Infertility is a difficult and sensitive issue that many couples must face in their marriage. For many of these couples, questions about the complicated process of in vitro fertilization must also be answered. In vitro fertilization is itself a serious issue full of many decisions that can be difficult to navigate. If you or someone you care about is dealing with infertility or issues surrounding in vitro fertilization, they can contact Shiloh, Watermark’s infertility ministry, at firstname.lastname@example.org.
In vitro fertilization (IVF) is a medical procedure where eggs are removed from a woman’s ovaries and fertilized in a laboratory setting using a man’s sperm. When fertilization happens, the egg and sperm join together to create the first cell of a new, unique person. The words “in vitro” actually mean “in glass”. This is because the egg is fertilized outside the woman’s body in a glass dish. Once the egg is fertilized, it begins to develop into an embryo, and this embryo is then placed into the woman’s body where it can attach to the uterus and continue to grow and develop.
In some cases (primarily for the reasons mentioned in the episode of RTRQ) more embryos are produced than can be safely transferred to the woman’s body. In these instances, the embryos (humans in earliest stages of development) are often frozen through a process called cryopreservation. As clearly articulated in the previously mentioned video, in order to value and honor all life as Scripture exhorts followers of Christ, Watermark leadership does not support this decision and advises against consideration of it.
Scripture teaches and science increasingly confirms that life begins at conception (the moment an egg is fertilized by a sperm). A fertilized egg, also called a zygote, is the first complete cell of a new baby. This first cell contains a complete blueprint for the person that will grow and develop within the womb. Once this single cell begins to divide into a larger group of cells, it is called an embryo.
While it is appropriate to refer to life at this stage as an embryo, it is also important to acknowledge that the embryo is a life in God’s eyes. Just as we might refer to any person as an infant, teenager or adult based on his or her development, an embryo is a living person that is simply at one of his or her earliest stages of growth.
“Before I formed you in the womb I knew you, before you were born I set you apart: I appointed you as a prophet to the nations.”Jeremiah 1:5 (NIV)
The elders of Watermark see nothing in Scripture that explicitly forbids fertilization of the egg outside of the woman’s body and therefore see no reason to have to discourage couples from participating in IVF in order to conceive a child. However, the elders do believe that all of the embryos produced through the process of IVF should be immediately transferred into the woman’s body instead of being placed into cryopreservation.
Placing an embryo into cryopreservation suspends the embryo at that stage of development. It is the belief of Watermark’s elders that this life should not be suspended but should be allowed to develop at its natural pace, living out all of the days that God has ordained for it. In addition, none of us can know what tomorrow brings. While the intent of couples placing embryos into cryopreservation is almost always to return for those embryos, there may be future circumstances out of the couples’ control that prevent that from happening. Because of these points, Watermark’s elders believe that embryos should not be placed into cryopreservation.
“For you created my inmost being;you knit me together in my mother’s womb.I praise you because I am fearfully and wonderfully made;your works are wonderful,I know that full well.My frame was not hidden from youwhen I was made in the secret place,when I was woven together in the depths of the earth.Your eyes saw my unformed body;all the days ordained for me were written in your bookbefore one of them came to be.”Psalm 139: 13-16 (NIV)
“Now listen, you who say, ‘Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money.’ Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes.”James 4:13-14 (NIV)
Watermark does not take a stance on the exact number of embryos that should be created during an IVF procedure, but we do believe that all of the embryos that are created through the process of IVF should be transferred into the woman’s body instead of being placed into cryopreservation. Watermark’s elders do understand that there are necessary limitations on the number of embryos that can be safely transferred into a woman’s body. Because of this, they would advise against creating more than the number of embryos that could be safely transferred or carried to term by the mother. However, this specific number could be different for different women based on a number of medical factors.
To achieve higher success rates, doctors typically attempt to create more embryos than would be safe to transfer into a woman’s body. This is because some embryos will stop developing at very early stages. This is not uncommon, and it can even happen inside a woman’s body after fertilization has occurred naturally. Knowing that it is likely that some embryos will stop developing, doctors typically aim to produce more than enough embryos so that at the end of the process there will be viable embryos left to transfer. However, since there is no way to accurately predict which embryos will continue to develop, these methods can also produce more embryos than it would be safe to transfer. This forces couples to cryopreserve the remaining embryos. There are even times when the majority of embryos that were created remain alive and continue to develop. In these instances, there may be a large number of embryos that would need to be cryopreserved.
Doctors also give embryos a letter grade based on their quality, and they typically try to transfer the best quality embryos first. These are embryos with grades of A or B. Embryos that appear to be less hearty may receive a grade of C or D and not be transferred at all, even though these lives are completely viable and would normally develop just as successfully as other higher graded embryos. Sometimes these lower quality embryos may also be seen as too low of a quality to survive the freezing process by advising “experts”. In these cases, the embryos may be discarded instead of placed in cryopreservation by some clinics or advising professionals. Couples choosing to participate in IVF should be certain to clearly understand this grading process and contend for the life of every life (fertilized egg) they allow to be created with their egg and sperm.
Ultimately, the only way to completely insure that no more embryos are created than the number that is safe to transfer is to limit the number of eggs that are exposed to sperm. For example, if a doctor’s position is that it would only be safe to transfer two embryos, then by attempting to fertilize only two eggs the couple could be sure that there would be no embryos left to cryopreserve. This would be true even if all of the embryos developed and could be transferred.
By performing IVF in this way, couples can be sure that they do not produce too many embryos. They also avoid the risk of having any embryos that have been labeled as low quality discarded. The couple should prepare to hear from the advising professionals that this careful stewardship of creating life will greatly reduce the probability that any of the embryos will continue to develop to the point that they can be transferred.
It is important that couples share their beliefs and desires with their doctor at their initial consultation. This will allow the couple and their doctor to get on the same page about their plans for IVF. The doctor will certainly discuss the risk of failure that accompanies fertilizing such a small number of eggs, and couples should be prepared both emotionally and mentally for this conversation. In some cases, the doctor may not even be willing to limit the number of eggs that will be fertilized in their practice.
It is also important to understand the difference between the number of eggs that are retrieved and the number of eggs that are fertilized. The doctor may seek to retrieve many eggs to insure that the eggs that are fertilized are of the best possible quality. These eggs are not considered a life prior to fertilization, so retrieving many eggs is not particularly an issue. However, couples must understand that it is not necessary to try to fertilize all of the eggs that are retrieved. Once these eggs are fertilized, they have become a new life, so controlling the number of eggs that are actually exposed to sperm or attempted to be fertilized is the primary issue.
Whether or not to pursue IVF is a difficult decision that many couples facing infertility must make. In addition to being a serious financial commitment, it is also an incredibly emotional decision. For many couples, IVF may be the only option for conceiving a biological child. IVF is also a medical procedure that requires women to subject themselves to large amounts of medication, and women may react to these medications differently. As with any decision of this magnitude, Watermark would encourage couples to process through this with trusted members of their community instead of trying to make the decision in isolation. Couples should seek biblical and godly counsel throughout the decision making process. Watermark’s Shiloh ministry is also a place where couples and women in particular can seek counsel and talk openly about these decisions with others that are going through similar circumstances.
It should be anticipated that any egg that is attempted to be fertilized will need to be implanted. It is not wise to assume that you need to attempt to fertilize ten eggs so that you get six viable eggs, it should be assumed that you will have ten viable children and no children should be introduced that are not immediately able to be implanted in the uterus. Any mention of attempted fertilization should be accompanied with clarity saying that attempted fertilization should always be assumed that it will lead to viable life and therefore the need to be implanted. Any attempt to create life should be accompanied with an attempt to bring the life to term. The elders of watermark believe that any possibility of creating life should be undertaken with the assumption that the attempt will be successful and that it will lead to creating children that will need to be immediately implanted, cherished and nurtured toward healthy development and beginning the days that the Lord has ordained for them.
“Plans fail for lack of counsel,but with many advisers they succeed.”Proverbs 15:22 (NIV)
The issue of IVF is a very sensitive one that affects a large number of couples. Watermark’s elders understand that many of the couples that will see the Real Truth, Real Quick video about IVF or read their position on cryopreservation will already have embryos that have been frozen through this process. The elders’ intent in being more vocal on this topic is to provide greater pastoral counsel and support to those considering IVF. The intent is not to bring guilt and shame to those that have already undergone the procedure. However, in light of the belief that fertilized eggs are life created by God for us to cherish, honor and steward for His glory, couples with embryos currently in cryopreservation are urged to fight for the life of their children in the same way they would a child at any age.