Chapter 2 – IVF: Questions We Should Ask

Author: Greg Kenyon, Mitchell, Ontario, Canada
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Before reading -Please note

–This is a chapter from an online version of a book I am writing with the purpose of providing true information about organ donation and invitro fertilization (IVF) as well as raising some of the questions that should be asked.
–This book is written from a Biblical-Christian perspective.  To learn more about what this means feel free to read some of the other material on my blog at https://greg.kenyonspage.ca/.  You may also read my attempt to describe my beliefs at http://greg.kenyonspage/i- Believe/.
–This is a work in progress.  If you are reading from a printed version or coped material, rather than directly from my website, https://greg.kenyonspage.ca/,   then you may not have the most up-to-date draft of this book.  Please do not copy it or pass it on to others.  Instead, go to the book on my website at , https://greg.kenyonspage.ca/greg-kenyons-book-questioning-medical technologies/.  Feel free to direct others to my book on line.

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The following chapter was last updated in Jan 2014 – this means that the foot notes of websites refer to how the websites were at that time.

-section on complications of IVF updated 2016
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I believe it is a good idea to read Chapter 1 – Questioning Medical Technologies: Compassion and Asking Important Questions along with this chapter. Use the links above to find it.
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Chapter Two

IVF:   Questions We Should Ask

Author: Greg Kenyon, Mitchell, Ontario, Canada

Click links below to jump to subsections of this chapter.
Procreation and the Image of God
Now, let us walk through the process of IVF
Ovarian Hyperstimulation
Collecting Sperm
In the Petri Dish
IVF Doctors
Tiny Frozen People
Implantation Trouble
Twins, Ectopic Pregnancies and Other Complications
Selection of Sperm, Eggs and Embryos
Natural and Mild IVF
IVF and God’s Commandments

From the beginning one of the mandates of creation has been to be fruitful and multiply.   Clearly in scripture, this includes procreation, which is the conception and bearing of children. Children are described in scripture as a blessing.   When a couple finds that they are not able to have children, they often find it distressing and seek medical assistance. Problems with procreation are recorded early in the Bible. Problems with infertility are not new.   Hannah, in her infertility poured her heart to the Lord.[1] Sarai after waiting a long time turned to the infertility treatment of her day and said, “perhaps I can obtain a child through my maid.”[2] Abraham agreed. The treatment of their infertility turned out to cause distress in their relationship and was not God’s best plan for their marriage. Similar things happened with Jacob, Rachel and Leah. Sharing this is not meant to imply that modern day infertility treatments will necessarily result in similar problems, but is meant to highlight that infertility is distressing and can result in distress in relationships. Solutions for infertility remained the same for centuries, leaving many just hoping for children. That is, until, in the recent past, technology began to hold out hope for those who, in the past, seemed to have no hope. As I write this, I find myself asking, to what extent should we place our hope in having children?[3] To what extent has the hopes of those of us who have had children been answered through our children, to our satisfaction?

 

Infertility is a significant problem. It is not surprising, when medical technology holds promise of a solution, that we consider using it. Medicine has done much to help those who struggle with infertility. At the outset, I want to stress that this essay is not an essay about infertility or one that is meant to raise all of the questions that we need to ask as we seek medical help with infertility. It is an essay about one aspect of infertility treatment, that being, invitro fertilization, also called IVF. This term describes the fertilization, or the joining, of the egg and sperm, outside of the body, then placing the resulting new human life inside the womb so that it can continue to grow.

 

In many Christian circles, it is known that these new technologies offer some solutions that we ought not to pursue. We also know that IVF is often associated with the destruction of life. Faced with infertility personally, or with those close to us, we ask, can IVF be used in a way that does not destroy life and that is acceptable before the Lord? This can be a pressing question for a couple struggling with infertility? How can we utilize this technology that promises us the child that we have been unable to have by ordinary means? How can we help our brothers and sisters who struggle with infertility? Is IVF part of Jesus’ New Testament answer to heal the broken hearted, to liberate those captive to infertility, to make the infertile fertile? (Luke 4:18-19) It is the return of society to biblical roots in the 15 and 16 centuries, that really opened the way to scientific study and discovery. The discoveries of science are, at least in part, behind the development of IVF. Is IVF, somehow, part of fulfilling the dominion mandate that God presented at the time of creation?

 

To consider what questions to ask, we first need to know something about what actually happens with IVF. We will focus on husband-wife-only IVF, meaning that the eggs involved come from the wife and the sperm from the husband and that the resulting child is implanted into the wife’s womb rather than a surrogate mother. If you use third party’s sperm or eggs, or a surrogate womb, you introduce a parent other than the husband or wife into the relationship.   This raises questions that are beyond the scope of this essay

 

Procreation and the Image of God:

The first detail to consider is that IVF does not require that the husband know his wife.   What I mean by this is that there is no need for sexual intercourse. I described this as the husband and wife knowing each other, as this is the terminology used in the Bible. Having children, until recently, required that a man know his wife. The Bible describes this as becoming one flesh. In knowing each other, the Husband and Wife become one. When God created man, He created man in the image of God, male and female He created them. (Gen 1:27) Is there something about the intimate, knowing relationship between husband and wife that is involved in husband-wife being created in image of God? God is three in one. He is unity in relationship. In the one God there is relationship between His persons, Father, Son and Holy Spirit.[4] It is this God who created the earth. In our procreation we bear something of the image of God. From united relationship, God, Father-Son-Holy Spirit, created.   From the oneness of intimately, knowing each other through sexual intercourse, we, husband-wife, procreate.   From two, who are one, husband-wife, new life is created. Of course, we are not God. We are not created like God. Instead, we are created in His image. God creates.   We procreate. We do not form children when we want to, how we want to, or independently of God. We need God.   As described in the next paragraph, we need God to visit us in our oneness. Given that IVF does not require a husband and wife to know each other,[5] does IVF, in some way, take away some of the image bearing aspect of a husband and wife having children? If so, does it matter?

 

Another interesting aspect of procreation, seen in the Bible, is that to have children it took more than a husband and wife knowing each other. They had to be “visited” by the Lord. We see this with Hannah in 1Samuel 2:21 where it says, “the LORD visited Hannah, so that she conceived.” In Psalm 127 we learn that children, the fruit of the womb, are from the Lord. Conception happens in secret. (Ps 139) As we will learn later, IVF removes some of the mystery of conception.[6] Could we, in a sense, be seen as striving to control conception rather than waiting for the Lord to visit us in His own mysterious way? If the mystery of conception, in an image bearing sense, bears testimony of the mystery of creation, which happened mysteriously by the spoken word of God, can IVF, by removing some of the mystery, take something away from the image bearing aspect of traditional procreation?

 

As we consider these questions about IVF, we presuppose a Christian understanding of life and procreation. We use procreation as the name for the process of bringing forth children, in part, because of the image bearing that is contained in a husband and wife being involved in bringing forth a new life. Procreation brings forth new life. Although it is like creation, unlike creation, procreation does is not create from nothing. God created from nothing. Bearing testimony to God, in whose image we are created, we procreate. Procreation still contains the mystery of God’s creation within it. In modern times, we have shifted away from calling it procreation to calling it reproduction. Unlike procreation, which contains more of a mysterious element, reproduction is a more technological term and refers more to the achievements of mankind. To what extent does the shift from procreation to reproduction and reproductive technologies reflect a change in belief about the origin of life? Considering how sin is rooted in people desiring to be gods unto themselves, rather than living to bear the image of the Creator God, should we be wary of the exploding field of reproductive technologies?

 

Now, let us walk through the process of IVF:

The production of a woman’s eggs requires two special cell divisions.[7]   The first one occurs while the woman is still growing inside her mother’s uterus.   This results in many immature eggs, each containing an individual set of DNA that, when linked with the sperm, will define the new child. These pre-eggs lay dormant in a woman’s ovaries until child bearing years. Then, every month, or so, many thousands of eggs begin the final phase of development. This happens, through a process that is not well understood. In this process, one egg surpasses the rest.   This egg develops to maturity and all the other eggs end up regressing. IVF is not very efficient. If we began with only one egg, the chance of success would be very low.[8]   Therefore, many eggs are needed. Drugs have been developed that effect the process so that, rather than most of the developing eggs regressing, many eggs progress to maturity at the same time.   When the doctors think the time is right, another drug is given that causes the many eggs to be released.   Then, many eggs are collected by use of a special needle. So, IVF uses medications that cause an unnatural process where many eggs are caused to develop toward maturity at the same time. In the natural menstrual cycle, that God has given women, one egg wins over all the others. To what extent do we create problems because we cause many eggs to develop that normally would regress? Is there a good purpose for the one egg surpassing all the others, a purpose that we are interrupting? Could we be promoting the development of some eggs with genetic defects that would normally have regressed? Could this be part of the reason why so many of the embryos that are formed during IVF fail to grow well and do not implant in the wall of the uterus? Could this be part of the reason why, as we will see later, a greater number of children born by IVF have birth defects than do children born by natural conception?

 

Ovarian Hyperstimulation:

Can these drugs have an adverse effect on the subsequent pregnancy? I found one study that indicates that when women take medications to hyperstimulate egg production that it decreased the chance of the subsequent embryo implanting in her uterus.[9] So, even if there was no loss of life prior to placing fertilized eggs in the uterus, using these drugs results in some loss of life.

 

Another important question is about the safety of using these medications. A potentially serious condition, called ovarian hyperstimulation syndrome, is a known complication. One report said that in 20 to 30% of IVF cycles, women develop a mild case, with abdominal pain, nausea and vomiting as a result of enlargement of the ovaries. In 0.1 to 2% of IVF cycles women develop severe cases, with severe abdominal pain, fluid retention, breathing problems and blood problems that can be life threatening.[10] Whether or not there are significant long term problems from using these medications cannot be known because the technology is relatively new.   Are we causing future problems with these medications?   Could society be biased when sharing or gathering information about any problems which develop because we, so much, want these procedures to be available?

 

Collecting Sperm:

When the eggs are harvested, a fresh sample of sperm from the husband needs to be available.   Many men will be expected to produce the sperm at the clinic, while the wife is having her eggs harvested. It is possible to collect the sample in a condom during a conjugal act of love, but this is not likely to happen at the clinic.   If the sperm is collected at home, it has to be mixed with a special egg-yolk medium to increase the life of the sperm. Collecting sperm at a different time than the wife’s egg collection may be done, and the sample frozen in liquid nitrogen until it is needed. Generally, sperm collection is not likely to result in physical medical problems other than possibly decreasing the viability of the sperm,[11] but it does have an impact on the relationship between the husband and wife. In the Bible, children come from a man depositing his sperm in the women by sexual intercourse with her. Common biblical terminology for this is that the two “know” each other. For a husband to know his wife seems to be important in the Bible. A husband can know his wife and not produce children, but all legitimate children in the Bible[12] are the result of a husband knowing his wife.   With IVF a couple have children without having to “know” each other, that is without a conjugal act of love. As mentioned above, when procreation occurs through the oneness of a husband and wife knowing one another, it displays something of God’s image that He create in mankind. From the unity and intimate relationship of His persons, God created.   How concerned should we, as Christians, be about the distance the IVF moves us away from the image bearing process of the husband knowing his wife? Will children conceived through an intimate conjugal act of love somehow be viewed differently by parents then those arising out of IVF?

 

In the Petri Dish:

Once the eggs and sperm are collected, the IVF doctors clean the eggs and the sperm and may select eggs and sperm they think most likely to lead to successful fertilization.[13] The eggs and the sperm are put together in a solution in something like a petri dish.   They are likely to put many eggs and many thousands of sperm together.[14] They hope that 8 to 10 eggs will become fertilized, from which they select the two embryos they think are most likely to survive, which they will place in the uterus.   Reported pregnancy rates range between 15 to 50 percent for each IVF cycle.[15] If you try to only fertilize one or two eggs, with plans to implant all that are fertilized, the success rates are much lower than if you fertilize many eggs and select out the two embryos that look the best. In the normal IVF process, there is loss of life. If they get, the hoped for, eight successfully fertilized eggs and implant what they think are the best two, then six will be lost. As will be discussed below, some consider freezing the extra embryos but the process of freezing and thawing results in the death of some of these tiny human beings during the freeze-thaw process.[16]

 

Also, we should consider the losses of tiny new human beings that die before they get to the stage of looking like tiny successfully fertilized embryos. When does life begin? Does it begin the moment a sperm enters, or is injected into, an egg? Let us assume that life begins as soon as we can see signs of the cell beginning to divide into two cells, before two cells yet exist. How many times is a new life encouraged to begin outside the womb via IVF and then ends up getting to only the 2, 4, or 8 cell stage and then dying?   If the doctor tells you that they will only fertilize two eggs, how many eggs does the doctor attempt to fertilize that only get to the 2,4, 8 or more cells stage and die before getting to what he/she considers two “successful” fertilizations? How many tiny 2, 4, 8 or more celled humans does the doctor consider fertilization failures, not even thinking that a new human life has occurred?   Is the doctor likely to tell you about any of these deaths of your children?

 

IVF Doctors:

What about the doctors involved in IVF? Just considering the loss of human life and the killing of tiny human beings that surrounds most IVF treatment, can a doctor, who is a biblical Christian or who comes to love the Lord Jesus Christ while working as an IVF doctor, continue to involve himself or herself in aiding IVF? If it were possible for a biblical Christian doctor to do IVF without any destruction of life, currently the success rates would be so low, he or she would not likely have enough patients to maintain such a practice. Considering these things, would it be likely that your IVF doctor would be a lover of the Lord and a true lover of life? Would your doctor’s definitions of life be likely to line up with scripture as yours ought to? Do you think it would be important to him or her to keep track of every child who is conceived, even those who only grow to 8 cells? What do you think the likelihood would be that he or she would be willing to continue to fertilize more eggs, watching them died at 2, 4, 8 or more cell stage, until two “successful” fertilizations had occurred?   Given the fact that the IVF doctor is a doctor who has, by the nature of what he or she does, shown disregard for human life; should you trust him to handle, with a high degree of respect for life, your children from conception onward? Should you trust such a person to do exactly what he or she says?

 

There is another important consideration when thinking about the involvement of the doctors in the IVF process. To understand this we will compare the natural process of procreation to the process of IVF. In the natural way of procreation that God has designed, the husband leads his wife, who, out of love, submits to his loving advances and opens herself to him and they share an intimate sexual union that gives opportunity for the sperm of the husband to unite with the egg of the wife, in the supportive environment of the mothers fallopian tube. Somehow, by the power of God, the union of the egg and sperm result in a new life. The new child is guided to the supportive womb of his mother and supported and nourished there, for some nine months, along with the husband at his wife’s side. In IVF there is more than husband, wife and God. The husband gives his active leadership role over to another person.   The husband, with his body, does what he is told by the other person and masturbates his sperm into a container.   The husband allows the other person to take control of the wife. The wife submits her body to the other person, who is not her husband and does with her body what the other person tells her to, when he tells her to (takes medication, submits to examinations, etc.). The wife opens her body to the other person, allowing the insertion of sterile instruments and lets the other person remove eggs from her. The other person, then, takes the sperm and the eggs and puts them together in a somewhat hostile environment in a glass container. The other person selects the newly growing child that he thinks is the best one and eventually inserts, into the wife, the child into her womb. With IVF, it is no longer a husband cleaving to his wife and the two, as one flesh, procreating a child, as directed by God.   Instead, rather than leaving the creation of their child under the control of God, another person is selected to take control. The other person comes between the one flesh union of the husband and the wife and directs things. Rather than leaving the egg and sperm and waiting on what God will do, the egg and the sperm get handled and manipulated by the other person, to make a pregnancy happen. The other person decides, as the one in control, which embryo to select.   Actually the other person is likely a number of other persons, if you include all involved in the handling of the sperm and eggs.   Is the sin of Adam and Eve in the garden, multiplied in IVF? Adam and Eve wanted to be like God, they wanted to do be in control and do it their way, rather than to submit to the good way of the Lord. To what extent is the use of IVF a case of wanting to be in control of our procreation, rather than trusting God to manage it? To what extent is the promotion of IVF involved in separating what God has put together? To what extent do the IVF doctors and technologists attempt to takes God’s role in procreation?

 

When considering the doctors and technologists involved in IVF, the question arises, ‘How is it possible for these people come to the point where they are willing to involve themselves in such destruction of tiny human beings?’ Is there not a similarity in approach to human life in the IVF doctor and the abortionist? Do they not both somehow see some early human beings as having low enough value that their destruction is justifiable? Dr. W.H. Velema, a Christian ethicist in the Netherlands, gives this sobering summary, “The development of IVF finds its ground of justification in a liberal view of abortion. This should make us stop and think seriously. The increasingly technological approach to procreation, which naturally required tests with human embryos, has been set in motion by the acceptance of the right to induced abortion. One can also say, “Liberalization of abortion is the price that man had to pay for this way of procreation.”[17] Should we be concerned that for IVF to develop and thrive, society first needed to accept abortion as justifiable?

 

Tiny Frozen People:

If you become involved with IVF, you will be likely to be faced with the question of fertilizing extra eggs and freezing some for another attempt. To the person who is not concerned about the loss of these very early lives, freezing makes sense. If one is willing to freeze eggs and/or embryos, then the woman only has to take the medications and go through the egg harvesting once. It would seem that freezing eggs rather than embryos would be better, for then no tiny human beings would be suspended in time, frozen in liquid nitrogen. Those wanting to increase pregnancy rates prefer to freeze embryos since thawed eggs are harder to fertilize and it is thought that freezing and thawing damages the eggs.[18] For non-donated embryos, success rates are better with frozen embryos than fresh,[19] but not all embryos that are thawed remain viable.[20] Only viable ones will be transferred into the uterus. If the success rates of using donated fresh embryos are compared to donated frozen embryos, the fresh embryo success rate is higher.[21] These findings indicate that freezing and thawing these tiny human beings or embryos run a risk of harming the embryo. Since parents ought to nurture and protect their children from conception onward, should we even consider entering into an arrangement where we would freeze our children, at the embryo stage? There are other questions that arise with frozen embryos that I will not take time to write about now, such as the ethics of suspending the life of a human in a state of arrested growth for a prolonged period of time.

 

Implantation Trouble:

Even if, somehow, you can manage to only fertilize two eggs, without any killing of any tiny human lives in the process, there are still hurdles for these tiny humans to get past. The process of implanting is not without problems. They are implanted, using a small catheter, into the centre of the uterus under ultrasound guidance. The technique of transferring the embryo into the uterus is important and can be responsible for significant loss of life of embryos.[22] Even if they are put in the ideal location, the chance of pregnancy per embryo transferred is about the 8 to 22%.[23] The chance of live birth from a pregnancy after normal conception has occurred is about 75%.[24] [25] This means that there are early losses even in normal pregnancy, but the loss in IVF, after the embryo transfer stage, is 3 to 4 times greater than in normal pregnancy. If you also include the loss that occurs trying to get to the point of a “healthy” embryo to transfer into the uterus, the loss during IVF is far far greater than in normal conception. We are to nurture and protect our children. Is it right to conceive children into a situation where we know the risk of death, in the early stages, is significantly higher than when conception occurs naturally?

 

Twins, Ectopic Pregnancies and Other Complications:

A well known potential problem of IVF is twin pregnancies. To have a twin pregnancy may seem encouraging because both of your children (the two embryos put into the womb) survived at least to the point of getting pregnant. But, you need to know that twin pregnancies have a significantly higher risk of bad outcomes, mainly because of the significant risk of prematurity. If entering into IVF, should you fertilize two eggs because the odds of success are higher while at the same time increasing the risk of problems or early death for each of your children?

 

Like twin pregnancies, it is accepted that IVF pregnancies are known to result in a higher rate of ectopic pregnancies. These are pregnancies where the newly growing person implants somewhere other than in the uterus, such as in the fallopian tube or in the abdominal cavity, outside the uterus. In normal conception, the rate of ectopic pregnancy is about 1 in 150 pregnancies.   In IVF, the rate is between 1 in 50 and 1 in 20 pregnancies (between 2 and 5% risk).[26] Ectopic pregnancies have to be removed, thus killing the embry, and are a significant risk to the mothers health. Should we proceed with IVF knowing that there is a significantly greater risk of an ectopic pregnancy, which has increased risks for the mother and results in the death of the child?

 

The IVF complications of twin pregnancies and of ectopic pregnancies have long been accepted.   Now, there is growing evidence, that IVF is associated with a number of other increased complications to the mother and to the baby. In the March 2011 Wikipedia entry for IVF, under the heading “Complications” they included the problems associated with multiple births (twins, triplets), where evidence was easy to find, but it said that birth defects were controversial.   They cited a review that suggested defects were not increased, and they had two citations suggesting that they were increased. One was a 2008 analysis of the data of the National Birth Defect Study in the US that found certain defects more common, including septal heart defects, cleft lip, esophageal atresia and anorectal atresia.[27] [28] Some might argue that this analysis was not designed specifically to look at IVF related birth defects and thus lacked power. The second was said to be a 2002 study reviewing the birth defect records of all the IVF babies in Western Australia. It found that IVF births were twice as likely to have birth defects as normal births. They controlled for multiple births (twins), as multiple births independent of IVF could account for birth defects. Defects found to be more common included, heart defects, chromosomal abnormalities like Down Syndrome, gastro-intestinal abnormalities, musculo-skeletal disorders like dislocated hips and club feet. There was also lower birth weights, pre-term births and cerebral palsy.   Unfortunately, what the Wikipedia referenced was not a study but a news commentary.[29] News commentaries, from the point of view of evidence, are not very powerful. At that time, I looked for compelling evidence that IVF caused birth defects and found hints but nothing absolutely convincing.   Then, in January 2012, the Wikipedia site has evolved and it no longer says that the association of IVF with birth defects is controversial. They cite a 2012 systematic review and meta-analysis of obstetric and neonatal outcomes in singleton IVF pregnancies. By looking at singleton births (only one baby) only they exclude the added risk associated with twin births. This study shows that birth defects are 1.6 times more likely in IVF births than in normal births.[30]   This 2012 study is more difficult to argue against. They reviewed a number of problems that were increased as well as birth defects, including, bleeding at the time of birth, high blood pressure, premature rupture of membranes, caesarean sections, gestational diabetes, induction of labour, low birth weight babies, premature babies, and death of baby around the time of birth. The increased risks were 1.18 to 2.49 times as likely as in normal births.  Now, in 2016, another study also demonstrates  a similar increase in birth defects in IVF births.[30b] One can argue that these risks are low, but should we be trying so hard to have babies using IVF when we know that it puts mothers and our children at increased risk?

 

Selection of Sperm, Eggs and Embryos:

There is a variation in IVF that is becoming more common, especially when dealing with male infertility problems. It is call intracytoplasmic sperm injection. It is used when men have low sperm counts or the man’s sperm seem unable to penetrate and fertilize the egg. In the normal process that God has designed many thousand sperm are usually needed. Some are required to prepare the opening into the uterus. Following this, many sperm enter the uterus and some swim faster than others. The fastest sperm make it into the fallopian tube where many are needed to attach to the egg. These soften the coating around the egg and allow one sperm to entre the egg. If the sperm count is too low or the sperm are not mobile enough, then simply putting the eggs and sperm together in a petri dish does not achieve much success.   So, they have developed a process where they use a tiny needle and they inject one sperm inside of one egg. These sperm might be collected by the usual method but, if this is not possible, they do a small surgical procedure to expose the tubes in the scrotum of the man that have sperm in them, Then they remove some sperm with a needle. Many of these sperm are not fully mature. They have a process, using a special chemical that selects out sperm that they think are the more mature, in order to increase the chance of successful fertilization. They also select out what they think are healthy eggs. God’s design of one egg winning out over numerous others and one sperm gaining entry into the egg over many others, that occurs in the natural process, may be God’s design to allow procreation of robust humans.   When we use IVF are we considering the problems, such as genetic/DNA problems, that may develop because of these manipulations done in IVF?

 

In the process of IVF, a successful fertilization is one were the new tiny human being grows to what they call a morula with 12 to 16 cells. Many clinics today attempt to grow these tiny people to the blastocyst stage that have 70 to 100 cells. Part of the problem with IVF is that growing these tiny humans has not proved to be simple. As time goes on, they have developed better culture media, or food solutions, to grow embryos in so that less die before they get big enough to attempt transfer.   When the doctors tell you that they now have two successfully fertilized eggs ready to implant, there have been many fertilized eggs that have died before the point where successful fertilization is consider to have occurred. Does this matter? Of course we know that even with natural conception some die before an implanted pregnancy is achieved. But this is God’s design with His way of supplying the right nutrients for the embryo.   Given our inability to produce anything as well as God does, it is likely that many more die along the way in man-made-culture-media then in the natural process.

 

Another question with IVF which is even more evident in the use of intracytoplasmic sperm injection, has to do with the selection of what the doctor believes is the best sperm to inject, the best egg to use, and the best tiny human to transfer to the uterus. How likely is it that the doctor’s criteria for selection are anything like the Lord’s criteria? Especially when the Lord often selects the poor, the needy, and the sickly as the best pick for His plans. If we buy into any of the selection processes that are available to try to get what society believes are the healthy kind of children, are we at risk of trying to work against God’s best plans? Another less obvious aspect of selection with IVF is that IVF may be trying to skirt around God’s normal selecting process. As mentioned before, God has a process where one egg wins out over the many that start to develop. God has a process where one sperm wins out over many others in the race to fertilize the egg. God likely has a process that decides which embryo implants in the wall of the uterus.   Should we concern ourselves that IVF, and even more so the use of intracytoplasmic sperm injection, interrupts these processes?

 

Natural and Mild IVF:

There are some recent additions to the approach of IVF that have likely come about in response to some of concerns that have surfaced with the use of IVF. Some propose Natural IVF and Mild IVF. The proponents of Natural IVF suggest that no drugs are used to affect egg production in the mother and the eggs are collected once they form. In nature usually only one egg will usually form. So, in natural IVF only one egg should usually be collected. In the United Kingdom the Human Fertilization Embryology Authority, an organization that regulates fertility clinics, commented on natural IVF statistics that they collected over a 12 month period in 2008.   Of 185 women who received natural IVF only 3 resulted in a live birth.[31] We are not told how many ovulations were involved, how many eggs were collected, or how many eggs were fertilized. If natural IVF becomes more common and accessible it would appear to address some of the concerns, such as the risks associated with fertility drugs, and those concerns associated with fertilizing many eggs in hope of getting two embryos to implant. But the newly fertilized human eggs are still subjected to the risks of death and damage associated with conception and early growth occurring in the unnatural environment of a petri dish or test tube. In the study mentioned, only 3 live births resulted. Either, it is very difficult for a “naturally” collected egg to be fertilized (which is likely not the case) or there are many losses associated with natural IVF. If the women involved in the report attempt to become pregnant more than once by natural IVF, then the number of associated losses is even greater. So with natural IVF many of the questions remain. The potential of bringing about the death of these tiny humans remains. The questions related to tampering with God’s design of procreation, remain.

 

Another newer approach is called mild or minimal IVF. Drugs are used to cause multiple eggs to mature but the doses are lower and the protocols different. The side effects for the woman are less. The goal is to harvest about 2 to 7 eggs and produce healthy embryos.   A review of mild IVF found that live birth rates were similar for both standard and mild IVF, but mild IVF involved more cycles.[32] Other than the possibility that less drugs may leave the eggs healthier and lead to fertilized eggs that are more likely to implant, the concern of putting the life of tiny human beings at risk, leading to the death of some, and the concerns that IVF may be tampering with God’s design of procreation, remain the same.   The questions remain the same.

 

IVF and God’s Commandments:

I began this essay, considering some examples of infertility in the bible, asking to what extent we place our hope in having children.   Then, we considered the husband-wife unity as an image bearer of God’s unity in relationship, asking if IVF may take something away from the image bearing aspect of traditional procreation. Have we turned our focus away from procreation, which is of God, turning toward reproduction, which is of us? Following these thoughts, the bulk of this essay has shared the technical details of IVF, highlighting problems with loss of life, at the hands of doctors who do not have a high regard for human life. Much of this discussion focussed on the sixth commandment that we should not kill. Let me conclude by encouraging us to consider IVF in terms all of the commandments of our Lord.

 

Thoughts on considering IVF in terms of all of God’s commands came as I was reflecting on IVF in terms of the image of God. The entire Decalogue (the Ten Commandments) is a better representation of God’s Image than the 6th commandment alone. What about the 5th commandment, to honour those in authority over us? Is not God the ultimate one in authority over us? If we try to change the way that God has designed for us to procreate, are we at risk of breaking the 5th commandment? What about not committing adultery? Does adultery not indicate that nothing should come between the unity of husband and wife? IVF is considered extremely stressful and can take its toll on the husband-wife relationship. Does IVF risk putting the having of children on a very high pedestal that can, in some way, come between the husband and wife? If so, could pursuing IVF not risk breaking the 7th commandment? We can likely walk down a similar path with steeling or taking something that is not God’s best design for our lives. We can bear false witness by accepting the lie that no human life is lost in the process, or that these very tiny lives are not yet human, or do not yet matter. If we are in anyway failing to bear the image that God intends us to bear, are we also not bearing a false witness? It is easy to see how coveting could be involved. Are we at risk of setting ourselves up as gods before the face of the Lord God? When God has not yet given us a child, can IVF be our way of trying to make a child ourselves, our own way, rather than God’s way? If we plead with God, saying, not my will but your will be done, then try to have a child by IVF could we possibly be saying that we do not believe that God can give us a child His way? Could we be saying that we do not believe God is as powerful has He says He is? If so, are we not defaming His most Holy name? If we think of IVF in the context of the image of God, as He reveals Himself to us in His law, the law that is to direct us in the way that is good, do we come to the same conclusion as when we focus primarily on whether or not we are breaking the 6th commandment?

 

Should we as Christians remain quiet, or should we be placing these questions before our fellow Christian and before the rest of society?

 

It is also valid to ask positive questions. Could some aspects of IVF be given to us by God to be used to accomplish God’s good plan for our lives? Since God works all things together for good for those who love Him and are called according to His purpose, those children of God who have walked the difficult path of IVF will have gained something good from God. Some aspects of IVF ought not to be done. It is likely that some Christians have involved themselves in some of these things. There are numerous biblical examples of God bringing good out of sinful processes.   Even today, when a child is conceived via the sin of premarital sex, we accept the child as a gift from God. God is the author and finisher of life. It is by God we live and have our being.   Sin is involved even in some of those conceived in the line to Christ. In Luke 3:33, we learn of Perez, the son of Judah, was conceived as a result of Judah having an incestuous sexual relationship with his daughter-in-law. (Gen 38). While we can and should rejoice in the children the Lord has given us through IVF, should we encourage Christians to travel down the path of IVF? God can bring about good but does this mean that He condones the path? If we have learned that we are going down a path that we ought not to travel, then the instruction we are to follow is to go and sin no more. (John 5:14, John 8:11) We are to strive to be holy because Christ is Holy. (Lev 11:45, 1Peter 1:16)

 

I hope that I have been faithful to the Lord in presenting the details of the process of IVF and in raising questions that arise. I encourage you to consider these things and to ask the Lord if there are others who should have these things brought to their attention.

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____Footnotes______

[1] 1Samuel 1

[2] Genesis 16:2

[3] Parenting in western culture is taking a concerning path where many define parenting as the right to have a family and even the right to reproduce. Society seems to stress reproductive freedom.   Having children and parenting have become an act of the will of two people. The advancement of reproductive technologies has opened the path to saying that everyone has the right to reproduce. Does everyone really have the right to reproduce? Does having a child equal parenthood? Is a child the product of the will of the parents? What does the Bible teach us about these things? A child is a gift of God, not a product of technology. There are numerous references in the Bible about God opening and closing the womb.   It is also clear that children are not the property of the parents.

[4] Defining God is beyond the scope of this essay. Christians confess the doctrine of the trinity, as outlined in the historic Apostles’, Nicene and Athanasian Creeds, saying, “we worship one God in Trinity, and Trinity in Unity.” This is taught through the whole of the Bible. We baptize in the name of the Father, in the name of the Son, and in name of the Holy Spirit. (Matthew 28:18) Jesus tells says in John 10:30, “I and my Father are one.”

[5] As described above, a husband and wife “know each other” when they have sexual intercourse.

[6] There is much mystery that IVF has not removed. It has given an impression mankind being in control of procreation and allowed some of the mysterious details to be observed but there is still much mystery. Why does the union of a sperm and egg result in new life? Why do some develop and grow in the womb and others do not? There are many more “why” questions that we cannot even begin to answer. For this reason I have described the process as mankind “striving to be in control of conception” rather than being in control.   How we approach life at a heart level is important. Remember what God said to Samuel. Man looks at the outward appearance but God looks at the heart. (1Samuel 16:7)

[7] In life, when things grow or injuries are repaired, living cells produce new living cells through the process of cell division. Each living cell has two almost identical sets of DNA that are reproduced, so that both of the cells, that result when a cell divides, each have their own two sets of DNA. The DNA is the code that describes everything about the cell and the living being the cell belongs to. The production of the gametes (the egg and the sperm) that are used in sexual reproduction is different. First a cell with two almost identical set of DNA divides into two cells that each have only one set of DNA. Since the original two sets of DNA were not identical, only almost identical, these two new cells are not identical and will contain some of their own characteristics.   After this first cell division, a second step takes place, where each of these cells with one set of DNA divide into two cells, each with one set of DNA. Through these two special cell divisions, from one cell with two almost identical sets of DNA, four new cells are formed, each with one set of DNA.   These are the gametes, known as the eggs or the sperm.

[8] With IVF, in order to get at least two fertilized eggs (embryos, also human beings) that are considered to be in good enough condition to lead to the possibility of success, many eggs are needed. Not all the eggs placed in solution with the sperm will end up being fertilized and not all of the eggs that are fertilized will end up growing into what are considered to be healthy embryos. Because of these reasons, for IVF to have a significant hope of success, many eggs need to be harvested all at once. With “natural IVF” where only one egg is collected, live birth rates are very low. (See the paragraph associated with footnote 29.)

[9] A retrospective comparison of pregnancy rates (PRs) and implantation rates was made between oocyte recipients versus their donors, who shared half of the retrieved oocytes, and regular patients undergoing in vitro fertilization–embryo transfer (IVF-ET) who were not sharing eggs. Superior implantation rates and PRs in oocyte recipients versus donors were not related to better oocyte quality for recipients because of egg sharing or to a better uterine environment because of similar results with frozen ET in all three groups. An adverse effect of the hyper-stimulation regimen best explains the difference.

Jerome H. Check, et. al., “Controlled Ovarian Hyperstimulation Adversely Affects Implantation Following In Vitro Fertilization-Embryo Transfer”, Journal of Assisted Reproduction and Genetics, Vol 16, No 8 (1999)

 

[10] Kirsten Riggan, “Ovarian Hyperstimulation Syndrome: An update on Contemporary Reproductive Technology and Ethics”, Published on the CBHD.org (http://www.cbhd.org) and in Dinitas, CBHD’s quarterly publication, Vol 16 No 3 (Fall 2009)

 

[11] Sperm with decreased viability is less likely to be able to fertilize the egg.

 

[12] By legitimate children, I mean children who come from the lawful union of a husband and wife. Jesus is an exception because Mary, Jesus mother, had never known her husband, Joseph, prior to the birth of Jesus. Jesus was still the result of an intimate, knowing, relationship, as seen in the Holy Spirit coming upon Mary and the power of the highest overshadowing her. (Luke 1:35)

 

[13] In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs with optimal chances of successful pregnancy In the meantime semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.

http://en.wikipedia.org/wiki/In_vitro_fertilisation – 2012-05-27

 

[14] The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours. In most cases, the egg will be fertilised by that time and the fertilised egg will show two pronuclei. In certain situations, such as low sperm count or motility, a single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.

http://en.wikipedia.org/wiki/In_vitro_fertilisation – 2012-05-27

 

[15] These pregnancy rate numbers are my own comment after viewing multiple sources.

 

[16] See the paragraph associated with footnotes 16 through 19.

 

[17] Dr. W.H. Velema, “An Ethical Consideration of In Vitro Fertilization”. This is an unpublished English translation taken from a book titled “Reageerbuisbevruchting – Verantwoord?” (“Test Tube

Fertilization – Justifiable?”). The book, edited by W.G.M. Witkam, W.H. Velema, and A.P. van der

Linden, was published by Buijten & Schipperheijn in Amsterdam, the Netherlands, 1990. The

translation was done by Rev. C. Sonnevelt in 2009. This article, in English, is found as Appendix 3 in a report titled, “What should be Our Stance on In Vitro Fertilization?”, approved by the 2010 Synod of the Netherlands Reformed Congregations of North America.

 

[18] “Thawed oocytes had lower chances of being fertilized and developing into top-quality zygotes and regularly cleaving embryos when compared with sibling fresh oocytes irrespective of female age… Reduced fertilization and cleavage rates in frozen cycles when compared with sibling fresh oocytes suggest that, even if surviving thawing, the process of slow freezing has a negative impact on the potential of further growth that is evident as early as the first cleavage divisions.”

Luca Gianaroli et al, “ Impact of oocyte cryopreservation on embryo development,” Fertility and Sterility, Volume 93, Issue 2, Pages 510-516, January 15, 2010.

 

[19] A number of studies can be found that indicate that a woman has better success with her frozen embryos then her own fresh embryos. A woman may have better success rates with her own frozen embryo than her own fresh embryos because she is also subjected to fertility drugs at the time she has a fresh embryo implanted, as fertility drugs are used make possible the harvesting of the eggs used to produce the fresh embryos. When the frozen embryos are used in the same woman, no fertility drugs are needed at the time of implantation. This does not necessarily mean that frozen are better. More likely that the fresh embryos do not do as well because the fertility drugs that are used to cause the egg production, in order to produce the fresh embryos, have a negative impact on implantation.

 

[20] I have not yet found a good study to report this. The Genetics and IVF Institute, which is self described as a fully integrated, comprehensive, fertility centre in Washington, DC, made the following statement on their web site, “we define embryo survival based on the number of viable cells in an embryo after thawing. An embryo has “survived” if >50% of the cells are viable. We consider an embryo to “partially survive” if <50% of its cells are viable, and to be “atretic” if all the cells are dead at thaw. Approximately, 65-70% of embryos survive thaw, 10% partially survive, and 20-25% are atretic. Our data suggests that embryos with 100% cell survival are almost as good as embryos never frozen, but only about 30-35% survive in this fashion.”   One would expect the Genetics and IVF Institute, an organization that promotes IVF, to paint IVF in the best possible light. The fact that they discuss embryo losses associated with freezing suggests that this is a real and significant problem. http://www.givf.com/fertility/embryofreezing.shtml, January, 2013.

 

[21] J.H Check, J.K. Choe, A. Nazari, F. Fox, K Swenson, Fresh embryo transfer is more effective than frozen for donor oocyte recipients but not for donors, Human Reproduction, vol 16, No 7, p 1403-1408, 2001

 

[22] It is estimated that poor embryo transfer technique may account for as much as 30% of all failures in assisted reproduction (Cohen, 1998). Unfortunately, this failure must have affected thousands of couples every year since the beginning of IVF. – Hum. Reproduction, (2002) 17 (5): 1149-1153. – http://humrep.oxfordjournals.org/content/17/5/1149.full

 

[23] From the web site IVF.CA, the following statistics are given. The overall live birth rate was 26% per cycle started (which should be the same as per embryo transfer. 69% of births were singletons. 95% of the multiple births were twins. It is also interesting to note the rates per age of the mother.   For women under 35 years old, the live birth rate was 32% . For women aged 35-39 years, the live birth rate was 24%. For women 40 years old and over, the live birth rate was 12%. As far as I can tell these represent Canadian numbers where we only put two embryos in per transfer. This means that the live birth rate per transfer is 12% to 32 %.   70% of these are singletons. Most of the rest are twins. So, if we calculate the live birth rate per embryo transferred, rather than per transfer event, the live birth rate per embryo transfer is 8 to 22%.
http://www.ivf.ca/results.htm (2012-09-09)

 

[24] Williams Obstetric text book suggests that, of naturally fertilized eggs, no implantation occurs in 12% and early pregnancy loss occurs in 12% of cases. Of the remaining pregnancies, 85% result in live birth. The live birth rate based on conceptions is 75%.

Willams Obstetrics, 20th Edition, Appleton & Lange, 1997. P580.

 

[25] A study of 221 women attempting to conceive naturally after stopping contraception found, that 75% of those who conceived still had a pregnancy at 6 wks.

Wilcox AJ, Baird DD, Weinberg CR (1999). “Time of implantation of the conceptus and loss of pregnancy”. New England Journal of Medicine, 340 (23): 1796–1799.

 

[26] I have not found specific studies that have investigated the ectopic pregnancy rate in IVF.   Looking at various IVF web sites I found a range of 1.5 to 5% risk. One study suggests that the main risk factor is having IVF done for infertility for tubal abnormalities. It may be that there is an increase in ectopic pregnancies not specifically due to IVF but instead due to some of the reasons that IVF is done.

[27] Esophageal atresia is failure of the esophagus (the swallowing tube) to develop a passage way in it. Anal atresia is failure of the anal opening of the bowels to develop.

 

[28] Reefhuis J, Honein et al., “Assisted reproductive technology and major structural birth defects in the United States”, Human Reproduction, 24(2): 360-366, 2008

 

[29] Jonica Newby, “IVF Defects”, Catalyst, Australian Broadcasting Corporation, http://www.abc.net.au/catalyst/stories/s904186.htm.

 

[30] Pandey, S.; Shetty, A.; Hamilton, M.; Bhattacharya, S.; Maheshwari, “Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: A systematic review and meta-analysis”. Human Reproduction, Update 18 (5): 485–503, 2012

 

[30b] Sheree L. Boulet, DrPH, MPH1; Russell S. Kirby, PhD2; Jennita Reefhuis, PhD3; Yujia Zhang, PhD1; Saswati Sunderam, PhD1; Bruce Cohen, PhD4; Dana Bernson, MPH4; Glenn Copeland, MBA5; Marie A. Bailey, MA, MSW6; Denise J. Jamieson, MD, MPH1; Dmitry M. Kissin, MD, MPH; for the States Monitoring Assisted Reproductive Technology (SMART) Collaborative1, “Assisted Reproductive Technology and Birth Defects Among Liveborn Infants in Florida, Massachusetts, and Michigan, 2000-2010”. JAMA Pediatr. 2015.4934. Published online April 04, 2016. doi:10.1001/jamapediatrics.
This article can be found at http://archpedi.jamanetwork.com/article.aspx?articleid=2506140 as of July 2016.
There is a news article reporting on this study at http://www.reuters.com/article/us-health-ivf-birth-defects-idUSKCN0X122D as of July 2016

[31] Human Fertilisation and Embryology Authority,   http://www.hfea.gov.uk/natural-cycle-ivf.html As of Jan 2013.

 

[32] BC Fauser, et al, “Mild ovarian stimulation or IVF: 10 years later,” Human Reproduction, 2010 Nov;25(11):2678-84

____________________________
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Author:  Greg Kenyon, Mitchell, Ontario, Canada
–This is a chapter from an online version of a book I am writing with the purpose of providing true information about organ donation and invitro fertilization (IVF) as well as raising some of the questions that should be asked.
–This book is written from a Biblical-Christian perspective.  To learn more about what this means feel free to read some of the other material on my blog at https://greg.kenyonspage.ca/.  You may also read my attempt to describe my beliefs at http://greg.kenyonspage/i- Believe/.
–This is a work in progress.  If you are reading from a printed version or coped material, rather than directly from my website, https://greg.kenyonspage.ca/,   then you may not have the most up-to-date draft of this book.  Please do not copy it or pass it on to others.  Instead, go to the book on my website at , https://greg.kenyonspage.ca/greg-kenyons-book-questioning-medical technologies/

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