What to Know About IVF: Information for Christian Ethical Decision Making

Introduction

One anonymous day around 1969, two men in a British medical office gazed into a microscope, excitement soaring. After nearly a year of experimenting with infertile couples’ gametes, Robert Edwards and Patrick Steptoe were beholding four “beautiful” five-day-old human embryos, “the first ever grown in culture.”1 “What are we going to do with them?” asked Steptoe, a gynecologist. “We’re going to flatten them,” replied Edwards, an independent researcher and council member of the British Eugenics Society, “to check their chromosomes.”2 When Steptoe asked what he should tell his patients, Edwards said they could be reassured that “we have taken another step forward.”3 Nearly a decade of further experiments passed before the first in vitro fertilization (IVF) baby was born, ultimately winning Edwards a Nobel Prize.

Fast-forward 40 years. By 2018, IVF had facilitated the births of an estimated 8 million children.4 On the one hand, many of these births represented exhilarating breakthroughs for couples facing the anguish of infertility, which the World Health Organization estimates may affect 1 in 6 people.5 On the other hand, the relatively low birth rates from all initiated IVF cycles correspond to countless other embryos who are lost, destroyed, or detained indefinitely in freezers.6 These embryos’ fates unfold against the backdrop of the fertility industry, with its unruly regulatory landscape, commercialized nature, and ethical questions about issues including commodification,7 control, and dehumanization. Also, even the best-intentioned uses of biotechnologies like IVF can have unintended consequences, influencing attitudes toward matters of paramount human significance. These matters include the value of human life, the meaning of family, procreation, children, and questions of human futures.

With IVF usage predicted to accelerate in coming years, Christians must be equipped to think about this procedure from a biblical basis.8 In response, the following discussion presents considerations to help Christians reason theologically about the ethics of IVF. Part One introduces what IVF is. Part Two examines the past and present of the IVF industry. Part Three contrasts secular and biblical worldview approaches to the ethics of IVF. Part Four identifies four relevant ethical issues worth special consideration. Finally, Part Five unpacks how principles from Genesis can help guide ethical decision-making about IVF.

Part One: The Facts About IVF

In vitro (meaning in glass) fertilization refers to the fertilization of a human egg in a laboratory rather than a mother’s body. This procedure can be attempted for a variety of reasons, using a variety of techniques, with a variety of outcomes.9 Typically, an IVF “cycle” begins by administering hormones that alter a woman’s natural reproductive cycle and stimulates her ovaries to maturate many eggs at once. A physician removes these eggs, usually with an ultrasound-guided needle. The eggs are then either stored frozen or incubated in a dish. An embryologist later takes fresh or thawed sperm from the designated father and either adds it to the dish or injects one sperm into each egg. Successful attempts produce one or more zygotes—single-celled beings who are, biologically, living human individuals who will keep maturing until death.10

These individuals are generally nurtured in vitro until they grow into two- or several-celled embryos. Meanwhile, they are monitored for apparent health, normalcy, and survival likelihood, often undergoing genetic testing to determine disability- or disease-related traits. The embryologist and parents then select which embryos to transfer to the mothers’ womb. Clinics used to routinely transfer three or more embryos together to maximize the odds of a live birth, aborting “extra” fetuses if more survived than could safely be born. However, transferring one or two embryos at a time is becoming more common.11

Embryos who are not immediately transferred or discarded are typically frozen for possible future transfer. “Surplus” embryos may be frozen indefinitely, adopted, or killed via disposal or “donation” to research. As one research team described in 2024, “Data analysis show that at least 130,000 stored embryos have been discarded in the UK since 1991, while another 500,000 embryos are currently being stored in a frozen state, of which a significant proportion is likely to be discarded in the future.”12 Graphically, a survey of 703 fertility workers across 65 countries found that most practitioners “dispose of embryos by placing them directly in a trash can strictly dedicated for embryo disposal for both fresh and frozen cycles.”13 Enough human lives to populate entire cities are literally being thrown in the trash.

Enough human lives to populate entire cities are literally being thrown in the trash.

In America alone, data suggest that of nearly two million embryos frozen between 2004 and 2013, only 37% were transferred as of 2020, with the fates of the remaining 1.2 million embryos unknown.14 And in 2021, over a third of all initiated IVF cycles reported in America were not started “with the intent to transfer at least one embryo” but rather to “bank” frozen eggs or embryos for “potential future use.”15 Of the cycles where parents did intend pregnancy, 63% did not result in live birth.16 These statistics were very similar for 2022.17 Neither did births follow from 78% of all embryo transfer procedures in Germany in 2018 or 70–76% of embryo transfers in the UK in 2022.18 So while multiple factors, including maternal age, correlate to success rates, most IVF cycles overall do not currently result in births.19

Some research, however, suggests that parents commonly overestimate the likely success and underestimate the psychological risks of this procedure.20 A major study in Germany, for instance, concluded that patients often “received insufficient information . . . on the emotional risks and burden, in particular the risk of developing an overwhelming desire for a child.”21

In terms of physical impacts, the US Department of Health and Human Services describes IVF as “relatively safe” but notes various risks and burdens for women and children.22 Previously, such risks were attributed to IVF mothers’ higher rates of bearing two or more children at a time.23 However, a growing body of research links IVF to “increased risk of preeclampsia, preterm delivery, placenta previa, placental abruption, intrauterine growth restriction and low birth” among other adverse impacts, even for the births of single children.24 Some researchers argue that aspects of these outcomes may relate to epigenetic effects from the manipulation of hormones, gametes, and embryos inherent in IVF.25

Part 2: The IVF Industry Past and Present

With these realities in mind, we can examine the IVF industry’s historical development and current landscape. While other scientists had generated—and destroyed—human zygotes in vitro in 1944,26 Edwards and Steptoe’s experiments described above laid the basis for today’s fertility industry. When these experiments began in earnest, Edwards was deeply involved in the eugenics movement.27 This movement, founded by Charles Darwin’s cousin Francis Galton, seeks to “improve” humanity by preventing the births of babies with “unwanted” traits and by promoting “wanted” traits.28 Eugenics fell from favor after Nazism but never disappeared, as Edwards’ involvement illustrates. Reflecting these eugenic undertones, Edwards in 1989 looked forward to when genetic testing would mean that “embryos carrying crippling genes could be identified and flushed away, sparing patients the unhappiness of abortion following a much later diagnosis.”29 Essentially arguing for voluntary eugenics, Edwards qualified that while not every “less-than-perfect” child need be destroyed, “every parent makes his or her own rules.”30 He also realized that IVF opened the doorway “of genetic engineering, of impermissible research upon the unborn, of the possibilities for surrogate motherhood, for the storing of frozen embryos, [and] for the ability to choose a baby’s sex.”31 But he recounted that IVF’s novelty “drowned out” such concerns: “The world had greeted its first test-tube baby. Ethical arguments could wait.”32

Twenty-four years later, the President’s Council for Bioethics (PCB) did call for (at least temporary) moratoriums on IVF’s most controversial potential applications. These included transferring human embryos to animals, creating human-animal chimeras, and trafficking human embryos.33 However, the US has no federal protection for human research subjects living in vitro, except that such research cannot gain federal funding or be used in certain clinical trials.34 The most relevant federal law otherwise is the 1992 Fertility Clinic Success Rate and Certification Act requiring IVF clinics to report live birth rates. However, this law neither has an enforcement mechanism nor requires reporting adverse health outcomes or numbers of embryos created, frozen, transferred, implanted, or discarded.35 Such policies have previously let clinics present skewed success rates, for instance by transferring fewer embryos to older women.36

Equally striking, most regulation of the fertility industry comes from within the (exceptionally lucrative) industry itself.37 According to a 2024 editorial in The Lancet, “The global fertility market was valued at US $34.7 billion in 2023 and is projected to grow to 62.8 billion in just 10 years.”38 In the US, Forbes reported in 2023 that just one IVF cycle can “range from $15,000 to $30,000, depending on the center and the patient’s individual medication needs.”39 These costs increase with clinical “add-ons,” additional tests and interventions that a major study in 2023 reported are overwhelmingly “supported only by low-quality randomized controlled trials, observational data, professional experience, or consensus of the development group.”40 As another research group from the European Society of Human Reproduction admits of add-ons, “In some contexts, vulnerable patients (who are prepared to do anything to conceive) are burdened by (and charged for) often costly treatments that lack scientific evidence.”41

Part 3: Worldview Foundations for Approaching IVF

With all these realities in mind, we can begin to ask, “How should Christians think about IVF?” Although IVF is a modern intervention that Scripture does not address directly, God’s Word provides ageless principles for thinking ethically about such technologies . We can distill seven of these principles from truths about humanity grounded in Genesis. First, humans are creatures within a given, orderly realm that God created very good (Genesis 1:31). Second, humans are costly, imbued with intractable value as God’s image bearers at every stage of life (Genesis 1:27; c.f. Genesis 9:6). Third, humans are corporeal, meaning that we are embodied as well as ensouled. Fourth, humans are contingent, dependent on God and finite from creation’s beginning. Fifth, humans are communal, relational beings, with the very first human relationship God created being marriage. As Genesis 1:28 and 2:18–25 describe, God ordained this one-flesh union between husband and wife as the context in which to “be fruitful and multiply” (c.f. Mark 10:6–9). Sixth, humans are called to vocations God designed humanity uniquely to fulfill, such as having dominion over creation and parenting any children God gives us (Genesis 1:28; Psalm 127:3). Seventh, humans—and all creation—are corrupted due to sin, which ushered suffering, grief, and death into reality (Genesis 2:17–3:24; Romans 5:12, 8:19–22).

God sent his Son, Jesus Christ, to take on human flesh and die as the only perfect sacrifice for sin. Jesus rose from the dead, ascended to heaven, and will return as the eternal king over a new heaven and earth without suffering, death, and tears. This assurance gives us hope amid our fallen world, as does Jesus’ promise to be with us always (Matthew 28:20), which strengthens us to endure every circumstance (Philippians 4:11–13). Meanwhile, we rightly work to love others by seeking to alleviate the pain of our fallen world. But we will ultimately cause more harm if we try to reach even noble goals in ways that trespass the boundaries and designs God established for our flourishing.

Opposing this biblical perspective, a secular worldview assumes that humans evolved naturally with no God whose character is the source of truth, morality, and goodness. By this thinking, neither our bodies nor our children’s bodies are designed as they are for purposes intended by an all-wise, loving Creator. Such thinking leads to a “fact-value divide,” wherein facts need not correspond to specific value judgments.42 As a result, the fact that an embryo exists can say nothing either about that embryo’s worth or about how his or her parents should behave in response. Nor, by this thinking, do the facts of natural procreation tell us anything about how procreation should happen. Rather, autonomous individuals can bestow their own values on facts and then act accordingly, including by altering those facts however technology allows. Edwards illustrated such thinking, asserting that “it was evolution, rather than an arbitrary, one-off act of God, that bound the transmission of life to the sex act,” so the association between sex and procreation “is therefore always open to modification or abandonment.”43

This view of humans as self-creators who can freely modify reality to fit their own values has been called expressive individualism. We see this view behind policies that allow people who can express their values to make decisions at the expense of other people who cannot.44 Legal scholar O. Carter Snead argues that such thinking underlies the IVF practices in which voiceless embryos become casualties in the service of adults’ wishes (even when these wishes are for good things).45

Part Four: Underlying Philosophical and Bioethical Issues

Clearly, a biblical and secular worldview offer drastically different foundations for thinking about the ethical issues of IVF. Four of these issues to consider include (1) the destruction of embryos, (2) effects on our understanding of family, procreation, parenthood, and children, (3) questions of commodification and control, and (4) eugenic considerations.

Regarding embryo destruction, we’ve already seen how today’s IVF practices historically required and continue to cause the deaths of countless human individuals whose lives have just begun. These deaths are often intentional, illustrated by the fates of the embryos being purposefully thrown into trash bags or “flattened” under microscopes. But what about the many unintentional deaths evidenced in the high percentages of embryos who are transferred but never born? Some people argue that these deaths differ little from the unintended deaths of naturally conceived embryos—a tragedy that happens often in our fallen world (although perhaps not as often as previously estimated).46 Yet Christian ethicist Matthew Eppinette, writing in the context of his own struggles that he and his wife faced with infertility, suggests that “there is a moral difference between the possibility of natural embryo loss and the intentional use of a technique that will result in embryo loss.”47 (Understandably, however, many couples have not been made aware of these relative risks for embryos and have opted for IVF in good faith based on the best information they had.) Another difference is that the natural course of reproduction also does not allow parents or clinicians to selectively destroy embryos that do not meet certain criteria.48

What if, out of regard for the value of every human life, parents committed to creating and transferring only as many embryos as could be safely delivered at a time, regardless of each embryo’s genetic traits (and despite the potentially heightened costs and physical burdens associated with the likely need to repeat this procedure)? If the birth rates cited earlier are any indication, then these embryos may still face at least a 65% chance of death—a much higher risk factor than parents would normally willingly subject their existing children to.49 The risks of natural conception are not fully comparable here, for a couple attempting to conceive without IVF cannot know in advance if an embryo will be procreated.

Can the loss of life typically inherent in IVF be justified by appealing to “the principle of double effect”? This principle states that sometimes, actions that are meant to produce a positive outcome can be ethically permissible even if they will predictably lead to proportionate, unintended negative side effects.50 Parents may wonder whether this principle can rationalize IVF, if embryo loss is just a “proportionate side effect” and not the main intention.51 However, proportionate side effects must also be fair .52 That is, the intended positive outcome must not mainly benefit one party at the expense of forcing a non-consenting party to bear the brunt of the unintended negative outcome. Statistically speaking, IVF fails this test of fairness in many cases, with parents benefiting only at the expense of non-consenting embryos who bear the disproportionate burden of dying as casualties for the cause.53

Along with such destruction of human life, a second concern surrounds IVF’s effects on people’s understanding of family, medicine, procreation, parenthood, and children. Social commentator Neil Postman warned that new technologies change human thinking, altering our view of fundamental aspects of reality.54 Illustrating one such change, Edwards (the IVF pioneer) noted how with reproductive technologies like IVF, “even traditional notions of parenthood are made obsolete.”55 IVF also further facilitates our secular society’s altered view of the family by enabling novel possibilities for nontraditional family arrangements.56 Remarking on this outcome, a writer who interviewed Edwards for Living Marxism in 1989 observed, “It’s easy to understand why those in the establishment are so unsettled by embryo technology. The techniques pioneered by Edwards don’t just challenge scientific boundaries, they challenge existing moral and ethical boundaries too.”57

These shifting definitions of family coincide with shifting definitions of infertility. An emerging trend is to redefine infertility to include not only medical but also social factors. These redefinitions call single or homosexual-identifying individuals “infertile” even if they are physically able to procreate.58 In these cases, and in cases where fertile couples seek IVF for reasons like sex selection, fertility doctors are not addressing diseases. Such uses of IVF reflect still another redefinition, changing the meaning of medicine toward a “provider of services model.” This model, consistent with expressive individualism, sees doctors not primarily as healers but as technicians that autonomous people can contract for their own self-determination projects.59

Pro-creation recognizes children as gifts received from the Creator, while re-production views them as manufacturable consumer products subjectable to quality control

More notable still are IVF’s effects on society’s view of children, reflected in the distinction between the terms procreation and reproduction. As Christian ethicist Oliver O’Donovan observes, pro-creation recognizes children as gifts received from the Creator, while re-production views them as manufacturable consumer products subjectable to quality control.60 Another scholar describes how this “logic of production” means IVF “does not merely offer another possible option” but “leads to a fundamental change in the attitude towards human life as such.”61

This fundamental change, evidenced in the objectifying language of “using” embryos for IVF, highlights a third ethical issue: the commodification of reproduction and of children. After all, the fertility industry readily puts a price tag on every conceivable aspect of the technologized reproductive process—even on gametes and embryos themselves. In America, egg “donations” can entail transactions of over $100,000.62 Many states also allow IVF clinics to combine donor sperm and eggs into embryos with no prearranged parents.63 Clinics can then offer these intentionally created orphans as anonymous “donor embryos,” using set prices per embryo.64 As one research team summarizes, “Human embryos have, thus, also become a tradable commodity, even though ethical guidelines for embryo donation still prohibit the ‘sale’ of embryos.”65

IVF’s embryo selection practices are inescapably eugenic

In a society that treats children as commodities, we shouldn’t be surprised to find adults who want to buy and sell the best possible human “products.” So commodification dovetails with the fourth issue—eugenics. As another Christian ethicist argues, IVF’s embryo selection practices are inescapably eugenic, with the births of existing embryos being prevented or promoted based on genetic traits.66 Such practices aren’t just on the sidelines of IVF. Rather, as one journal article states, “Embryo selection is essential in IVF practice for increasing pregnancy rates and reducing the negative effects of repeated failures.”67 These practices have, together with selective abortion, helped facilitate the virtual disappearance of children with Down syndrome in various countries—a classic example of eugenics.68 Some companies take these eugenic practices even further by selling genetic tests that allow for selecting embryos based on future risk of disease.69 Going further still, at least one American clinic reportedly allows their clientele—90% of whom are fertile—to select for traits including eye color.70 In all these ways, today’s IVF practices often continue the eugenic legacy present from the industry’s conception.

Part 5: Theological Considerations and Action Points

In light of these concerns, how can Christians apply the seven Genesis truths described above to guide a theological evaluation of and response to IVF? First the truth that humans are fundamentally creatures (i.e., created in God’s image) rather than creators of themselves or their children affirms the concept of pro-creation rather than re-production. Children are not products that consumers are entitled to manufacture, store, possess, or discard. Rather, every child is God’s own craftsmanship and, therefore, belongs to God. Parents cannot even claim partial ownership rights as “co-creators” of their children with God. Not only is the “co-creator” concept absent from Scripture, but also, God’s design for procreation does not allow parents to play any conscious role in choosing, designing, or “knitting together” their offspring.71 Under ideal natural conditions, parents’ role enables an egg and sperm to meet inside a woman’s body but cannot determine which sperm (if any) meets which egg at what time. Neither do parents play a natural, intentional role in crafting or choosing the genetic components they contribute to offspring.72 Because “children are a heritage from the LORD” who created them (Psalm 127:3), the opportunity to parent is not an entitlement but a gift of grace. A biblical view thus cannot accommodate the use of any biotechnology in ways that predispose us to view ourselves or our children as anything but the given creatures we are.

The opportunity to parent is not an entitlement but a gift of grace

Second, the truth that every human life is costly, bearing God’s image, prohibits any use of IVF that intentionally harms, destroys, devalues, or otherwise dehumanizes embryos. This implies no embryo should be created apart from the unconditional intention to parent that child.73 Even then, parents must consider the high risks and unequally distributed burdens that each IVF embryo would bear. No embryo, as a unique image bearer of his or her Creator, should be treated as a mere means to an end—much less, as a statistically necessary sacrifice for others’ ambitions.

Third, the truth that humans are corporeal as body-soul unities has led some (though not all) Christian ethicists to question the wisdom of technologically removing procreation from its God-given context of marital intimacy.74 On a related, although slightly different, note, O. Carter Snead argues that America’s lack of IVF regulation harmfully ignores humans’ corporality.75 As a result, the law not only fails to recognize embryos as bodily human individuals but also neglects to adequately protect parents who are vulnerable from the anguish of bodily infertility.

Fourth, the truth that humans are contingent reorients the contexts in which parents might be seeking IVF. As one professor observed, “Infertility profoundly brings home the reality that we are finite, contingent creatures, who do not control all aspects of our lives.”76 She notes that society assumes “technology can compensate for human finitude,” encouraging parents to do so at virtually any cost.77 As previously discussed, the overall cost in terms of embryo loss, parental heartbreak, and other ethical complexities has proven immense. A recognition of our contingency can help prevent these consequences, reassuring us that the loving Creator, whom we depend on, will not withhold anything that he knows is right for us.

Fifth and sixth, the truths that humans are communal and called means we must consider how any application of technology (including IVF) may affect our relationships and vocations, such as marriage and parenthood. Some of these impacts have been noted earlier, whether psychological stressors on couples or other potential effects that may vary by situation. For instance, Kummer notes that practices such as gamete donation contribute to more children coming into “a family no-man’s land” that “deliberately imposes a foreign origin on the child, which will be a great challenge to overcome.”78 Additionally, fulfilling our human vocations well requires wisely stewarding the resources God has entrusted us, raising additional factors for Christians to consider in light of IVF’s physical and financial costs.79

Seventh, the reality that humans are corrupted reminds us that because of Adam’s sin, we occupy a fallen world wracked with suffering—including the grief of infertility. We can apply technology to mitigate suffering but doing so in ways that overstep the moral boundaries and creational designs God gave us will lead to harm. To avoid this outcome, we must seek ways to mitigate suffering that work within rather than against God’s Word, intentions, and created order.80

For instance, couples need to know that multiple alternatives exist to IVF that do not entail the same suite of ethical issues, particularly regarding embryo destruction and eugenics. Flushing the fallopian tubes with oil- or water-based solutions, for example, has known fertility-boosting effects among women suffering from certain fallopian tube issues,81 with a recent case study reporting that flushing enabled pregnancy without further fertility treatments.82 Another recent study found “no robust evidence that in couples with unexplained infertility IVF achieves pregnancy leading to live birth faster than [artificial insemination].”83 As a 2023 article in the journal Fertility and Sterility aptly observed, “There have been concerns on the potential overuse of [IVF] in view of the lack of evidence on effectiveness in certain populations, potential short and long-term safety risks, and economic considerations. On the other hand, the use of alternatives to IVF seems to be underappreciated in clinical practice as well as research.”84 Further research into such alternatives offers one way to ethically address the pain of a fallen world. Meanwhile, as the Southern Baptist Convention resolved regarding IVF, “We grieve alongside couples who have been diagnosed with infertility . . . affirm their godly desire for children, and encourage them to consider the ethical implications of assisted reproductive technologies as they look to God for hope, grace, and wisdom amid suffering.”85

Conclusion

Ultimately, a close examination of IVF reveals significant ethical issues that Christians must consider in light of principles from God’s Word. Foremost among these issues is the staggering degree of (intentional or unintentional) loss of embryonic life associated with IVF. Another issue is IVF’s potential to shift our view of parenthood and children from a procreation to reproduction model, raising still further issues of commodification and eugenics. All these questions arise against the backdrop of a highly commercialized, largely self-regulated fertility industry that continues to perpetuate the legacy of its ethically problematic past.

A secular worldview encourages parents to participate in this industry however their autonomous wills dictate. In contrast, a biblical view invites a different set of considerations corresponding to the truth that humans are creatures, costly, corporeal, contingent, communal, called, and corrupted. These truths reinforce a view of each child as an embodied, relational, pro-created gift fashioned in God’s image and belonging to God. Many of today’s IVF practices do not accord with these realities, rendering these practices unethical from a theological perspective. Even if IVF can be undertaken in ways that avoid intentionally harming embryos, other factors to consider include (1) inherent risks and burdens to embryos, (2) stewardship considerations, and (3) other unintended consequences such as IVF’s potential to shape our views of parenthood. Encouragingly, alternatives to IVF exist that may address certain forms of infertility in ways that raise fewer ethical issues. Such alternatives allow for combating the suffering of our fallen world without contributing to its injustices, compounding its confusion, or crossing vital moral boundaries—especially God’s prohibitions against taking innocent life. Through the lens of his Word rather than Edwards’ microscope, we can recognize each human being—both the born and the preborn—not as a specimen, product, or commodity, but a person beloved by God.