why they don’t have children, even if they desire to have them. Instead, let me encourage you to love all members and care for their whole person. They should not be defined by this one issue that they’re facing, so wait until you really know them well and have a relational context within they can bring this up.

Book recommendations for you: Fearfully and Wonderfully Made by Megan Best; Adopted for Life by Russell Moore.

As we consider infertility, it is good for us as well to recognize God’s sovereignty and His goodness in all things. He knew us before we were born. He knows what is best for us. He is working all things for the good of those who love Him. Infertility is difficult but it is yet another area in our lives where we are called to trust Him and His purposes.

For all of us, I pray that we would be approach this topic with hope, looking forward to eternity. After all, in heaven, there will be no childbirth. On one hand, Jesus says in Mark 12, men and women will not be given in marriage to each other, and thus there won’t be new babies there. But more importantly, God will be glorified in all the world, as people from every tribe, and tongue, and language worship around His throne. God’s desire to be glorified in all the world will be accomplished. And we will marvel at His plan, which triumphs in spite of any frustration.

So we can have hope. The pain we experience here is real but praise God that He will use it for His glory and for our good. 

FAQs

What is infertility?

The National Infertility Association defines “infertility” as the “inability to conceive after one year of unprotected intercourse (six months if the woman is over age 35) or the inability to carry a pregnancy to live birth.” They say that one in eight couples (12.5 percent) in the U.S. are affected by infertility; the Mayo Clinic suggests it may be as high as one in six (17 percent). So whether it’s ever been a subject of conversation for you and a friend or not, you know people who have struggled (or are struggling) with this trial.

What other uses may there be for ARTs?

Or, this technology might not even be used for infertility treatments but to let people think they have a variety of options in front of them. For example, a single woman in her late 30s may choose to get a sperm donor and have her own baby. Or, a gay couple could use it to have children.

What are other reasons why freezing an embryo may be wrong?

  • As humans, we can never predict the future and can not guarantee that any such embryos will be implanted, even with best intentions – there are a number of situations that can arise: pregnancy with the first batch of embryos can be difficult and create health concerns for future pregnancies or advanced age can make it more hazardous to the wife to bear the child. There are so many things that can happen that we should not presume that we know what is best for a life.
  • The process of freezing and unfreezing an embryo is inherently risky – it is getting better but still only about 90% viability, which means that 10% of the time, an embryo will die.

What’s another example where clinics may recommend the willful destruction of embryos?

Clinics may recommend the wilful destruction of embryos after they are frozen. If the couple decides later that they don’t want to implant these embryos, they face the dilemma of what to do with these embryos. Some may just let them thaw and therefore die while others may seek to donate them to research.

What might happen to surplus embryos?

We have been talking about surplus embryos. But what if they aren’t needed in the future, either because the couple has the child they have desired or because those embryos, after undergoing genetic testing, aren’t deemed to have “high development potential”? Couples may keep them frozen indefinitely. The decision to stop freezing an embryo can be gut wrenching so keeping the embryos frozen is a way to postpone the decision. As a result, there are a surplus of these embryos scattered in fertility clinics around the US – estimated at 400,000 embryos, 10 years ago (I couldn’t find any more recent data).

Notes about why people might not agree:

  1. First, it can be an emotional topic. Infertility has been around since the beginning of the world; in Genesis, Rachel says to Jacob, “give me children or else I die” – and the desire for children, which is a good desire, is arguably the strongest desire that we as human beings have.
  2. Second, Christians disagree on these topics. You’ll find believers with different opinions. My call for us is for us to be gracious and to love other members even if we disagree. That being said, I am grateful that on the essentials, there is much agreement and we can be thankful for that.
  3. Third, the world provides very skewed thoughts on this topic. Distorted ideas about life bleed into this discussion on ARTs. Infertility treatment specialists are incentivized to make you use whatever treatment is possible in order to have a baby. Fertility clinics also report statistics of success to the Center for Disease Control, so it’s in their best interest to make you go through all the fertility treatments. Any advice a treatment center gives needs to be weighed against a Biblical worldview. If you table your cynicism, then you might say their highest goal is help you have a child. As Christians, our highest goal is to glorify God and enjoy Him forever. Those are different goals that may lead to a very different set of decisions.
  4. Fourth, it’s good to note that we living in America are living in one of the most unregulated countries in the world when it comes to ARTs. For example, whereas countries such as Sweden and the UK have legal restrictions to the number of embryos that can be implanted in the women’s uterus, America has none. That means that fertility clinics in the US are more likely to adopt an anything goes approach to fertility treatments than even in other places in the world.

Birds and bees question?

Let me briefly give you a description of what needs to happen for childbirth. Typically, every month or so, a woman ovulates, that is, releases an egg. The egg lives in her uterus for 12-24 hours, during which time if a sperm fertilizes it, a life starts. This is called conception. As the fertilized egg, called a zygote, grows, it becomes an embryo. For the next 9 months or so, the embryo grows into what’s called a fetus and a baby is born. That’s if everything goes well.

Why is private adoption not recommended?

Legally risky. Easy to fall through. Birth parents can take adoptive parents' medical support for months and then decide to parent. Also no counseling. No support system. No guidance. Emotional minefield. Also easy to make legal mistakes that could bring the validity of the adoption into question

If later a birth parent claims they signed away their rights under duress there is no agency to rebut the claim or document that everything was done proper.

What about adopting a child from a different ethnicity?

In Christ there is no Jew and Gentile and we should be open to doing so. At the same time, I personally think that adopting a child of a different ethnicity requires the parents to understand potential challenges that the child may uniquely experience given his or her ethnic background. 

What was Asherah?

Basically, worship of a fertility goddess involved a doing things for her that, in return, would lead to fertility broadly defined, from pregnancy and childbirth to also having a good crop harvest. It is incredible how persistent this worship of Asherah was – it basically tracks the whole history of the nation of Israel, from the time of Moses through Gideon through kings both in the nations of Israel and in Judah. Even after the exile, the people of Israel still persisted in serving Asherah (see Micah).

How is the timing for adoption?

In some instances domestic adoption is faster than international adoption, but there are many variables for both. 

What other considerations are there for domestic option?

Domestic adoption sometimes has what is called “open adoption,” where there is on-going contact with the birth parents -- and associated on-going obligations. 

Should singles adopt?

We believe that the Biblical model is for a child to be raised by a married man and woman. There are lots of ways singles can care for the widow and the orphan (e.g., mentoring a child who does not have one or both parents, supporting/sponsoring a child through responsible organization, supporting work that helps keep children in their families such as anti-trafficking organizations). Singles can also help support adoption by helping a couple in the adoption process or by helping them care for the child. 

What about rejoicing with those who rejoice?

Should we add to the manuscript?