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Christian Perspective Reproductive Technologies

Dr Alex Tang

Adam called his wife Eve because she was the mother of all humankind. Following God’s mandate to be ‘fruit and multiply’, they are parents to about 4 billion human beings on earth today with more being born everyday. While some couples are very fertile and want or need to limit the size of their families, there are other couples who want to have children but are unable to. Research in human reproduction has developed many methods to limit or improve fertility. These are the reproductive technologies.

Contraceptive Technology

There are many ways to prevent pregnancy. Some Christians have problem with the idea of contraception because of God’s command to be fruitful and populate the earth (Genesis 2). The Roman Catholic Church stand is based on the idea that marriage is for procreation and childrearing. Hence any control of fertility is wrong and unnatural. Roman Catholics are forbidden to use any form of contraception. This thinking is largely from Augustine (Marriage and Concupiscence) who considers anything distracting from the spiritual realm and moral behaviour as wrong.

The best way to prevent pregnancy is abstinence. However, this should not be practised in a marriage because sexual intimacy is a very important part of marriage. Sexual intimacy has a physical, emotional and spiritual dimension that bonds the husband and wife together. Paul taught that a husband and wife should not avoid sexual intercourse except for special reasons like prayer and fasting. Sexual intercourse produces babies. And there are many reasons why a couple may not want a baby at certain phases of their married life. So over the years, many methods of contraception to prevent pregnancies were developed. Basically, contraception can be divided into the following categories:

Methods That Prevent Conception

Methods that prevent conception include ‘coitus interruptus’, rhythm method, barrier method, the pill, Norplant and sterilisation.

‘Coitus interruptus’ and the rhythm methods may raise some concern as it interferes with the natural course of sexual intercourse. ‘Coitus interruptus’ is the withdrawal of the penis during sexual intercourse so that ejaculation occurs outside the female. In this way, no spermatozoa will be deposited in the vagina and be sucked up to the fallopian tubes where fertilisation usually takes place. The Bible mentions ‘coitus interruptus’ in connection with Onan in Genesis 38:9. One of the customs of the Patriarch period was that when a husband died, his brother was required to have sexual intercourse with the widow so that she could bear children. Onan disobeyed the custom by practising ‘coitus interruptus’. The Bible mentioned that Onan was regarded as wicked, not because of ‘coitus interruptus’, but that he disobeyed God.

In the rhythm method, couples abstain from sexual intercourse during the period when the woman is ovulating. This is the simplest method of contraception and is widely used. Most people have no ethical problem with this method except when one considers the biblical mandate to ‘go forth and multiply’; it could be considered a problem in obedience.

The barrier method is a means to prevent the spermatozoa from getting into the uterus and fallopian tubes. It can either be a condom used by the male or a cervical barrier inserted into the vagina by the female. In both cases, conception is avoided because there is a barrier between the spermatozoa and the ovum.

In the use of contraceptive pills, a combination of estrogen and progesterone is ingested. Different types of pills contain estrogen and progesterone in different ratio which regulates a woman’s menstrual cycle and prevents the release of the ovum. Without the ovum, fertilisation and conception cannot take place.

Methods That Prevent Implantation

Some types of contraceptive pills cause the uterine wall to be hostile to implantation of fertilised ovum or stimulate menstruation thus washing out any product of conception.

Methods that prevent implantation are intra-uterine devices (IUD), progesterone only contraceptive pill, morning-after pill and RU-486. Intra-uterine devices are usually small plastic coils that are inserted into a woman’s uterus. While in the uterus, it irritates the uterine wall and makes it hostile to implantation of any fertilised ovum. An intra-uterine device may be left in a woman for many years. The progesterone only pill, morning-after pill and RU-486 also act on the uterine wall, making it a hostile environment for implantation. All these methods entail abortion as they prevent the embryo from implanting in the lining of the uterus. Their acceptability to Christians depends on their understanding of when human life begins. If a ‘pre-implantation embryo’ which is made up of less than 100 cells is not considered a human being, then there should not be any issue using these methods. As pointed out earlier, if conception is a process consisting of fertilisation and implantation, then conception has not taken place if implantation has not occurred. But if human life is considered to begin at fertilisation, then these methods will not be acceptable because by making the uterine walls hostile to the implantation of the fertilised ovum, one is intending to kill these fertilised ova. However, if one is to hold to the belief that human life begins at 14 days after conception, these methods will then be acceptable.

Infertility Technology

Infertility occurs in about one in eight couples in the USA. A couple may begin to seek advice about infertility if the wife has failed to become pregnant after one to two years of unprotected sexual intercourse. Even under the best of circumstances, there is only a 15 to 20 percent chance of pregnancy among ‘normal’ couples having sexual intercourse regularly. In young women having unprotected intercourse, the rate for pregnancy is about 20 percent per month while for women over 40 years of age, it is 5 percent. Some Christians regard infertility as a medical problem and are comfortable with seeking medical help. Others regard it as a curse as there are many cultural stigmata attached to infertility. There are many biblical examples where infertility or being barren is regarded as a curse while God rewards those who are faithful to him by ‘opening their wombs’.

For many Christian couples, being infertile is a traumatic experience especially in the Asian context of extended families where it is ‘expected’ that a marriage will produce children. Often, some church members and leaders are not too supportive and even forbid these couples from seeking medical help.

The Bible and Infertility

Children are a gift from God. The psalmist says, “Behold, children are a heritage from the Lord. The fruit of the womb is his reward. Like arrows in the hand of the warrior, so are the children of one’s youth. Happy is a man who has his quiver full of them” (Psalm 127:3-5a). Children are gifts, not a right. If God should decide to give children to a Christian couple, they should celebrate this fact and embrace the responsibility of nurturing these little gifts. It is not a right.

Secondly, God is sovereign in a marriage. It is he who opens and closes wombs. The biblical examples of Sarah, Hannah and Rachel are illustrations of his sovereignty and the mystery of providence. Doctors working with infertile couples are able to identify that one third of the causes lie with the woman, one third with the man while the last one third cannot be identified. In some cases, it may not be God’s will for a couple to have children. God may have other better purposes for them. Christian couples should never think that infertility is God’s judgment on them. It is estimated that 10% to 20% of couples will be unable to conceive after 1 year of attempting to become pregnant. This is termed primary infertility.

Thirdly, infertility, like all other trials may be a call to pray. 1 Samuel 1 is a powerful example of that call. Hannah was an infertile woman who was mocked. In her desperation, she called out to the Lord. Once she was so absorbed in her prayers that people thought she was drunk (1 Samuel 1:11-15)! In time, God answered her prayers and she conceived a son named Samuel (‘heard of God’ in Hebrew). Infertility may be a call for the couple to seek the Lord in prayer for fulfilling his loving purposes in their lives.

God often accomplish his purposes by using human instruments, in this case doctors and nurses dealing with infertility. There should be no objection to Christian couples seeking medical help in treating infertility. It is however important that they understand the reproductive technologies and the ethical and moral consequences they may pose.

Reproductive Technologies

For a couple to have a baby, the husband must be able to produce adequate amount of healthy spermatozoa and the wife must have patent fallopian tubes, a normal uterus and healthy ovaries to produce enough normal ova (egg). If any one of these factors is missing, the couple will not be able to produce children. However, barrenness need not be accepted as a curse; there is now technology to help such couples produce children.

Artificial Insemination

Artificial insemination by husband (AIH) is used when the husband’s sperm count is low. It involves concentrating several semen samples and then introducing these into the cervix or neck of the womb when the wife ovulates. Though this procedure has been used for more than 50 years, unfortunately the success rate is low. The only possible objection to this is that sexual intercourse did not take place. It might even be considered an ‘unnatural’ means of conceiving.

Sperm donation

If the husband cannot produce adequate amounts of sperm or have abnormal sperm, sperm donation may be considered. A sperm donated by another person other than the husband may be used to fertilise the wife’s ovum by direct insemination (AID). Fertilisation may also take place in a ‘test tube’ and the egg transferred into the wife’s womb. Would a woman who receives another man’s sperm in her body be considered to have committed an act of adultery? Clearly, this will be carrying the biblical and social definition of adultery too far. Adultery is considered to have happened when a man or woman has sexual intercourse with another who is not their spouse. In sperm donation, no sexual intercourse has taken place. However, the child produced will have some of the genetic material of the donor father.

Egg Donation

If the wife is infertile, a donor’s ovum can be fertilised by the husband’s sperm in a ‘test tube’ and then transferred to the wife’s womb. Again this may be considered an ‘unnatural’ conception as the conception takes place in a test tube and not in a woman’s body. However, the fertilised ovum is ‘normal’ in the sense that there is no genetic damage and when implanted into the womb will produce a normal baby. To date, there are thousands of normal healthy children produced as a result of conception taking place in test tubes.

Embryo Donation

If both husband and wife are infertile, it is possible to get the ovum and sperm from donors, fertilise the ovum in a ‘test tube’ and then transfer it into the wife’s womb. The child born will have neither of the parent’s genetic inheritance. This can be considered a form of ‘test tube baby’ adoption.

Womb Donation – ‘Surrogate Motherhood’

If both the husband and wife are fertile but the wife’s womb is unable to bear children, it is possible to fertilise the wife’s ovum with the husband’s sperm, and transfer the embryo into another woman’s womb. The woman becomes a ‘surrogate womb’. This has become common practice in some countries and occasionally one hears of surrogate mothers so attached to the children they carried to term that they refuse to be parted from them.

In-vitro Fertilisation (IVF)

In-vitro, in Latin means ‘in glass’. The technique of in-vitro fertilisation (IVF) followed by embryo transfer was first developed by Dr. Robert Edwards, a Cambridge University physiologist and Dr. Patrick Steptoe, a gynaecologist, in the United Kingdom. Their first ‘test-tube baby’ was Louise Brown who was born in 1978. Since then, thousands of babies have been conceived by IVF.

In in-vitro fertilisation, eggs and sperm are collected and brought together in a petri dish. The fertilised egg or zygote is incubated for a few days until it is a blastocyte of eight or more cells. The woman is often given fertility drugs so that she can ovulate many eggs at one time. Sometimes as many as 24 eggs are extracted from the ovaries at one time. Hence many blastocytes or embryos are produced each time. These are examined and healthy blastocytes are inserted into the mother’s womb. The more blastocytes inserted, the better the chances of success. Current international regulation does not permit more than three blastocytes to be inserted at one time.

IVF technology has been helpful to many infertile couples. What is of concern to many Christians is what to do with the spare embryos. For those who hold to the idea that human life starts at fertilisation or conception, they are left with the question of what to do with these extra little persons. It would not be an issue if they believed that these embryos are not human beings but masses of cells.

In a survey of some IVF laboratories in the USA, the fate of these embryos differs. Some of them are frozen. It is estimated that there are 100,000 to 180,000 frozen embryos in storage in the USA. Many experts believe this to be a very low estimate. There is really no hope for these frozen embryos. A very small number may be ‘adopted’ by other couples and a few may be used again for the next cycle by the mother. But most embryologists prefer to make a new fresh batch. One of the reasons why these embryos are frozen in storage is that nobody knows what to do with them and for religious reasons are afraid to get rid of them. As time passes, their own parents may not want them. There is a suggestion which is gaining popular support that these stored unwanted embryos be used for stem cell research in the USA.

Another issue of Christian concern with IVF is that of ‘embryo reduction’. Each cycle of IVF is very expensive so the doctors are under pressure to produce a viable pregnancy. The more blastocytes or embryos implanted, the better the chances of success. Although most regulations recommend no more than three embryos be implanted, there have been cases where up to six embryos have been implanted at one time. Some of the implanted embryos will die. The problem arises when a few of them survive. The doctors will then suggest that they be allowed to remove the extra embryos. Doctors allow four weeks for the implanted embryos to survive and grow into foetuses. So they are actually asking for permission to abort some of the foetuses. Christian couples must be aware of this possible scenario if they go for IVF. They must discuss with their doctors and insist that no more than three embryos be implanted. Then the most they will get are triplets.

GIFT

In Gamete Intra-Fallopian Transfer (GIFT), the egg and sperm are collected and placed in a fine tube separated by an air bubble. The tube is inserted into the woman’s fallopian tube and the contents released, allowing the egg to be fertilised naturally. Many consider GIFT to be preferable to IVF. Technically, it is simpler and cheaper. Ethically, it precludes the production of ‘spare’ embryos.

ZIFT

Here the egg and sperm are brought together before being inserted into the fallopian tube. This means that fertilisation takes place outside the body. The newly fertilised egg is immediately inserted into the fallopian tube, hence the name—Zygote Intra-Fallopian Transfer (ZIFT)

Sex Selection and Genetic Screening

With the recent advances in genetics, it is possible to remove the embryos, check the sex of the embryo as well as other hereditary diseases and then reimplant the embryo into the mother’s womb. This technology is called pre-implantation genetic diagnosis (PDG). Sex selection has always been an art rather than science. With the preference for male children especially in the Asian context, many people are happy for the opportunity to choose the gender of their babies before they are born. Unwanted gender embryos are not implanted. Also embryos with inherited defects or diseases will not be implanted. There is a case that can be made for not implanting those embryos with genetic defects. But not implanting those embryos because of gender is questionable. If we believe that children are a gift from God, then we should receive the gifts as they are—little boys and girls. There are no grounds for predetermining the gender of the gift we receive from God, and then helping by removing those we do not want.

Conclusion

Reproductive technologies have made tremendous advances in the last two decades. Preventing pregnancies and allowing couples to plan when to have children, and how, is helpful in these times when things are changing so rapidly. They also allow a family some sort of control over their lives and make sure children are valued and wanted. Fertility technologies have also helped many infertile couples but they have also created new issues of excess embryos. Christian couples need to be aware of this before using reproductive technology for the treatment of their infertility but a frank discussion with their doctors about their religious beliefs may be helpful. The issue of extra embryos should be an important discussion point.
 

                                                                                                                                                                          Soli Deo Gloria

 

|posted 10 June 2006|

               

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