Alex Tang
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Medical Students /Paediatric notes
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|
