Ethical Implications of Assisted Reproductive Technologies

While the use of assisted reproductive technologies (ARTs) is quite common today, many have yet to consider some of the broader philosophical, theological, and moral aspects of using these technologies, especially as it relates to their pro-life and pro-family commitments. Central to any conversation surrounding the moral aspect of intrauterine insemination, in vitro fertilization, and surrogacy are the rich theological principles of the image of God, the sanctity of human life, the sanctity of the marital bond between husband and wife, the blessing of children, and God’s providence over procreation. These principles must guide any Christian moral engagement with ARTs, especially for pastors and other ministry leaders seeking to care for couples struggling with infertility, as well as future developments in these biomedical technologies and questions of public policy.

Central to any conversation surrounding the moral aspect of intrauterine insemination, in vitro fertilization, and surrogacy are the rich theological principles of the image of God, the sanctity of human life, the sanctity of the marital bond between husband and wife, the blessing of children, and God’s providence over procreation.

Introduction

Across the United States and around the world, countless couples hear the news that they may never be able to naturally conceive children as they face the devastating realities of infertility. While often not widely discussed given the private nature of these challenges, infertility is quite common. According to the Centers for Disease Control and Prevention (CDC), in the U.S., around 1 in 5 married women are unable to get pregnant after one year of trying, and around 26% of those women will have difficulty carrying a pregnancy to term.¹ Many share this suffering with close family and friends, but some suffer in silence as the pain of what they are facing is just too great to share and for fear of either not being heard, being given simplistic advice, or having their pain minimized. However, couples facing this type of news naturally long for answers as well as help in conceiving and having children of their own. Infertility is widespread and affects both men and women in different ways, and thus, ministry leaders, family, and friends need to be aware of what it is as well as the ethical complexities of assisted reproductive technologies (ARTs).

According to the Centers for Disease Control and Prevention (CDC), in the U.S., around 1 in 5 married women are unable to get pregnant after one year of trying, and around 26% of those women will have difficulty carrying a pregnancy to term.

With the rise of modern medical technologies, couples may initially find hope in discussing their options with medical professionals, given the widespread availability of various methods and medicinal interventions, including the common use of ARTs such as in vitro fertilization (IVF). The array of options can be quite dizzying depending on the circumstances a couple faces. Couples who are decidedly pro-life may have additional questions or concerns about the nature of these procedures, including procreation outside of the natural bodily union between husband and wife. Given the significant ethical issues at stake, we all must slow down and ask the perennial question of wisdom: just because we can do something, should we?

While the use of ARTs is common, many today have yet to consider some of the broader philosophical, theological, and moral aspects of using these technologies, especially as it relates to their pro-life and pro-family commitments. These types of questions are key for couples facing the devastating realities of infertility to consider, but also for pastors and other ministry leaders to engage as they seek to walk alongside those in their care. At the center of utilizing these reproductive technologies lies the central question that drives nearly every ethical issue we face in society today: what is a human being?

We all must slow down and ask the perennial question of wisdom: just because we can do something, should we?

Human anthropology is one of the central questions raised in philosophy and theology, one that is clearly articulated in the Christian moral tradition where we see that all human beings have inherent dignity, not a dignity based on their capacities, abilities, stage of development, or even location. Our common dignity and value flow directly from the fact that God has made us in his very image and he subsequently calls us to love him and our neighbor—no matter how small—as ourselves (Matt. 22:37-39).

With the continued emphasis on protecting life and upholding human dignity throughout the pro-life movement, there are a number of vitally important biotechnology-related questions surrounding human life that the Church needs to consider as we seek to apply our pro-life commitments to the use of an array of reproductive technologies. Questions of ARTs are especially important for the Church to consider as so many in our congregations and communities face the devastating realities of infertility and a deep longing for children amid our sin-torn world and bodies that do not always work in the way they were designed.

Our goal in this project is both to inform couples facing infertility as well as to aid church leaders and policymakers as they navigate these complex ethical and political questions surrounding the use of ARTs. Christians must think deeply about the issues and act in light of our deeply held pro-life commitments as we face the ever-evolving landscape of reproductive technologies and related questions of bioethics. Many of the moral implications of a distinctly Christian anthropology will naturally intersect with pro-life and pro-family public policy matters and future research in the biotechnology space.

Many in our congregations and communities face the devastating realities of infertility and a deep longing for children amid our sin-torn world and bodies that do not always work in the way they were designed.

What Are Assisted Reproductive Technologies (ARTs)?

Definitions of ARTs abound across the literature as lines are drawn in different places based on a number of presuppositions and worldviews. For the purpose of this paper, we will define an ART as any reproductive technology that involves the handling or manipulation of sperm or sperm and egg.² Many of the contemporary questions being asked around the ethics of ARTs feel quite novel as many of these technologies were developed in the mid-20th century, including the first live birth from IVF taking place in England in 1978.³

Often, couples seeking fertility support go through a number of tests to determine what might be the underlying cause of infertility, which could involve either or both the man or the woman. Testing may include measuring the production level of gametes (sperm and egg) and whether natural bodily processes are functioning properly. These tests may reveal a particular underlying cause, but this is not always the case. They are often helpful in determining what might be stopping a couple from conceiving through natural and routine sexual intercourse. Doctors may prescribe particular medicinal and hormonal interventions that stimulate egg production as they encourage the couple with best practices for naturally conceiving. If these noninvasive means fail, medical providers may encourage the couple to consider other options, including a number of ARTs⁴

The most popular or common ARTs include intrauterine insemination (IUI), which is also labeled by many as artificial insemination, IVF, and surrogacy or surrogate motherhood.

The most popular or common ARTs include intrauterine insemination (IUI), which is also labeled by many as artificial insemination, IVF, and surrogacy or surrogate motherhood.⁵ Each of these ARTs involve the use or handling of gametes in hopes of giving a couple the children that they have long hoped for and sought after. It is important to note that not all ARTs are used for the treatment of infertility-related medical conditions. These technologies can also be used to extend the ability to have biological children well beyond traditional childbearing years for a host of reasons including, but not limited to, career advancement, financial stability, delayed marriage, and a host of other personal reasons. Some of these procedures are also used by same-sex couples to facilitate childbirth that would be otherwise biologically impossible. These factors contribute to the ethical issues surrounding the use of ARTs, as they can shift the focus from caring for couples struggling with infertility to taking control of one’s fertility and having children on one’s own terms or timing.

– Intrauterine Insemination (IUI)

IUI is quite common, especially early in a couple’s fertility journey, and presents the least amount of ethical complications compared to other ARTs. This procedure involves the collection and processing of male gametes (sperm) and injecting them into the uterus of the woman.⁶ The collection of sperm may include various tests for any genetic abnormalities or microscopic physical indicators as to why natural conception is not taking place. The male gamete is placed into a catheter, and the woman is artificially inseminated often during an in-office procedure. This process does not involve creating human embryos outside the female body. Thus, it presents the fewest concerns for most evangelical ethicists, despite insemination occurring outside the natural physical connection of husband and wife.⁷ IUI can be employed in deeply concerning ways, though, especially in surrogacy, with the use of third-party gametes, and/or in couples that are not married or plan to be married. These particular situations are ethically problematic in light of the theological considerations highlighted in the next section.

– In Vitro Fertilization (IVF)

If other interventions fail and/or a couple wants to try a different approach for a number of reasons, IVF is often recommended as a more dependable option for conceiving a child. IVF is by far the most commonly used ART and is the subject of intense moral debate as it involves the creation, implantation, storage, and care of fertilized eggs, not simply the handling of gametes. Despite the widespread acceptance of IVF inside and outside the Church today, ethical concerns abound for protecting these human embryos—including their creation in a laboratory setting, cryopreservation and its long-term effects on human life, the use and disposal of human embryos, and the use of reproductive technologies that intervene in the natural sexual union of a man and woman in marriage.

Currently, around 2% of all births in the U.S. employ IVF technologies.8 The procedure involves the harvesting of ova from a woman and sperm from a man, both of which are prepared before fertilization of the egg(s) takes place in a lab. Often, but not always, the “best” fertilized eggs are chosen for implantation based on various characteristics, and selective reduction may occur once a procedure is complete as multiple embryos may implant at one time.⁹ Implantation of human embryos is not always successful, though, and couples may go through multiple rounds of IVF treatment as only 37.5% of cycles result in a live birth.10 In fact, one study suggests that three to six cycles are needed for a 65% chance of success.11 A couple may choose to keep trying to conceive in subsequent rounds with other human embryos from their “cohort,” which traditionally ranges from six to eight embryos, given the efficiency of creating multiple embryos at once rather than one at a time. Many couples also choose to freeze their embryos for possible future use, even if they do conceive.

The procedure is widely embraced by many, including some Christian couples for whom it might be one of the only options for having biological children. Advocates see this procedure as morally good, or at least permissible because it can allow couples to conceive despite the many ethical complications and dangers. Many couples have been encouraged by trusted medical professionals to utilize this technology and may not have been aware of the extent of the ethical issues at stake when it was undertaken. It is vital to note in these conversations about the ethics of IVF that all children conceived through this technology are not only made in the image of God but should also be seen as good gifts from God. How a child is conceived does not change that fundamental truth.

It is vital to note in these conversations about the ethics of IVF that all children conceived through this technology are not only made in the image of God but should also be seen as good gifts from God.

How a child is conceived does not change that fundamental truth.

Serious ethical questions arise from the IVF procedure that needs to be considered by all involved, including separating fertilization from the bodily union of man and woman, production of human embryos (especially the creation of more embryos than are planned for immediate transfer), cryogenic storage of human embryos and its long term effects on human life¹², loss of life during the thawing process¹³, donation and/or disposal of leftover embryos, freezing unfertilized eggs as a future insurance on health or to have more time to pursue career opportunities before committing to marriage and parenthood, and questions as to how life can be honored through the adoption of frozen embryos through local and national registries.¹⁴ Concerns also include how human embryos are often deemed as mere “property” in some jurisdictions and widespread debate over their future when marital disputes, divorce, and/or remarriage takes place.

Other concerns include the donation of human embryos for scientific experimentation, especially research on embryonic stem cells. As noted bioethicist Gilbert Meilaender argues, this research often involves the use of these stem cells, “derived from the inner cell mass of early embryos, which are destroyed in the process.”¹⁵
Research also includes the “editing” of the human genome, which involves using human embryos.

-Surrogacy or Surrogate Motherhood¹⁶

Surrogacy refers to a procedure in which the gestation and birth of a baby occur either inside the body of a woman who is not the child’s biological mother or inside the body of a woman who is willing to donate her egg and carry the child but relinquishes her parental rights to those who contracted her to carry the child.

There are two main ways that surrogacy occurs. Genetic surrogacy occurs when the husband donates his sperm for the surrogate to conceive. Often, this method employs an IUI procedure, albeit outside of the traditional union of a single man and a single woman in a committed marital relationship. While the child can be genetically related to the surrogate mother who carried the child, the child “belongs” to the couple who hired/contracted her to carry the child.

Gestational surrogacy often occurs using the IVF process, where a human embryo is implanted by way of embryo transfer (ET) into the surrogate mother. The child is often not biologically related to the surrogate mother who carries the child to term. Most often in surrogacy, a fee is exchanged for the “services” provided and the child belongs to the couple hiring the surrogate mother.

Many Christian ethicists rightly see both types of surrogacy as completely off-limits for couples, given the introduction of a third party (genetically or gestationally) into the sacred union of marriage. Another ethical angle to consider in this debate is the dignity of the surrogate mother, hiring her and using her body in this manner, as well as the unique natural relationship she has with the child, whether or not she is genetically related to them. Moral questions also include the use and enforcement of contracts, given the significant connection that a gestational surrogate has to the child she carried to term. A tendency with ARTs is the commodification of children, treating them as mere property rather than image bearers with inherent dignity and worth.

Despite their early developmental stages and microscopic size, these embryos are human beings with inherent dignity and value as image bearers of God.

The use of ARTs raises a number of important ethical questions that require deep theological and philosophical consideration from a Christian perspective, especially for pro-life couples, as many ARTs involve the creation, handling, and storage of human embryos outside of the womb.¹⁷ Despite their early developmental stages and microscopic size, these embryos are human beings with inherent dignity and value as image bearers of God. Thus, we must slow down in an age of technological hubris to consider whether we should employ such technologies and, if we do, how we will go about protecting and caring for our embryonic neighbors despite their perceived value in society or location inside or outside the womb.¹⁸ Since our desire is to approach the usage of ARTs from a theologically informed position, it is important to identify theological principles that guide the ethical discussion around ARTs.

Guiding Theological Principles

As noted earlier, the central question of what is a human being is at the center of the debate over the use of ARTs. The beginning of human life is both a miracle and a great mystery. In Psalm 139:13-14, David declares, “For it was you who created my inward parts; you knit me together in my mother’s womb. I will praise you because I have been remarkably and wondrously made. Your works are wondrous, and I know this very well.” Based on his limited knowledge nearly three millennia ago, David notes the hidden mystery of human development in the womb and acknowledges God’s role in the process. In our current age of advanced medical technology, there is still an element of marvel as a couple peeks into the womb during an ultrasound to see the wonderfully mysterious development of their child.

ARTs present challenges that require significant moral and theological consideration. Even the least concerning versions of ARTs still need evaluation to determine if they are consistent with biblical principles that ought to drive our theology and ethics. For that reason, the following guiding principles will assist us in evaluating the moral choices faced by those pursuing the use of ARTs.¹⁹

1. The Image of God

Every discussion related to the creation of new human life must begin with the doctrine of the image of God (imago Dei).²⁰ First introduced in Genesis 1:26-27, the image of God differentiates human life from every other part of the created universe. When God declared, “Let us make man in our image, according to our likeness,” (Gen. 1:26a), he gave us the foundation for how to think about humanity. The implications of this doctrine are immense, but we want to explore three components of the doctrine that are essential for a discussion of ARTs.

No individual has more of the image of God than another, and there is nothing that can be done to an individual to remove the image.

First, the doctrine of the image of God applies to our understanding of the substance of humanity. While it is impossible to identify the “location” of the image in mankind, it is biblical to say that part of the essence of being human is to bear God’s image. Thus, all humans—from adults participating in ARTs to preborn children from the moment of fertilization and conception—are universally made according to the image of God. Stages of development, location, rational capacity, and maturity have no bearing on the substance of the imago Dei. No individual has more of the image of God than another, and there is nothing that can be done to an individual to remove the image.

Second, the doctrine of the image of God impacts how we relate to God and one another. The storyline of Scripture involves the creation of mankind in a perfect relationship with God, the loss of that relationship, and God’s plan for restoring that relationship. This implies that human beings are made for a unique relationship with our Creator because we are made in his image. As Millard Erickson notes, “The relational view [of the imago Dei] has correctly seized upon the truth that the human alone, of all the creatures, knows and is consciously related to God.”²¹ Because all people are designed for a relationship with God, how we relate to one another should reflect this fact. We should not see other image bearers as a means to an end but rather as an end in themselves.

Third, the image of God gives us a specific function that God declares in Genesis 1:26 and 28—

Then God said, “Let us make man in our image, according to our likeness. They will rule the fish of the sea, the birds of the sky, the livestock, the whole earth, and the creatures that crawl on the earth.” . . . God blessed them, and God said to them, “Be fruitful, multiply, fill the earth, and subdue it. Rule the fish of the sea, the birds of the sky, and every creature that crawls on the earth.”

The creation mandate found in these verses gives mankind dominion over the rest of the creation, including the idea of developing technologies that can improve humanity’s station in this world. At the same time, this does not mean that God gives us the freedom to use creation merely for our own self-interest; instead, we function as stewards of creation for the true owner of this universe (Ps. 24:1-2). Therefore, the development of ARTs as part of the function of ruling over creation is consistent with the image of God, but it should be tempered with the idea that we must not violate the image of God in others through our exercise of dominion.²²

2. The Sanctity of Human Life

Building upon the doctrine of the image of God, another guiding principle for considering the ethical nature of ARTs is the sanctity of human life. The sacredness of human life finds its foundation in the doctrine of the image of God. God himself connects these dots for us early in the narrative of Scripture as part of his instructions to Noah after the flood. In Genesis 9:6 we read, “Whoever sheds human blood, by humans his blood will be shed, for God made humans in his image.” The explicit instruction to Noah and his descendants is that human life has intrinsic value because all people are made in God’s image. The explicit application of Genesis 9:6 is that anyone who takes innocent human life relinquishes his own right to life.

Moving ahead in biblical revelation, the same line of reasoning comes into play in the application of the sixth commandment, “Do not murder” (Ex. 20:13). The term translated as “murder” in this text is the Hebrew word ratsakh and has a meaning beyond the unjust killing of innocent human beings. It also includes “negligent homicide,” where death results from the failure to take appropriate precautions for the protection of human life.²³ The protection of the lives of image-bearers extends to all humans from the moment of fertilization and conception.

This particular guiding principle is significant for the discussion of ARTs because many of the methods employed to bring new human life into existence also risk the possibility of causing the death of children after conception. The practices of freezing, storing, and disposing of embryos, as well as selective reduction in a multi-child pregnancy, run afoul of the principle of the sanctity of human life, particularly the idea of failing to take necessary precautions to protect life. Such negligence may stem from a lack of understanding that human dignity or personhood is not gained at a particular point or developed over time but rather is rooted in the biological fact of being human. All human beings are image bearers regardless of age, developmental state, or location. Thus, failure to care for and protect all human life—even in embryonic form—violates the principle of the sanctity of human life.

3. The Sanctity of the Marital Bond

One of the least emphasized and understood principles in evangelical appraisals of ARTs is the sanctity of the marital bond. The previous two principles have direct application to the new life created in the ART process. This principle, though, looks back to God’s design for procreation within the proper context of the marital relationship.

God established marriage in the opening chapters of Genesis as a divinely ordered institution through which mankind would fulfill the mandate to “be fruitful, multiply, fill the earth, and subdue it” (Gen. 1:28). While the text of Genesis 1 does not give us the specifics about marriage, the following narrative of Genesis 2:18-24 lays out that God’s design for multiplication would come through the institution of marriage. As noted by Liederbach and Lenow, “God designed marriage to be a comprehensive, covenantal union between one man and one woman intended to endure for a lifetime and proximally directed toward the rearing of the next generation.”²⁴ This does not mean that procreation is the defining characteristic of marriage. Many couples struggle with infertility, and we should be sensitive to the emotional and physical struggle of infertility. At the same time, infertility does not undermine the fact that the institution of marriage is proximally directed toward rearing the next generation.

God’s design for procreation is centered squarely within the context of marriage. His plan for man to flourish and fill the earth with other image bearers—even before the Fall—was marriage. Therefore, the sanctity of the marital bond is crucial to any discussion of procreation. Leiderbach and Lenow, summarizing Augustine’s teaching on the matter, note that “the procreation of children, the unity between the husband and the wife, and the sacramental element that orders the marriage relationship toward God as an act of worship.”²⁵ Prior to the development of ARTs, any discussion of procreation involved the sexual act between a man and a woman, and the question of morality pivoted primarily on the basis of whether or not those two individuals were married. Now, the situation has changed because procreation can take place without the act of sexual intercourse, even among those in same-sex relationships.

Since God designed marriage as the context for procreation, we must consider the sanctity of the marital bond as we contemplate the morality of ARTs. Some versions of ARTs run the risk of violating this guiding principle because they may introduce a third party into the procreative process through the use of a surrogate, egg donor, or sperm donor. While the introduction of donor gametes or a surrogate may not involve a physical act of sexual intercourse between individuals outside the context of marriage, the procreative act is still taking place between people who are not married. Biologically, this is still a sexual process, and the label of adultery could be applied in such cases.²⁶

In addition, we should at least pause and consider the question of whether intentionally initiating the procreative process—especially in creating human embryos—outside the human body is a potential violation of this principle. This is not a wholesale rejection of technology. However, technology that separates the emotional, psychological, and physiological connections between the human body and procreation, especially within the context of marriage, should give us pause. While there is likely disagreement on this particular application of the principle among faithful Christians, we nevertheless need to wrestle with the idea prior to adopting technological advances as somehow morally neutral, especially as it relates to the commodification of children²⁷ and having them on our own terms rather than seeing them as a gift from the Lord.

4. Children Are a Blessing from the Lord

Our fourth guiding principle to assist in evaluating the morality of ARTs is the biblical concept that children are a blessing from the Lord. We derive this principle from both Genesis 1 and Psalm 127. In Genesis 1:28, we read, “God blessed them, and God said to them, ‘Be fruitful, multiply, fill the earth . . .’” From the initial creation of mankind, the ability to procreate is declared a blessing from God. Solomon elaborates on this blessing in Psalm 127:3, as he writes, “Sons are indeed a heritage from the LORD, offspring, a reward.” In addition to an overall biblical perspective of children as interconnected to the marriage relationship, these verses demonstrate that we need to think of childbearing and childrearing as a creation-order blessing from God. Despite the difficulties of childbirth introduced at the Fall (Gen. 3:16) and the subsequent trials of childrearing, the joy and blessing ultimately exceed the difficulties.

On the surface, this particular guiding principle seems to support the use of ARTs because these technologies aid in conception and childbirth. The application of this principle is certainly different than how it might be applied when considering contraception or birth control.²⁸ We could make the argument that viewing children as a blessing points us to a liberal use of ARTs to facilitate procreation; however, there is a different concern when it comes to some types of ARTs that needs to be addressed. Particularly, ARTs that produce numerous fertilized eggs, which are later discarded, violate this principle.

5. God’s Providence over Procreation

Our final guiding theological principle reminds us of God’s divine providence over the procreative process. The progress of science over the last 50 years has opened up new frontiers for reproductive technologies. From the first live birth due to IVF in 1978 to advances in genetic engineering, the possibilities for employing technology in procreation seem endless. Lost in the conversation over medical technology, however, is God’s role in procreation.

Scripture makes it clear that it is God who opens and closes the womb. There are several examples in Scripture where this exact language is used. Throughout the narrative of God’s dealings with Abraham and Sarah, we see promises of a child who will be the first fulfillment of God’s larger promise to make Abraham into a great nation (Gen. 12:1-3; 15:1-6; 17:1-22; 18:9-15). But all along the way, Sarah is barren. Sarah even places the responsibility of her barrenness on the Lord when she says, “Behold now, the Lord has prevented me from bearing children” (Gen. 16:2a). Finally, when Sarah was 89 years old, the promise was fulfilled. In Genesis 21:1-2 we read, “The Lord visited Sarah as he had said, and the Lord did to Sarah as he had promised. And Sarah conceived and bore Abraham a son in his old age at the time of which God had spoken to him.” This child fulfilled God’s promise and the result of God’s sovereign providence over procreation.

In a New Testament example, we see God’s providence over the conception of John the Baptist. Luke introduces his readers to John’s parents, Zechariah and Elizabeth, and says, “But they had no children because Elizabeth could not conceive, and both of them were well along in years” (Luke 1:7). While performing his priestly duties at the temple, an angel appears to Zechariah and tells him that his prayers have been heard and his wife will bear a son. Despite Zechariah’s disbelief, the Lord answers his prayers, and Elizabeth conceives the child we ultimately come to know as John the Baptist. Her response is probably the most direct statement about God’s providence in John’s conception as she states, “The Lord has done this for me. He has looked with favor in these days to take away my disgrace among the people” (Luke 1:25).

In both of these examples, we see the Lord’s sovereignty over procreation in both closing and opening the womb. With the advance of medical technology, we are aware of various biological causes of infertility, but those causes do not negate God’s providence in the process of procreation. Those causes of infertility merely highlight the extent to which God is in control. In applying this principle to ARTs, we are not saying that all ARTs are prima facie a violation of God’s providence. In fact, some use of ARTs may fit the creation mandate to exercise dominion over creation. However, a pursuit of ART without understanding that God is still the one who opens and closes the womb may result in frustration. As Liederbach and Lenow note,

Therefore, we must encourage those who desire to overcome infertility . . . not only to cast their cares on the Lord because it is he who opens and closes the womb, but also to approach the process with a humble posture of prayer and willing obedience, lest a desire to have . . . children be pursued by means contrary to the commands of God.²⁹

Thus, we must ask the question of whether should we use these technologies rather than simply can we, especially from a Christian moral perspective.

These guiding theological principles provide us with a framework by which we can evaluate the use of ARTs. They do not always give us a definitive answer on the morality of a specific ART in a particular situation, but they point us to someone greater than ourselves. As with any medical technology, we need to ask ourselves how our use of such technology relates to the wisdom given to us in Scripture and by the Holy Spirit. And most importantly, we can use these principles as guidance for how we are to worship God through our actions.

Thus, we must ask the question of whether should we use these technologies rather than simply can we, especially from a Christian moral perspective.

The Future of ARTs and Ongoing Moral Questions

Biomedical technologies, including ARTs, continue to grow and change through continued innovation and progress. This field is rapidly changing, and there will inevitably be a host of pressing moral questions for Christians to consider, for which we may not even have categories for today. While the novel nature of the questions will challenge us, the core questions remain the same, especially as these technologies cause us to consider the question: what is a human being? Technology indeed does expand our moral horizons of what is possible in this space, but the underlying biblical principles of human dignity as rooted in the imago Dei, the sanctity of human life and marriage, children as a blessing, and God’s providence over procreation, nevertheless remain the same.

As the technologies continue to develop and expand, Christians are already seeing significant moral questions stemming from embryonic research and emerging ARTs like in vitro gametogenesis (IVG) that may allow same-sex couples or even a single person to have biologically related offspring given the use of stem cells to produce sperm and eggs.³⁰ IVG has already been performed in laboratory settings with animals, but at the time of this writing, it is still not available for use with human gametes. Despite the novel nature of this technology potentially producing gametes from stem cells, the underlying concerns of human dignity and God’s design for marriage and procreation remain applicable. Other ongoing challenges include embryo creation for research purposes as well as the ongoing challenges of human cloning.³¹ All of these questions are downstream from assisted reproduction and must be considered by Christians through the lens of the theological and ethical framework as presented above.

Technology indeed does expand our moral horizons of what is possible in this space, but the underlying biblical principles of human dignity as rooted in the imago Dei, the sanctity of human life and marriage, children as a blessing, and God’s providence over procreation, nevertheless remain the same.

Policy Considerations³²

While the main emphasis of this project has been on the theological and ethical principles as they relate to couples struggling with infertility and equipping ministry leaders to navigate these questions alongside these couples, there are vast social and political implications of these principles. Support for reproductive technologies, especially IVF, is quite high in the American electorate, and much of this support seems to stem from a good desire to see more children and to come alongside couples struggling with infertility. However, as discussed, significant moral questions must be asked as these technologies are not morally neutral. They shift our view of God, ourselves as human beings, and what we believe is morally possible with technological innovations in this space. We all must consider what is at stake in the development and use of ARTs as a society and as a nation.

Overall, policy decisions regarding ARTs must be rooted in what is morally right, wise, and sensitive, not merely driven by public opinion, as the purpose of law and government is to both promote good and restrain evil/vices (1 Pet. 2:14).

Overall, policy decisions regarding ARTs must be rooted in what is morally right, wise, and sensitive, not merely driven by public opinion, as the purpose of law and government is to both promote good and restrain evil/vices (1 Pet. 2:14). This necessarily means protecting and caring for the most vulnerable among us given the inherent dignity of all human beings—no matter their stage of development, location, age, or perceived usefulness. Political debates over ARTs must consider the dignity and value of all human life, including in embryonic form, and not simply the desire for children. Law is not neutral as it always promotes a particular view of morality, and policies both restrain evil practices and teach what ought to be valued. In light of this, law must not be based on public opinion or fluctuating desire but in the created moral order.

We believe that any law or policy surrounding assisted reproductive technologies must first and foremost be centered on the dignity of human embryos. All policies and regulations must seek to protect human life, even in the embryonic stage. They also ought to support the natural family in a restorative way that helps to assist those struggling with infertility. Policies should also distinguish between heterosexual couples struggling with infertility and same-sex couples who are biologically unable to procreate. The latter are not, by definition, infertile, as fertility was never biologically possible in the first place.

Regulation of ARTs should include basic standards of care for human embryos as well as disincentivizing the fertilization of more eggs than are implanted, prohibit the destruction of non implanted fertilized human embryos, and prohibit the use of non implanted human embryos for any type of scientific research. In addition, any legislative approach should also include robust support for couples, including expanded healthcare coverage to aid them in their infertility journeys in ways that are consistent with the dignity of all human beings and pro-life commitments.

Given the widespread and unregulated nature of human embryo generation, we hope to see expanded access to embryo donation registries and regulating privately held registries to make sure they have consistent care for human embryos in cryogenic freezing, robust protocols for access to these cryogenic units, and standardized procedure for dethawing and preparation for donor implantation.

Given the widespread and unregulated nature of human embryo generation, we hope to see expanded access to embryo donation registries and regulating privately held registries to make sure they have consistent care for human embryos in cryogenic freezing, robust protocols for access to these cryogenic units, and standardized procedure for dethawing and preparation for donor implantation. These provisions should also encourage and lower the burdens for embryo adoption among couples seeking to conceive, as it is a moral good to give these children a chance at life despite the circumstances surrounding their generation. They are not mere property but people made in the very image of God. Given the overwhelming amount of human embryos on current registries, we want to encourage couples to consider embryo adoption over the creation of additional embryos, given that these lives have already been created.³³ Our goal is to give these children, already created through the ethically compromised process of IVF, a chance at life.

Our goal is to give these children, already created through the ethically compromised process of IVF, a chance at life.

Conclusion

No matter the challenges Christians face in the coming years in these areas, it is vital to remember that God’s Word is more than sufficient for navigating these bioethical questions as it reminds us of the foundational principles that ought to guide every aspect of our lives. Nothing that we face or will face in the future catches God off guard or challenges his sovereign providence over every aspect of creation, including the devastating realities of infertility that many couples in our neighborhoods, churches, communities, and nation are dealing with right now.

As we consider the ethical challenges and implications before us, we recognize the realities of suffering that many face as well as the abiding hope that we have in God, no matter the circumstances. We must be firmly rooted in God’s Word as we stand for both truth and grace amid the challenges of this earthly life. Christians champion God’s good design for marriage, the family, and children as we long for the day when every tear will be wiped away from those struggling with infertility, as well as the reality that sickness, brokenness, and death will be no more since God is indeed making all things new (Rev. 21:4-5).

Recommended resources

Books
- Bioethics: A Short Primer for Christians (Fourth Edition) by Gilbert Meilaender
- Bioethics and Medicine: A Short Companion by C. Ben Mitchell (Forthcoming, 2025)
- Christian Bioethics: A Guide for Pastors, Health Care Professionals, and Families by C. Ben Mitchell and D. Joy Riley
- Bioethics and the Character of Human Life by Gilbert Meilaender (2020)
- Embryo: A Defense of Human Life (2nd Edition) by Robert P. George and Christopher Tollefsen

Articles
- “Breaking Evangelicalism’s Silence on IVF” by Matthew Lee Anderson and Andrew T. Walker | The Gospel Coalition
- “The Pandora’s Box of IVF” by R. Lucas Stamps | World Opinions

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Introduction