Outside the Womb: Moral Guidance for Assisted Reproduction

Outside the Womb: Moral Guidance for Assisted Reproduction

by Scott Rae

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The use of assisted reproductive technology (ART) is on the rise in our culture as an alternative for couples facing infertility issues and single women desiring to have children. Is it right – morally, ethically, biblically – to engage this new technology? Are there some aspects of ART that are more acceptable than others?  Outside the


The use of assisted reproductive technology (ART) is on the rise in our culture as an alternative for couples facing infertility issues and single women desiring to have children. Is it right – morally, ethically, biblically – to engage this new technology? Are there some aspects of ART that are more acceptable than others?  Outside the Womb: The Ethics of Reproductive Technologies addresses the whole issue of “making life”, providing valuable information, both theologically and scientifically, for Christian couples to reflect upon as they consider the various fertility treatments.

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Moody Publishers
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Outside the Womb

Moral Guidance for Assisted Reproduction
By Scott B. Rae D. Joy Riley


Copyright © 2011 Scott B. Rae and D. Joy Riley
All right reserved.

ISBN: 978-0-8024-5042-5

Chapter One

The Experience of Infertility

The faces of infertility are many and varied. Sometimes the most surprising one is seen in your own mirror. At first, getting pregnant is just something you're waiting to have happen. After all, a couple doesn't always become pregnant with the first several attempts. A few weeks pass. Then it is a niggling little reminder at the back of your thoughts. Could this be a problem? Months pass.

Friends are having children, and conversations in which you once felt included now only isolate you. For some reason, you cannot bring yourself to ooh and aah over the latest positive pregnancy test, labor and delivery story, or nursing or diapering ecstasy. Holidays when families gather have become difficult, and Mother's and Father's Day are actually painful.

By the time one year of having unprotected sexual intercourse without pregnancy passes, a couple has met the criteria for infertility.

Infertility statistics are just that—statistics—until those numbers include the person in the mirror. In addition to the difficulties of the holidays with family members and their children and the ever-shrinking list of friends in similar circumstances, there are problems in unexpected places.

Jake and Mandy

Jake and Mandy Anderson's story is a case in point. In their early thirties, they had been trying for a year and a half to have a baby, without success. They had seen their doctors. Mandy's tubes were clear of blockage and Jake's sperm count was satisfactory. Mandy was checking her temperature for a rise denoting ovulation. She called Jake whenever that happened. More than once, he had had to interrupt his workday for what initially seemed a romantic rendezvous. Over time, the pleasurable and gratifying sex life they had anticipated became something they never imagined. It seemed at times a chore, and was always a reminder of the fact that they were unable to conceive. Mandy would typically be in tears when her period began each month. They even wondered out loud if having a child was worth going through all of this, and contemplated a life without children. Together, they started looking into adoption as an alternative, but found they were still not quite ready to give up trying to have a child of their own.

Another unanticipated experience, which made their infertility even more difficult, was the way it affected each of their self-images. For Mandy, so much of being a fulfilled woman was bound up with having a child. Not that she would lose her identity in her child's, but she had a deep longing to conceive and experience childbirth and the bonding with her newborn that her friends talked about with such intimacy. She felt somehow less of a woman because she was failing to achieve one of her most significant callings in life.

Jake felt his manhood and virility were threatened; what kind of man was he if he couldn't impregnate his wife? Whatever they had expected, it certainly was not this level of soul-searching brought on by the clinical-sounding word—infertility.

After two years of frustration, Jake and Mandy reached a turning point. They consulted an infertility specialist one of their friends recommended. It was not without fear and trepidation. They had heard about the expense of fertility treatment. They had also heard some cautionary advice from Marc, their pastor. He seemed concerned that infertile couples were not trusting God to give them a child, but Mandy and Jake were confident that they had trusted God through the process so far, and they had prayed consistently as they tried to get pregnant. Marc thought that many infertility treatments were "unnatural." This bothered Jake and Mandy, too, but then, taking one's temperature in order to know when to have intercourse was a bit odd. Marc was hesitant about using any procedure that would involve another person to help a couple conceive and bear a child. These thoughts and more were in the backs of the Andersons' minds as they consulted Dr. Waiters.

Dr. Walters was empathetic with their situation. He expressed more care for them than had many of their well-meaning Christian friends, whose advice had been basically to trust God or accept childlessness as His calling for them. The infertility specialist explained that there were a variety of reproductive technologies available, with the only constraining factor being their ability to pay.

He told them about a dizzying alphabet soup of techniques. There was IUI, DI, GIFT, ZIFT, IVF, and ICSI to name a few. Some were very expensive, and they did not know how they could pay for them. But others involved less money, so that was encouraging.

The doctor explained that some of these techniques would involve genetic materials from only the two of them. But others included a third person contributing either genetic material (the egg or the sperm) or the womb in which the child would be gestated. In some cases, a woman might even provide both egg and womb.

They left the meeting with the doctor, encouraged that their situation was far from hopeless, but also very confused about which treatment or treatments to try.

Another Couple

Jake and Mandy are only one of several fictitious, but typical couples you will meet in this book. No couple represents any real persons, but Jake and Mandy could have been named Scott and Sally Rae. We struggled with infertility for several years. Although we did eventually conceive and bear three children, our journey through infertility touched us deeply and changed us in ways we could not have imagined.

We have had other struggles as well. Recently, I asked Sally to compare the pain of infertility to what she experienced in her successful battle with breast cancer (radical surgery, reconstruction, chemotherapy, and so on). She replied without any hesitation that the pain of infertility was much more difficult to endure. She and I both remember vividly the pain we experienced, and believe that we can offer genuine empathy and sound advice to infertile couples, as well as those who advise them.

Bearing Advice

Long before a couple considers the technologies that are primarily the focus of this book, they talk to close friends, family members, or a professional, such as their pastor or a counselor. These confidants can offer a listening ear and a compassionate shoulder on which to cry, both of which are quite valuable. But frequently well-meaning individuals can actually increase the pain by the advice they give. Suggestions such as "just relax, you're trying too hard," or "it's just not the right time," often do more harm than good because they inadvertently communicate to the couple that their struggle is not that significant.

What may be worse are the spiritualized words of "encouragement" that tell a couple to trust in God, or that a couple may be childless because God has some other purpose for them. Both of the above may be true, but when offered as advice, it often seems callous and unfeeling, and a denial of the pain that the couple feels.

Is This Book for You?

If you are a couple struggling with infertility, we've written this book for you to help you navigate the confusing world of reproductive technology. This book is also written for those who know a couple like Jake and Mandy, and want to help. If you are a professional or layperson who is involved with infertile couples and has at some time found yourself wondering, as a Christian, what to say to a couple contemplating some of these technologies, this book is for you.

Reproductive technologies often make headlines; not so, the ramifications of using them. Deeper consideration is needed. If you are teaching a class in your church, or in a college or graduate school on social issues, medical ethics, or reproductive ethics, then this book is for you and the people in your class. We have tried to make a very complicated subject understandable to people who may be thinking seriously about this for the first time, while at the same time helping the professional grapple with the complexity of the issues involved.

We have tried to analyze reproductive technologies from the perspective of a Christian worldview to help you draw some conclusions about which are morally allowed and consistent with biblical ethics. First are some basic issues that need to be addressed for the infertile couple.

Spiritual and Emotional Aspects of Infertility

Infertility Produces Real and Deep Pain

For couples who strongly desire a child, the inability to have one produces a strange mixture of emotions—anger, frustration, and disappointment, which may reach the point of despair after a prolonged struggle with infertility. Being around families, especially those with babies or young children, may make this more acute. The Christmas season can be particularly difficult for infertile couples, who may prefer to spend time by themselves or get away. Public or church celebrations of Mother's and Father's Day are painful reminders of desires unfulfilled.

One of the main reasons that infertility causes so much pain is that the ability to produce a child is at the heart of many people's gender identity. Whether it is a man's inability to father a child or a woman's inability to become pregnant, both men and women struggling with infertility feel like failures. The sense of inadequacy can be overwhelming at times. It can produce anger and resentment at the partner who is the "problem." To the infertile couple, we would say, "Do not minimize the pain you are suffering. Resist those who would subtly encourage denial of the anguish you feel. Spend your time with those people who can empathize with you and encourage you."

For others, there are several platitudes as well as questions to be avoided. These include, but are not limited to, the following.

"Have you considered that God might not want you to have children?"

"If you adopt, then you'll get pregnant."

"All you need to do is relax; then you'll get pregnant. That's what happened to 'X.'"

"Whose fault is it?"

"What kind of undershorts do you wear?"

It Helps to Share Your Thoughts and Feelings about Your Struggle

During this time, both of you will be bubbling cauldrons of emotion. It is not helpful to keep these emotions bottled up inside of you. Men frequently have a difficult time talking about infertility and sharing how they feel about it. The more you can encourage this kind of discussion, allowing for breaks from it from time to time, the better.

It is certainly appropriate and helpful to talk with another person of the same gender, and to get together with other couples who are in the same position as you. There are many support networks available for infertile couples, either through your church (you may even encourage your pastor to start one if your church does not have one already) or through a counselor or therapist in your community. RESOLVE is a national support network for infertile couples, and Christian groups such as Stepping Stones and Focus on the Family can provide additional resources.

It is important to be honest with God with your feelings about infertility. Many couples are angry at God and doubt His sovereignty over them and His loving care for them. The psalmists in the Old Testament were extremely honest with God with their feelings, and there is never any indication that God thought any less of them for being so honest. To question God and to express anger at Him is not unusual for infertile couples who believe that God has a family in His plan for them. Many couples feel let down that God has not kept His promises to them. Many infertile couples would make wonderful parents, and it is not clear sometimes what God is doing in their lives.

Resist the Urge to Focus on "Why?"

Whenever a couple or an individual experiences a trauma or difficult time in life, the natural and obvious question is "Why is this happening to me?" For a Christian, there is a bit of a twist to the question when they ask, "What is God trying to teach me through this time?"

For the infertile couple, as for anyone enduring hard times, this question may be unanswerable this side of eternity. Although some infertility may be the result of a sexually transmitted disease, often infertility does not fit into a category that readily answers the why question. Even if the root cause of a couple's infertility can be medically pinpointed, the medical cause does not normally answer the deeper question of "why?"

Though it is true that infertility—as well as all illnesses or difficulties—is a result of the entrance of sin into the world, it is not normally the case that infertility is the result of some specific sin of a particular couple. Ecclesiastes 3:11 helps put the why question into perspective. Solomon writes, "He has made everything beautiful in its time. He has also set eternity in the hearts of men; yet they cannot fathom what God has done from beginning to end."

Similarly in Ecclesiastes 11:5, with a figure of speech particularly appropriate for infertility, he writes, "As you do not know the path of the wind, or how the body is formed in a mother's womb, so you cannot understand the work of God, the Maker of all things."

These verses indicate that there are significant limits to what human beings this side of eternity can know about the plan of God for their lives, especially how things fit together into a coherent whole. It is much like viewing an Oriental rug, but from the underside. When we look at the rug in that way, we will see knots and loose ends and can only faintly make out the pattern. But when we see the rug from on top, we can see the intricate design in all its fullness and beauty.

Until Christ returns, we see life, and especially infertility, from the underside of the Oriental rug of God's plan. That view, and our inability to answer why will not change until we meet Christ face-to-face. Thus it is not a fruitful way to expend emotional energy, and it can be presumptuous to suggest such an answer to a struggling infertile couple. The more fruitful questions are "How can we cope with this?" and "Where can we get support in this?" rather than spending a good deal of emotional energy trying to unscrew the inscrutable and answer the unanswerable question: "Why?"

Don't Let Desperation Cloud Your Judgment

There is little doubt that by the time many couples seriously consider some of the more expensive reproductive options, they have become desperate to have a child. Getting pregnant can become practically an obsession for them. To be sure, this springs out of a natural inclination to procreate, and the sense of desperation is understandable because of the way that infertility strikes at a person's sense of gender identity.

But it is also true that this desperation can lead couples to do things that they would not otherwise do. For example, it is not uncommon for people to go deeply into debt in a pursuit of the latest round of reproductive technology. It is also not uncommon for couples to be totally engrossed in this process, some to the point of not being able to take care of other important aspects of life. Though I would want to be very careful in talking to an infertile couple about this sense of desperation, it may be an appropriate concern.

The desperation to conceive a child needs to be evaluated in light of some important biblical virtues. Trust in God's care for and sovereignty over a couple is an important aspect of developing Christlike maturity. Patience, long-suffering, courage, and endurance are other significant Christian virtues that are sometimes compromised in the process of countering infertility.

This sense of desperation for a child and the feeling that a couple is not complete without one should not be taken as a given, but rather be brought to the light of Scripture. This is not to add further to the guilt and frustration that many infertile couples feel. Indeed, anyone who counsels an infertile couple and mentions their desperation should have earned the right to say things like these through their commitment to the couple and their consistent support of them in the process.

These are not questions to be brought up prior to the couple understanding your commitment to them and unconditional love for them. But support and love for a couple sometimes involves pointing out things about which they may not be aware. The virtue of the couple in the process of infertility does matter, and these questions should be faced, though never used as a club to bludgeon the couple into further guilt.


Excerpted from Outside the Womb by Scott B. Rae D. Joy Riley Copyright © 2011 by Scott B. Rae and D. Joy Riley. Excerpted by permission of MOODY PUBLISHERS. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

What People are saying about this

From the Publisher

“Rae and Riley offer a thorough, thoughtful look at the complexities of assisted reproduction from philosophical, theological, and scientific points of view. This book provides answers to the mind-boggling questions raised by new developments in reproductive technology. It’s a resource I recommend highly."

Chuck Colson
The Colson Center for Christian Worldview

"A rare blend of scientific information, biblical guidance, and empathy for those struggling with infertility. You won't find a better or more readable resource."

David Stevens, MD
Chief Executive Officer, Christian Medical and Dental Associations

“In addition to the emotional anguish experienced by couples with infertility, the treatment options now available through assisted reproduction present them with both a moral and scientific minefield. Scott Rae and Joy Riley do a superb job of unraveling the mystery and navigating the reader through this minefield.” 

Gene Rudd, MD (obstetrician/gynecologist)
Senior Vice President, Christian Medical Association

"If you are looking for moral guidance on assisted reproduction that combines empathy with ethics, biblical teaching with contemporary application, and simple explanations with profound insights regarding IVF, IUI, GIFT, ZIFT, egg donation, surrogate motherhood, and prenatal genetic testing, then you've come to the right place. Congratulations to Drs. Rae and Riley for an outstanding contribution!"
John F. Kilner, Ph.D.
Professor of Bioethics and Contemporary Culture and Director of Bioethics Programs, Trinity International University

"Where Catholic thinking has long been present in a theological ethic of the body, Rae and Riley make much-needed contributions that greatly add to the debate from a Protestant point of view. While their views on assisted reproductive technologies differ from my own, Outside the Womb is a thought-provoking and timely encouragement to think carefully and critically about these matters."

Jennifer Lahl
President, The Center for Bioethics and Culture Network

Meet the Author

SCOTT RAE, Ph.D., is professor of Christian ethics and chair of the philosophy of religion and ethics department at Talbot School of Theology. He's written six books, including Moral Choices: An Introduction to Ethics and Beyond Integrity: a Judeo-Christian Approach to Business Ethics.

D. Joy Riley, M.D., M.A. is board-certified in internal medicine and has a master's degree in bioethics from Trinity International University. The executive director of The Tennessee Center for Bioethics & Culture, she writes and speaks on a variety of bioethics topics, with special interest in reproductive technologies, medical ethics, and stem cell research. She and her husband, an obstetrician/gynecologist, have three sons and live in Brentwood, TN.

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