Technical Difficulties

Revisiting the Moral Hazards of In Vitro Fertilization

Anyone following the news this year has noticed that in vitro fertilization, or IVF, is getting a lot of airtime. IVF is not a new technology—the first “test tube” baby, Louise Brown, was born in 1978, and since then, more than eight million children have been born using this technology. Why, then, is IVF garnering attention and sparking debate?

IVF is a reproductive technology in which some of a woman’s eggs are taken from her body and fertilized with sperm in a lab. Following that, one or more of the resulting embryos are transferred back into her body to (hopefully) implant and develop into a healthy baby. It has become an increasingly common option presented to couples struggling with infertility, as well as those (such as singles or same-sex couples) who cannot conceive a child naturally.

IVF has been and remains quite popular in the U.S., even among many of those who are traditionally seen as conservative on reproductive issues: 78 percent of pro-life advocates support it, as do 83 percent of evangelicals.¹ However, ever since the Supreme Court’s 2022 Dobbs decision, which returned to the states the legislative authority to allow or prohibit abortion as they see fit, proponents of IVF have been concerned that it would become heavily regulated or even banned outright.

Costly Sacrifices

The connection between IVF and abortion is not immediately obvious—IVF’s goal is to bring a new child into the world, while abortion actively prevents that from happening. What many do not realize is that in creating a new child, IVF always involves the destruction of others. Practitioners are quite up-front about this reality, as articles such as “Embryo Loss Is Integral to IVF”² and “Why Discarding Embryos Is Inherent to the IVF Process”³ have made clear. Some embryos are discarded because they stop growing, others because they have some sort of genetic abnormality, and still others because they are simply “left over” after the procedure. Because the success rate of IVF is much lower than commonly thought, multiple embryos are sometimes transferred at once. If several of them beat the odds and implant, IVF doctors advocate for “selective reduction” (i.e., aborting some of them) to avoid a risky pregnancy.

This close connection between IVF and the destruction of embryos is why so many were concerned by an Alabama Supreme Court ruling in February 2024, which determined that frozen embryos are protected by the state’s Wrongful Death of a Minor Act. The incident that led to this decision occurred in 2020. A patient at a Mobile, Alabama, hospital was allowed to enter a restricted cryo-preservation storage unit. The patient tried to pick up—and then dropped—a container of frozen embryos, killing them. Parents of the frozen embryos then sued the clinic for wrongful death in the losses of their children.

In answer to the question at the center of the case—the legal status of these embryos—the Alabama Supreme Court determined that its 1872 Wrongful Death of a Minor Act applies to children at all stages of development, including embryos that are not in utero. According to the court’s opinion, “unborn children are ‘children’ . . . without exception based on developmental stage, physical location, or any other ancillary characteristics.”

Proponents of IVF fear that, with embryos accorded this status, IVF as currently practiced would eventually be prohibited, as it consistently destroys these developing persons in its quest for the best pregnancy possible. Notably, the Alabama Court’s decision did not ban IVF, nor does it make it impossible or illegal to pursue it. Several IVF clinics in the state suspended operations soon after the ruling, but they did so simply because they feared the potential for litigation. In early March, the Alabama legislature passed a bill granting civil and criminal immunity to those who damage or destroy embryos in the process of IVF, and the clinics resumed operation as before.

It should also be noted that there are ways of minimizing embryo destruction in IVF, but these can be both time-consuming and costly. Given that a single IVF cycle can cost between $15,000 and $30,000, this is not an expense most people are willing to pay. Nor does the IVF industry, which was valued globally at $40.7 billion in 2023, wish to see regulations that could cut into its profits.

Pro-Life Convictions vs. Political Expediency

The increased awareness of the destructive aspects of IVF is creating a struggle of conscience for many in the pro-life movement. While some, especially Catholics, have long been opposed to IVF, many approached the technology with a simplistic logic: if being pro-life means supporting the birth of babies and IVF helps create babies, then IVF must be good. Now, however, increasing numbers of pro-lifers are beginning to question this position and apply to IVF the same logic that has been applied to abortion. If life begins at conception and IVF necessarily involves the destruction of embryos after conception, then IVF must also be opposed.

In the wake of Dobbs and the Alabama decision, there has been a flurry of activity, both among those in favor of IVF and those opposed to it. Republicans are concerned that bans on IVF could harm their chances of reelection, so the GOP is actively working to distance itself from perceived opposition. For example, a memo from the National Republican Senatorial Committee Executive Director Jason Thielman tells candidates to “clearly state your support for IVF and fertility-related services as blessings for those seeking to have children” and to “publicly oppose any efforts to restrict access to IVF and other fertility treatments, framing such opposition as a defense of family values and individual freedom.”

Such concerns also led Senators Ted Cruz (R-Tex) and Katie Britt (R-Ala) to introduce a bill that would prevent states from obtaining Medicaid funds if they banned IVF. This was ultimately defeated by Senate Democrats who thought that it did not provide enough protections. Their proposed counter legislation, the Right to IVF Act, would, as the name implies, create a legal right for anyone to pursue IVF and have it paid for by insurance.

In the midst of these legislative maneuverings, the Southern Baptist Convention made its own headlines this summer by passing a resolution highly critical of IVF. The resolution does not forbid participation in IVF outright, but it makes it clear that “not all technological means of assisting human reproduction are equally God-honoring or morally justified,” and it urges Southern Baptists “to only utilize reproductive technologies consistent with” an affirmation of “the unconditional value and right to life of every human being, including those in an embryonic stage.”

Ethical Concerns

Opponents of IVF are quick to point out that their opposition to the practice does not in any way reflect on or delegitimize the children who have already been born using this technology. They affirm that IVF babies should be accorded the same dignity and worth as all other children. Their concern is not to attack those already born but to question our society’s use of and reliance on IVF technology. To that end, they identify numerous problems that go beyond the rampant destruction of human embryos inherent to the process.⁴

First, there is an alarming trend for couples facing infertility to be steered toward IVF before exploring any other options. As previously noted, the cost of a single IVF cycle can range from $15,000 to $30,000. Given that many women may need to undergo several cycles to achieve even a single viable pregnancy, there are huge financial incentives to push women towards it rather than towards other, significantly lower-cost options.

The very availability of IVF changes the way we think about and approach reproduction. The current trend of women waiting until later in life to begin family building is driven in part by IVF’s promised ability to extend the childbearing years. The availability of IVF makes it much easier for couples to put off growing their families until later in life, even in spite of the lowered chances of a successful pregnancy and the greater risks to the mother as she gets older.

Perhaps most importantly, reproductive technologies like IVF are changing the way we think about having children. The term itself—“reproductive technologies”—exemplifies this shift. Reproduction is an industrial term. In a reproductive-technology mindset, children are no longer gifts given by God and received by parents but rather are the product of a clinical process pursued to fulfill their parents’ wants and desires.⁵ It is telling that in discussions of IVF, the focus is normally on the prospective parents and their supposed right to have a child in whatever way they choose. Little consideration is given to the children who are formed as a result of IVF or the ones who are destroyed because the adults administering the process, whether the parents or the practitioners, decided that certain embryonic children would not fulfill their parents’ desires.

Debates over IVF and its place in society are, and will remain, complicated. Some would like to see it continue unchanged, others to see it completely banned. Between these extremes are those who want to strengthen regulations around IVF or discourage its use while encouraging less ethically problematic ways of approaching family formation.

People of all persuasions would be well-served to think deeply about IVF and why they support or oppose it. Though it is currently being fought over as a political issue, neither partisan rhetoric nor appeals to political expediency will provide guidance. What is needed is open and honest conversations about the profound ethical questions IVF raises around what it means to be human and the lengths to which we may go to perpetuate that humanity.

Notes
1. Samantha Latson and Ursula Perano, “Senate GOP Urges Its Candidates to Support IVF after Alabama Ruling,” Politico (Feb 23, 2024).
2. Annalisa Merelli, “Embryo Loss is Integral to IVF,” Stat News (February 22, 2024).
3. Rachel Robertson, “Why Discarding Embryos Is Inherent to the IVF Process,” MedPage Today (February 28, 2024).
4. Matthew Eppinette, “To Evangelicals: IVF Bioethical Questions to Grapple With,” The Christian Post (April 1, 2024).
5. Gilbert Meilaender, “Children: Blessing or Project?” Intersections (July 11, 2023).