Earlier this week, University of Alabama at Birmingham (UAB) healthcare system announced that it was pausing all in vitro fertilization (IVF) fertility treatments. This pause is due to the perceived fear of prosecution and lawsuits in light of the Alabama Supreme Court’s ruling on Friday, Feb. 16, stating that human beings in the embryonic stage have the same legal rights and protections as children who are born. 

Barbara Collura, president and CEO of Resolve: The National Infertility Association, released a statement noting that UAB has “been forced to make an impossible decision: pause IVF procedures for those hoping to build their families, or put their patients and doctors at risk of prosecution.” She went on to note that “[t]his cruel ruling, and the subsequent decision by UAB’s health system, are horrifying signals of what’s to come across the country.” UAB spokewoman Hannah Echols said they are “saddened” by the court’s ruling and noted that patients can continue the IVF process up through egg retrieval, though fertilization and implantation must be paused for this time due to the ruling.

What happened in the Alabama Supreme Court ruling?

The move by the UAB healthcare system centers around a case where the Alabama Supreme Court ruled in favor of three couples who sued a fertility clinic in Mobile after a 2020 incident where their frozen human embryos were dropped and destroyed. The court ruled in LePage v. Mobile Infirmary Clinic, Inc. that the state’s Wrongful Death of a Minor Act, first enacted in 1872, also applies to “extrauterine children” even if they are stored in cryogenic freezers. The Justices noted that the location of the unborn child, in or outside the womb, does not matter according to the existing statute.

Justices cited their interpretation of this act as in accordance with the language found in Amendment 2 of the Alabama state constitution which was ratified in 2002. The amendment states that “it is the public policy of this state to recognize and support the sanctity of unborn life and the rights of unborn children, including the right to life.” The ruling notes,

“Here, the text of the Wrongful Death of a Minor Act is sweeping and unqualified. It applies to all children, born and unborn, without limitation. It is not the role of this Court to craft a new limitation based on our own view of what is or is not wise public policy. That is especially true where, as here, the People of this State have adopted a Constitutional amendment directly aimed at stopping courts from excluding ‘unborn life’ from legal protection.”

This ruling has sent shock waves throughout the country, including the pro-life movement which has historically been torn over the ethics of IVF. 

What is IVF?

IVF has become a routine, albeit financially costly, procedure in many fertility clinics around the world for couples who want children but are unable to conceive by natural means. Doctors often give couples options ranging from various testing, medicinal interventions, and assistance in natural reproduction. If these efforts fail, medical professionals, such as an endocrinologist or an OBGYN, may recommend an IUI (intrauterine insemination) procedure where sperm is collected from the man, cleaned, and then inseminated into the woman at peak fertility via a catheter. If couples choose not to go this route or if it has been tried without success, many will be encouraged by doctors to consider IVF. However, the ethics of the treatment are rarely discussed in great detail with couples—whether in the fertility clinic or even in the Church itself. 

Resolve notes that around 2% of all births in the U.S. employ IVF technologies. The procedure involves the harvesting of ovum 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. Implantation is not successful for couples every time, thus a couple may choose to keep trying with other human embryos from their “cohort.” Many couples 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 who desperately want to have children. Many advocates see this procedure as morally good or at least permissible because it can allow couples to conceive. IVF has become so common throughout our society that you likely know someone who has utilized these technologies in hopes of having a family. 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. Further, the desire for children is a moral good as designed by God, rooted into the fabric of the created order. Infertility is a widespread reality, affecting 1 in 6 couples today, and is a sad reminder of the devastating effects of the Fall. 

When sin entered the world through Adam and Eve, it infected every part of creation, including our bodies, and introduced death, both spiritually and physically. Now, our bodies regularly get sick or do not function as they were intended, often due to no particular fault of our own. Infertility should be viewed as the tragic reality of living in a world that is broken (Gen. 3) and is a crushing diagnosis for couples who desperately want to have children. This is a difficult and sensitive subject that must be navigated with deep pastoral wisdom and counseling, including helping Christian couples facing these challenges to consider all aspects of this reproductive technology before moving ahead with the procedure.

What are some of the ethical considerations for Christians with IVF?

As already noted, the pro-life movement has historically been divided over the ethics of IVF and this issue must be navigated with wisdom rooted in both truth and grace. The desire for children is inherently good and a gift from God, but the IVF procedure should be concerning for Christians given the Bible’s affirmation of the inherent dignity and value of every human person—from fertilization/conception to natural death.

Many committed to a pro-life ethic are open to IVF as a fertility treatment in certain circumstances, including:

• Choosing to have only one egg fertilized at a time, ensuring no human life is created and left frozen or discarded; 
• Embryo adoption, where embryos are donated to other couples desiring children. This is a frontier issue in bioethics that is a moral good in light of the circumstances surrounding how these human embryos were created;
• No surrogacy or third-party donation of sperm or ovum, which introduces a third party into the marital union. 

Those who disagree with IVF on ethical grounds express deep concern for several reasons, including: 

• It severs/interrupts the natural union of a man and woman (including the possible use of donor ovum and sperm, introducing a third party); 
• An abundance of human embryos are often created but are not always implanted. Frequently, they are discarded and destroyed;
• And, in some cases, the underlying thinking displays a level of hubris that somehow humanity, through our technologies, are empowered to act in the place of God, deciding to create human life and choose which human embryos are given a chance, usually due to extraneous factors. 

Discarding or destroying human embryos is especially problematic. Until recently, many doctors believed that abnormal cell growth in human embryos may negatively affect the success of IVF. Thus, many human embryos were discarded or destroyed before implantation. But even among the “healthy” embryos, a couple often must decide what to do with them if they choose not to implant them. They are generally frozen (in suspended animation) until they are used in another implantation process or saved for the future expansion of a couple’s family. Embryos can also be put up for adoption—in local or national embryo registries for other couples trying to conceive. Sometimes, embryos are even donated for the abhorrent practice of scientific experimentation on human embryos. There are countless variables at play, but the bottom line is that children must never be discarded or destroyed. 

Some pro-life IVF advocates will note that even in natural conception, fertilized eggs do not always implant into the uterine lining of the woman for various reasons. Thus, they conclude that IVF is essentially the same as the natural process yet helps many couples conceive. However, this logic is flawed in that it equates the natural process of conception with the creation of embryos by fertility doctors through substantive human intervention and technological means. While the aim of helping couples conceive is laudable and to be commended, this particular procedure routinely seeks to interfere with the natural process to a degree that human life at the embryonic stage is commonly seen as something made by human hands and, thus, possibly disposable, rather than a gift from God through the miracle of life that is to be received and cherished at all times. It begs the question: Just because we can pursue these technologies, is it something that we should do? 

Life begins at conception, which means human embryos are children; they are human beings made in the image of God. Therefore, we all must seek to protect and honor their lives as we consider the gravity of what our technological developments have wrought—and that includes our best-intentioned efforts to overcome a challenge as heart-wrenching as infertility. Couples facing this can feel isolated or hurt, so it is incumbent on the Church to walk alongside them in this journey as they consider the ethical complexities associated with IVF and understand all possible options to grow their family.

As our family has and continues to struggle with infertility, I identify with the deep desire for children. This is a moral good married couples should pursue, but not by any means available or without adequate moral deliberation. Christians, of all people, must consider the full weight of procedures like IVF in community as we seek to prioritize the family and protect the most vulnerable among us.