by Sandra Glahn, Ph.D. and William Cutrer, M.D.

Ten years ago, the news reported that a California couple had become part of the world’s first five-parent arrangement. Having contacted the unmarried birthparents of their adopted child, they asked for a biological sibling. By that time, the birth parents had split up and lived in different states, but they offered to donate eggs and sperm. Because the adoptive mother was unable to carry a pregnancy, the adoptive father’s adult daughter (from another marriage) served as a surrogate.

Bring up the topic of “infertility,” and invariably someone will mention this sort of ethical quagmire pulled straight from the headlines.

In the process of creating a child together, why are couples often so willing to enter such a complex maze of moral dilemmas? Because, simply put, infertility is hard stuff. Researchers have determined that the depression and anxiety experienced by infertile couples are equivalent to that in those suffering from terminal illness. Proverbs 30:16 hints at this when it tells us that a “barren womb” is among four things on earth that are “never satisfied.”

God’s first command to Adam and Eve related to conceiving children, and most couples dream about their union producing a child who is the product of their love. Wrapped up in childlessness, then, are unfulfilled longings and the death of precious life dreams.

What exactly is infertility? It’s the inability to conceive or carry a child to term after one year of unprotected intercourse. It has many causes, but the idea that “infertile couples just need to relax and they’ll get pregnant” is a myth. In ninety-five percent of cases, there’s a diagnosable medical reason. About sixty-five percent of couples seeking treatment eventually have a biological child, but the percentage drops significantly for couples choosing not to pursue medical treatment. Fertility problems are as common in men as in women, and the number of couples appears to be on the rise due in part to delayed childbearing, sexually transmitted diseases, and environmental factors.

What Can Couples Do About It?

Some argue that infertility is a matter of “God closing the womb” (e.g., Sarah, Hannah), thus insisting that faith alone should be sufficient. Others believe that, while God is able to open and close wombs, He has permitted limited insight into the complex functioning of the human body. Recognizing that approximately sixty percent of couples pursuing treatment will go on to experience live birth, they argue that medical therapy is appropriate as long as no one violates scriptural principles. One biblical support for this would be that Paul told Timothy to take wine for his stomach’s sake (1 Tim. 5:23), which suggests that external means may be prescribed for correcting physical problems. For couples believing medical treatment can fall within the will of God, the next question is this: how far can or should we go with such intervention?

Medication – Based on the premise that drug therapies qualify as moral, many treatment options would qualify as fertility enhancing. To the man with a prostate infection, a simple course of antibiotics could be considered “fertility treatment.” To a woman with low thyroid, replacement hormone would represent a “fertility drug.” Yet when we talk of fertility drugs, we usually mean specific ovulation-inducing medications. These hormones bypass built-in protective mechanisms, resulting in the maturation of multiple eggs. Careful monitoring by use of ultrasound is required for couples using ovulation induction agents in order to avoid multiple births.

Surgical intervention – Diagnostic surgery can uncover hidden causes of infertility, and corrective surgery often helps. Surgeons may, for example, correct fallopian tube blockage or endometriosis, which affects the uterine lining. In men, surgery can reverse vasectomies or repair structural damage and varicose veins in the testicles.

High Tech Options – Most Bible-believing Christians approve the use of artificial insemination, in vitro fertilization, and other high tech procedures, provided doctors mix sperm or eggs of the spouse only (as opposed to a donor) and take precautions to honor life even at the one-celled stage. Couples using in vitro fertilization should limit the number of eggs fertilized to the number of babies they are willing to carry to term. By doing so they avoid the destruction of “excess” embryos and prevent themselves from having to decide to “selectively reduce” in cases where six or seven babies vie for available resources in utero. Some couples opt for freezing embryos; others have reservations about cryopreservation, feeling that it takes unnecessary risk to the embryo and that it presumes on the couple’s future. At the very least, couples cryopreserving embryos should have a plan for carrying each one to term.

Embryo adoption – Consider the couple who had eight embryos created during an IVF cycle. Doctors implanted three in the wife’s uterus and froze five. After she had triplets, the wife had emergency surgery to remove her uterus. That left her with three choices—to destroy the additional embryos, find a surrogate to carry them to term, or find someone willing to adopt them.

Embryo adoption is relatively new—developed in response to the more than 100,000 cryopreserved embryos in the U.S. alone. One Christian embryo adoption program works like a full-service adoption agency connecting couples wanting to carry frozen embryos with couples not wanting their frozen embryos destroyed. At the moment this costs about $6,000. However, some Internet services charge less than $75/month for couples on both sides of the embryo adoption equation to advertise and connect with each other. The couples negotiate the details after that. No matter what you believe about the ethics of cryopreserving embryos, embryo adoption is an option that is emerging as an alternative to destroying them.

Adoption – Pharaoh’s daughter adopted Moses. A family member adopted Esther when her parents died. God calls all those who believe in Christ his children through adoption. Thus, the Bible draws a beautiful picture for us of the adoption relationship.

However, of the many losses in infertility, adoption is the solution for only one—the loss of the ability to parent the next generation. Most experts encourage couples who pursue infertility treatment to exhaust medical options before pursuing adoption, as the two experiences require working through separate sets of losses. This is why so many infertile couples find it aggravating when people try to encourage with, “You can always adopt.”

Most infertile couples deeply grieve the loss of a jointly created child, the pregnancy and breastfeeding experiences, and a continuing family line. For them, adoption will never fill these voids. However, once they reach the “resolution” stage of their infertility, other options look more appealing. Only then can adoption become a wonderful means of seeing their dreams and longings come to life.

This article first appeared in Light Magazine.