Can IVF ever be done ethically?
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The point often arises in IVF conversations that surely, if IVF were done a certain way, such as if every created embryonic person is transferred and there are no “extras,” or if only one embryo is created and transferred at a time, then IVF will be an ethical practice.
Here are my responses to these arguments, and the short answer is…no:
First, we can make sure we’re transferring as many embryos as we like, but they still won’t all implant. We’re still creating multiple children in the hopes that one of them will survive the transfer process. And it is rare to create only one embryonic human person at a time because the procedure is so expensive. Embryologists want to up the odds of implantation, so they fertilize as many mature eggs as possible at a time. There are a few rare “Christian” clinics that conduct “mini-IVF” and “natural cycle” IVF with a “no discard” approach. Mini-IVF elicits fewer eggs for retrieval, resulting in fewer leftover embryos, and the natural cycle approach fertilizes the woman’s single ovulated egg each month.
After embryo retrieval, the embryos that die between day 3 and day 5 are said to mirror the process of natural conception, and lab technicians are simply watching what God does through the natural fertilization process, except that this isn’t true. The culture in which embryos develop inside the lab attempts to mimic the natural conception environment, but the artificial nature of the petri dish and incubators, and the culture environment such as the culture media, the light, temperature, and pH level can all reduce viability.
Creating children in laboratories should be discouraged even if no children are thrown away, as manufacturing children in laboratories is an affront to human dignity. Even if fertility centers don’t freeze embryos and require their couples to either transfer them or donate them, they are still complicit in the commodification of embryonic human beings that comes with the inherent trial-and-error of the transfer process.
Though a Christian approach to IVF is commendable, whether one embryo or 10 are created and transferred, trial and error with that one, full person, is still occurring. Further, was there any guarantee that this one embryo, which was intentionally and unnaturally created to be potentially disposable, would transfer successfully? Not at all. Participants are then responsible for the death, if this occurs, of that one human person, a blame which never falls on couples participating in the co-creation process that God conducts within the mysterious sanctuary of the mother’s body.
This one life is also still subject to the unnatural nature of the petri dish that can be harsh to developing embryos, as it does not perfectly mimic the natural conception environment. This embryo will also still undergo embryo grading, even if it doesn’t undergo preimplantation screening, to determine if he or she is worthy of transfer based on cell division. So, a unique person’s life was still intentionally devalued, whether one embryo or ten were created.
Dr. Lauren Rubal stated that PGT is not always accurate, and that chromosomally “normal” babies have been born from embryos deemed “abnormal,” or from “aneuploid” cells as opposed to “euploid” cells. These tests are prone to false positives and can show blastocysts as having abnormalities when they are indeed normal, resulting annually in thousands of healthy embryos’ destruction. It’s possible to biopsy the wrong area of chromosomes in an embryo and be incorrect about a diagnosis. And Dr. Turczynski stated: “...The current method of evaluating viability is based on visual inspection and we have some ideas of what makes a viable embryo, but it is imperfect. Things such as symmetry, fragmentation, stage of development for age of the embryo, vacuoles and appearance of the cells, shape, etc. The field has used PGD [Preimplantation Genetic Diagnosis] to try and confirm viability but even that is being questioned now because of the embryo’s capacity to self-correct by pushing abnormal cells to the placenta.” The placenta itself is able to function with “abnormal” or “aneuploid” cells—it doesn’t require normal genetic make-up, so embryos showing aneuploid cells can still be completely capable of developing.
Further, in addition to a lack of female cryptic choice that occurs in the natural conception environment, this unnatural conception environment of IVF can impact cellular processes and alter chromosome structure, the transcription of DNA, and embryonic development, leading to conditions such as heart disease, diabetes, cancer, autoimmune and neurological disorders in IVF children, congenital anomalies, endocrine abnormalities, and epigenetic imprinting effects. Previous studies have shown that the use of artificial reproductive technologies in general may cause epigenetic changes in children and lead to imprinting disorders. Epigenetic modifications impact chromosome structures to make certain genes more likely to be turned on or off, therefore regulating how the information in our DNA is used. Outside of IVF, epigenetics can be involved in metabolism function, diseases such as Parkinson’s and Alzheimer’s, cancer development, autoimmune diseases, and substance use disorders.
There are still the issues of separating the unitive and the procreative nature of the conjugal act and placing the literal creation of the embryonic human person, the combining of sperm and egg, in the hands of a third-party, who is in a very real sense, now a part of the couple’s marital union. This third party is a key element in the miracle of bringing children into existence that is ideally reserved for the intimate union of husband and wife.
Even if only one embryo is created at a time, the IVF process still doesn’t assist the natural conception process, but rather, completely bypasses it, and it still uncouples procreation to a degree that falls well short of the mark, does not honor the unitive and procreative nature of the conjugal act, and insists on our own will instead of God’s. We should never turn the creation of human life into a manufacturing process, but that's what IVF does every time even just one embryo is created in a laboratory.
Unnecessary harms
Physicians are called to heal, or at least treat, to the best of their abilities, to “do no harm,” and to uphold the innate worth and dignity of every human being. IVF is not healing, nor does it honor the worth and dignity of embryonic persons. IVF provides women with unneeded medications, risking unnecessary side effects, leaves underlying fertility conditions unhealed, and prejudices every single human being created as potentially disposable. This is human experimentation—not medicine.
What are these unnecessary side effects? To begin with, there are the known risks accompanying the use of birth control pills and synthetic hormones like progesterone (progestin) and estrogen (estradiol), and women seeking to have their eggs extracted must submit themselves to the unnatural, risky process that is hyperstimulation of their ovaries. This is done by the daily injection of follicle-stimulating hormones called gonadotropins. Some side effects of gonadotropins include blood clots, ovarian hyperstimulation syndrome, which occurs when ovaries respond too strongly to the medication and fluid leaks from the ovaries into the abdomen since the body is not naturally made to release the amount of eggs required for IVF, ectopic pregnancies, and a twisting of the ovaries due to heavier-than-usual follicles, which can result in the loss of an ovary. Ovarian hyperstimulation syndrome can also result in pulmonary issues, stroke, blood clots, kidney dysfunction, and even death. Even though a trigger shot of Lupron decreases the risk of ovarian hyperstimulation syndrome, moderate-to-severe OHSS has still been shown to occur in around 1-5% of IVF cycles. According to the American Society for Reproductive Medicine, there were approximately 432,641 IVF cycles in 2023, which calculates to between 4,326 to 21,632 women developing OHSS. Even though Lupron is used as a precaution against OHSS, it comes with its own risks, including chest pain, shortness of breath, blood clots, heart attack or heart failure, severe skin reactions, seizures, and loss of bone density, among several other risks.
The egg retrieval process, where a thin needle is inserted through the vagina into the ovaries to remove egg-containing fluid from the follicles, comes with risks such as injury to the bladder, intestines, uterus, ovaries, and blood vessels by the needle. There is also the risk of pelvic infection, ovarian infection, internal bleeding, ectopic pregnancy, ovarian torsion, miscarriage, inflammation in the lining of the abdominal cavity, pelvic abscesses, ovarian twisting, abdominal bleeding, and anesthesia complications. Regarding the embryo transfer process, or when eggs are fertilized and subsequent embryos are transferred into the uterus, a few surgical complications that can arise during the procedure include bleeding into the uterine cavity or perforation of uterine muscles following catheter insertion, and/or pelvic infections.
Since there is a known risk of infection and bleeding during the process, we can infer that it may pose a risk of harm to a woman’s future fertility. For example, infection and the surgery required to treat bleeding both can lead to abdominal adhesions, which are a common cause of infertility Furthermore, the puncturing of the ovary with a needle (which is required to retrieve mature eggs) can cause trauma to the ovary and lead to the formation of anti-ovary antibodies. Studies have found that anti-ovary antibodies can impact fertility by potentially affecting egg and embryo development, and contribute to implantation failure.
Women who undergo IVF are also at an increased risk for thromboembolisms, and general pregnancy risks such as diabetes, placenta accreta spectrum (where the placenta doesn’t separate from the uterus at delivery), hemorrhages, preeclampsia, preterm birth, low birth weight, birth defects, placenta previa, placental abruption, hypertensive disorders, and cardiovascular conditions all increase with IVF pregnancies. There are also studies showing a possible increased risk of ovarian cancer following the use of fertility drugs. Since they are being paid, women who aren’t undergoing IVF, but are only acting as egg “donors,” may be susceptible to more aggressive stimulation, therefore increasing the likelihood of risks.
This may seem like no big deal because all medications and procedures come with some risks, right? But, none of this is necessary. Physicians are intentionally risking harm in their patients for a procedure that they don’t need. They do not need these medications to stay alive, or even to improve their health.
Instead of IVF—a procedure that experiments with human lives while potentially masking treatable health conditions—restorative reproductive procedures to allow natural conception should be promoted. Natural restorative procedures seek to restore overall health while providing a better chance of natural conception.
As Dr. Craig Turczynski stated: “Infertility treatment needs to be therapeutic. IVF is not therapeutic—it’s actually traumatic. The benefit of restorative reproductive medicine is even if you don’t get pregnant, you’ll at least be healthier, you’ll have been treated therapeutically.” He likes to say that IVF is like the aphorism “if you have a hammer, everything looks like a nail,” because regardless of what the diagnosis is, IVF is seen as the answer.
I shadowed a restorative reproductive medicine doctor who studied at the Saint Paul VI Institute in Omaha, NE, who said that “unexplained fertility” is the same as a cardiologist telling someone they have “unexplained chest pain.” This diagnosis completely ignores and bypasses the underlying cause and treatment for the disease. It was eye-opening to me how many women actually have endometriosis and PCOS, and how varying the symptoms are from woman to woman. Since IVF is often the first route suggested by endocrinologists, there are an incredible amount of women having their treatable conditions masked.
Theological implications
IVF facilitates couples’ creating children artificially while bypassing that aspect of begetting that commands us to “be fruitful and multiply,” a command which is certainly not a license from the Creator allowing us to create children by any means possible. Husband and wife, in their reflection of Christ and the Church, reflect the love of Christ for His creation, and God doesn’t treat any of us as disposable, but this is unfortunately the case in the IVF process, even if only one embryo is created and transferred at a time.
Of course, children conceived outside of the marital union are still human beings made in the image and likeness of God, but the difference is that those conceived outside of the marital union do not have their right to be conceived in love and viewed as gifts honored, because the means of their conception is an offense against one’s inherent dignity. These children, of course, still have dignity from the moment of fertilization, but their inherent dignity is not being fully revered when they are conceived outside of the marital act. All children have the right to begin their lives within the mysterious sanctuary of their mother’s wombs, not to have their lives begin overseen by a third-party in a laboratory petri dish.
Inquiring about IVF from a Christian perspective, the question often arises: “Isn’t God still in control of who comes into existence through the IVF process?” God, of course, being the Author of life, is always in control. However, it is through our errant free will that we pursue IVF and other reproductive technologies that stand directly opposed to the reproductive ideals and truths that God has already revealed to us.
There are numerous ways in which conception, as do many other circumstances and conditions, occur outside of the ideals of God’s just ordering of creation, but God is the ultimate giver of life and therefore everyone’s existence is significant and precious. God can turn any human decision in the direction of ultimate Good, but that hardly allows us to make the tragic error of believing that when we make distorted and disfiguring decisions, as we all often do, that these are decisions ordained by God, as many claim. Every child has the “right to life and physical integrity from the moment of conception until death,” and “the right to be conceived, carried in the womb, brought into the world and brought up within marriage…The parents find in their child a confirmation and completion of their reciprocal self-giving: the child is the living image of their love, the permanent sign of their conjugal union, the living and indissoluble concrete expression of their paternity and maternity.”
In their parents’ reflection of Christ and the Church, and in male/female marriage, children get a wonderful glimpse into eternity. Distorting reproduction by creating children in petri dishes, allowing a third-party into the marital union by using sperm and egg donors or surrogates, or creating children into situations with single parents by choice, or with “two moms or two dads” (as is often the case in IVF), can’t properly reflect this Christ/Creation relationship to children.
Jesus was worthy of respect right at conception and upon becoming incarnate revealed how we, being made in His image, are worthy of this same respect. This respect is not afforded to those beginning their lives in laboratories, as every step leading up to their existence is overseen not solely under the gaze of the loving God, but also beneath the oversight of scientists chiefly concerned with calculating potential outcomes. Their calculations guarantee that IVF intentionally brings human life into existence with the full knowledge that not all of the lives are going to make it, if any, and this industry that experiments with human beings should not be condoned and Christians should not be contributing to its continuation.
And, if my thoughts aren’t convincing, here’s a quote from the Catholic Church document Donum Vitae, because they are dead right on these issues, even if you aren’t Roman Catholic:
“...it is asked whether, when there is no other way of overcoming the sterility which is a source of suffering, homologous in vitro fertilization may not constitute an aid, if not a form of therapy, whereby its moral licitness could be admitted. The desire for a child - or at the very least an openness to the transmission of life - is a necessary prerequisite from the moral point of view for responsible human procreation. But this good intention is not sufficient for making a positive moral evaluation of in vitro fertilization between spouses. The process of IVF and ET must be judged in itself and cannot borrow its definitive moral quality from the totality of conjugal life of which it becomes part nor from the conjugal acts which may precede or follow it.
“It has already been recalled that, in the circumstances in which it is regularly practised, IVF and ET involves the destruction of human beings, which is something contrary to the doctrine on the illicitness of abortion previously mentioned. But even in a situation in which every precaution were taken to avoid the death of human embryos, homologous IVF and ET dissociates from the conjugal act the actions which are directed to human fertilization. For this reason the very nature of homologous IVF and ET also must be taken into account, even abstracting from the link with procured abortion. Homologous IVF and ET is brought about outside the bodies of the couple through actions of third parties whose competence and technical activity determine the success of the procedure. Such fertilization entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children.
“Conception in vitro is the result of the technical action which presides over fertilization. Such fertilization is neither in fact achieved nor positively willed as the expression and fruit of a specific act of the conjugal union. In homologous IVF and ET, therefore, even if it is considered in the context of ‘de facto’ existing sexual relations, the generation of the human person is objectively deprived of its proper perfection: namely, that of being the result and fruit of a conjugal act in which the spouses can become “cooperators with God for giving life to a new person”. These reasons enable us to understand why the act of conjugal love is considered in the teaching of the Church as the only setting worthy of human procreation. For the same reasons the so-called “simple case”, i.e. a homologous IVF and ET procedure that is free of any compromise with the abortive practice of destroying embryos and with masturbation, remains a technique which is morally illicit because it deprives human procreation of the dignity which is proper and connatural to it.”
For more on reproductive technologies, check out my book!