Louise Joy Brown, the first child conceived by in vitro fertilization (IVF), was born in 1978. Since then, ethicists, theologians, and activists have expressed religiously-based objections to the practice of IVF, notwithstanding the joy it has brought to countless families. In this essay, I wish to survey the whole range of these objections and offer rebuttals to them. For the sake of clarity, I have grouped objections to the clinical practice of IVF according to the various commands implicit in the anti-IVF criticisms.
I. “Husband and wife should conceive only by sexual intercourse.”
Many people believe that IVF is wrong because people should not usurp God’s role in the conception of human life, a role they see as present in traditional intercourse. Religious people throughout the ages have given God credit for their offspring. Examples from the Old Testament include Eve’s bearing Cain (Genesis 4:1), Sarah’s conceiving in old age (Genesis 21:1-7), Hannah and Samuel (Samuel 1:19-20), and Samson’s mother (Judges 13:1-24). Women knew, of course, the role of sexual intercourse with men. However, whether it was fruitful or not and what kind of child was born was considered to be open to God’s influence.
Besides sexual intercourse, people have tried for millennia to help the process of conception by prayer, vows, and sacrifice. Less traditional participation has been viewed as an inappropriate intrusion into the origin of human life. Hence, the Roman Catholic Church has declared IVF to be “immoral and absolutely unlawful.” Although Catholicism generally embraces the idea that people may overcome natural obstacles to achieve God’s will on earth, such a liberal view has not yet extended to human assistance in the extracorporeal union of oocyte and sperm.
But does IVF diminish God’s role in human conception? The coming together of sperm and oocyte in a Petri dish need entail no less randomness and genetic unpredictability than conception by sexual intercourse. As IVF is routinely practiced, it leaves as much biological latitude for the exercise of God’s influence on offspring as does natural conception. In any event, to object to IVF because it limits God’s involvement in the beginning of human life is to challenge the concept of an omnipotent Creator, capable of participation in any initiation of life, even one contrary to prevailing mores.
Others take the broader view that IVF is wrong because science does not have the right to manipulate nature. Even an atheist could subscribe to this objection. But such a conviction usually entails misapprehensions, including the erroneous belief that IVF “creates” life in a test tube, and often reflects a pervasive suspicion of progressive science in all its manifestations. But to be consistent in this belief, proponents must reject not just IVF but all medicine.
Other critics frame this “nature”-based objection differently, arguing that IVF is wrong because it separates “lovemaking” from “baby-making,” which will destroy marriage by replacing the conjugal act with manipulations of a scientist. Several writers have rejected IVF because it sunders what God has united, namely, the procreative and unitive aspects of sexual intercourse. Catholic dogma uses elements of the same rationale in objecting to contraception. Contraception made it possible to have sex without making babies; now IVF has made it possible to make babies without having sex. These are two sides of the same coin, and consistent opponents of IVF might be expected to reject contraception for the same reason.
One also hears the critique that IVF is wrong because it may, as a result of improvement in technique, offer more efficiency and control, so that it eventually comes to replace natural conception. The moral objections to IVF raised earlier in this discussion have been based on its application to the small minority of married couples who cannot otherwise conceive. We now consider an objection that casts a much wider net. Could IVF realistically compete with natural conception among normally fertile couples in our society? The suggestion is not as improbable as it may seem.
When Robert Geoffrey Edwards and Patrick Christopher Steptoe achieved the first successful pregnancy by IVF in 1978, they had already tried it unsuccessfully in seventy-nine other patients. Forty-six years later, several groups around the world report successful implantation of an IVF embryo in one of every five or six attempts. This compares favorably with the success rate of natural human reproduction, where one of every four or five embryos is believed to become properly implanted, resulting in a pregnancy. Such rapid improvement in the technology of IVF may well enable it to equal or exceed the efficiency of natural conception.
Even more remarkable than the prospect of better-than-normal efficiency is the possibility of control. IVF already has the ability to select embryos for uterine transfer using criteria that extend far beyond microscopic observation of normal cleavage. Male embryos can be eliminated in the Petri dish by exposing them to antiserum against a male-specific H-Y antigen without harming female embryos. (Whether this kind of control should be exercised over human reproduction is the subject of another category of objections to IVF, which I will get to in a moment.)
But the premise of the objection currently under consideration is that the popular appeal of such control through IVF would largely eliminate procreational intercourse. Having sex to make a baby would presumably be relegated to the status of a quaint, atavistic impulse, driven by the same sense of nostalgia that motivates a tiny minority of our society to construct antique cabinets using only hand tools or to stalk deer with bow and arrow.
Having sex to make a baby would presumably be relegated to the status of a quaint, atavistic impulse, driven by the same sense of nostalgia that motivates a tiny minority of our society to construct antique cabinets using only hand tools or to stalk deer with bow and arrow.
Clearly, the eventual impact of IVF on procreational sex is highly speculative. Like IVF, Caesarean birth can be said to offer some elements of efficiency and control not found in natural parturition. Although Caesarean section has undoubtedly been used in occasional situations where natural delivery would have sufficed, it has never seriously threatened the status of vaginal birth as the preferred method for women. Even if IVF should make some inroads on procreational sex among normally fertile couples, there is no apparent basis for believing that it would decrease the frequency or quality of unitive sex.
Still others have argued that IVF is wrong because it loosens the biological tie linking mother and infant and the psychological and social tie linking mother, infant, and father. Without intercourse at the time of conception, this view holds, family bonds are weakened. Accordingly, they fear IVF may mitigate against personal intimacy and human contact and, ultimately, human community.
This objection discounts the effectiveness of those ties linking mother, infant, and father that remain unaffected by IVF. Years of effort to achieve pregnancy and the joint decision to resort to IVF testify to the psychological bond between husband and wife. The husband’s sperm are used, so his biological paternity is intact. The wife’s fertilized ovum is transferred to her uterus, where she gestates it as would a normal mother-to-be. Throughout the nine-month pregnancy, the wife and husband may appear at the usual social occasions that allow them to be recognized as prospective parents. Normal delivery of the baby provides the wife with the same subjective experience of motherhood felt by any woman giving birth to a child conceived by sexual intercourse.
A more serious objection to this reasoning comes from the experience of adoptive children. The success of families with adoptive children shows that intimacy and human community can develop in the absence of biological ties. Surely the mother’s gestation of a fetus is a stronger biological and social tie than the procreational sex act at the time of conception, yet adoption succeeds in the absence of both.
II. “Would-be parents should avoid harm to future offspring.”
Several objections to IVF have to do with a fear of harm to the offspring. For example, some worry about the possibility of producing a damaged human being—this concern was widely expressed in the early years of IVF. However, no one offered a hypothesis to explain in mechanistic terms why fertilizing oocytes and manipulating early embryos in Petri dishes should result in children with birth defects. Among the 590 babies conceived by IVF and born between 1978 and January 1984, only one was afflicted with chromosomal abnormality. Considering the age of the mothers in this series, this was a reassuringly low incidence of abnormality and is certainly no higher than in natural conceptions. Forty-six years’ experience with the technique has resulted in more than 8 million births and suggests that the risk of an abnormal child is no greater with IVF than with natural conception. People who still object to IVF for this reason should find natural conception equally objectionable.
Other objections that might have had force fifty years ago should no longer concern us. For example, in the early years of IVF, some worried that it was undertaken in humans before sufficient animal studies were done, and it therefore constituted unethical experimentation. This objection is not trivial and should not be dismissed lightly. Not infrequently, medical procedures and practices have gone forward to widespread clinical application with insufficient prior evidence of their efficacy and harmlessness. Vasectomy is a case in point. More than a million vasectomies per year were being performed in the U.S. during the 1970s, at a time when researchers were belatedly discovering autoimmune consequences of the operation. Fortunately for many millions of vasectomized men, the harmful autoimmune effects discovered in some experimental animals seem not to occur in humans. In IVF as in vasectomy, good luck rather than foresightful research must once again be credited with the avoidance of harmful consequences in human beings.
There was also a fear that the lives of children conceived by IVF would be overshadowed by the possibility of unknown problems yet to come from this unique genesis. Even then, it taxes the imagination to envision any physical problem, absent in infancy and childhood, that could appear later in life as a result of IVF. Perhaps with sufficient encouragement from others, an IVF child might be caused to worry about unknown and unlikely possibilities so that her or his life truly became “overshadowed.”
This too seems improbable, but it does lead to another theoretical concern for IVF children, the risk of psychological trauma—perhaps from publicity around how a child was conceived. Today, it is now entirely within parents’ power to control it. Early in the practice of IVF, this was not always the case. Indeed, the fact that we know of Louise Brown illustrates the reality that motivated this objection to IVF. However, now that well over eight million babies have been born by IVF, the novelty has disappeared, and parents find no barriers to privacy and anonymity. We are past the time when this objection carried any weight.
III. “Infertile couples should be spared more frustration or guilt.”
Some argued that IVF was wrong because the screening process denied the therapy to some couples and, in effect, decided that their claim to bear a child was inferior to that of another couple. But in contrast to the first few years of practice, when only a few IVF clinics struggled for success and only a tiny fraction of infertile couples who met the medical criteria could be accommodated, commercial clinics have proliferated throughout the world. The availability of IVF has increased to the point that medically qualified couples who can afford to pay for the procedure can get it.
Of course, this may make IVF even more objectionable from an egalitarian perspective. Whether IVF becomes a medical procedure provided by society for all its members, regardless of ability to pay, or whether it remains available only to those with adequate financial resources, depends on the medical status of infertility. The debate includes concern about allocating scarce medical resources to an elective procedure like IVF.
A version of this “frustration” argument is that IVF is wrong because unsuccessful patients will suffer disappointment and bitterness. But now that the odds of success have improved to one in four, even one in three, per attempt, a patient willing and able to make repeated attempts at IVF has a reasonable chance of pregnancy. Whether this makes the inevitably persistent failure of the technique in some patients more or less bearable will depend on the individual. But, in any case, is this not a decision to be made by the patient, rather than by a paternalistic medical system? To reject IVF because of the differential emotional toll that it may exact in comparison to natural reproduction may be a rational decision for individuals contemplating personal use of the technology. But it cannot be a valid reason for denying IVF to others, who may make little distinction between conception and implantation or who may prefer any stress to childlessness.
IV. “The human species must be protected from genetic tampering.”
Many have argued that IVF in its current form is not so objectionable, but that it opens the door to unacceptable genetic manipulation later; they believe that IVF is not wrong, insofar as it is used as a therapy for infertility, but it makes possible eugenic “improvement” of the human species, and this is clearly wrong.
Given the history of eugenics in the twentieth century, many have an understandable fear of its resurrection through gene therapy practiced on early embryos resulting from IVF. I am not persuaded. To understand the potential for genetic manipulation that IVF may soon enable, consider the most common genetic disease in humans, familial hypercholesterolemia (FH). Most people with this disease have one defective gene and one normal gene, limiting the concentration of cholesterol in their blood. Because two normal genes are required to keep blood levels of cholesterol from rising so high that arterial disease occurs, people with FH frequently have heart attacks in their thirties or forties. If one parent has FH, half of the offspring will be affected. If both husband and wife have FH, three-fourths of their children will have the disease, and one-third of the affected children will have a more severe form of the disease that causes heart attacks before puberty. Gene typing techniques will soon enable physicians to detect the defective gene for FH in the infant shortly after birth or in the fetus through amniocentesis. Eventually, IVF technicians will also be able to detect the FH gene in embryos prior to transfer into the mother’s uterus.
Should the detected presence of the FH gene in an IVF embryo be grounds for rejecting the embryo in favor of one not bearing the defective gene? Should this potential technology, when available, enable parents with FH to ensure the absence of the disease in their offspring and in their family lineage henceforth? The power of the new eugenics will be astounding. The morality of its use depends on the status of rejected embryos, the definition of bad genes, and the perceived risk of tampering with genetic variability in the human species.
This objection will look different in the more distant future when, instead of discarding embryos with defective genes, normal genes are spliced into them, thanks to the CRISPR technology. In either case, the effect will be the elimination of genes considered undesirable. Many would agree that the FH gene deserves elimination. Much human suffering results from the prevalence of the gene, and no one has identified an advantage afforded by the gene in contemporary societies. If ever a gene could qualify as “bad,” FH seems a sure candidate. On the other hand, elimination of the gene would reduce human genetic variability. What if a bizarre epidemic should sweep the world, and only people with high blood cholesterol levels could survive? As improbable as the scenario may be, it illustrates a reason to be cautious in declaring specific genes undesirable and advocating their elimination.
But what if the genetic selection is not to eliminate a disease, but to express a sex preference? The technology for selecting IVF embryos according to sex has been perfected in animal experiments. Other criteria for selecting embryos, including cosmetic factors like eye color, may ultimately be available through IVF. This kind of selection would not seek elimination of defective genes, so it should not be equated with eugenics. Instead, it attempts a more trivial control over human reproduction according to the tastes of the parents. The only serious threat to human population genetics is the unlikely possibility that sex selection might eventually cause departure from the normal ratio of males and females. However, employing sex selection may have more detrimental consequences for human society. Sex preselection, particularly when it results in destruction of embryos of the unwanted sex, has been called the most stupendously sexist act in which it is possible to engage. One does not have to believe that the destruction of embryos is murder to feel uncomfortable about selectively eliminating them for a reason as discretionary as sexual preference.
To get even more into the realm of science fiction, what about cloning? IVF does indeed make the theoretical possibility of cloning more feasible in humans. Cloning entails the replacement of the nucleus of a fertilized egg with the nucleus of an ordinary body cell from the individual being cloned. If the substitution works, the developing embryo would become a genetically identical copy of the individual who contributed the nucleus.
To get even more into the realm of science fiction, what about cloning?
The concept of creating multiple copies of a human being deeply unsettles many people. Personal worth is closely tied to the belief that each human being is genetically unique from the moment of conception. To duplicate an individual seems to cheapen personhood, in spite of evidence from monozygous twins showing that the value and richness of human life is not diminished by the existence of another genetically identical person. But what about—to go even further—human-animal hybrids to be produced? The idea of human-animal hybrids is an ancient one, with minotaurs, satyrs, and mermaids reflecting its grasp on people’s imagination. Could a living creature, representing mixed animal and human inheritance, actually result from IVF technology? Novel creatures have been produced by mixing the cells of two different early IVF embryos and allowing the reformed single embryo to gestate in a compatible uterus. The resulting offspring’s body is a patchwork mixture of the physical characteristics of the two species whose embryos were mingled. Such chimeras have already been made between goats and sheep; a thriving example appeared on the cover of Nature in 1984.
IVF, by avoiding certain physical and behavioral barriers to cross-species fertilization, may allow the generation of hybrids never before seen in nature. Would anyone attempt either a human-animal chimera or hybrid? Apparently, the latter has already been tried. A Russian biologist, Ilia Ivanov, attempted to create chimpanzee-human hybrids during the 1920s using artificial insemination. The feasibility of obtaining a viable hybrid seemed probable on strictly biological grounds. Chromosomally and genetically, humans and chimpanzees are more similar than horses and donkeys. Heterosis, the vigor seen in interspecific crosses, predicts a hybrid that would be stronger than a human and more intelligent than a chimpanzee.
But when no ape-man materialized, Ivanov’s research was forgotten. As a basis for serious moral concern, the production of human-animal hybrids dwarfs other potential consequences of IVF. Although biologically intriguing, the Ivanov experiments aroused in scientists as well as laymen a sense of having gone too far. It should be noted, however, that this offensive endeavor did not rely on IVF technology but on artificial insemination. For more than thirty years, artificial insemination has been an established clinical procedure for infertile couples, and no comparable incident of misuse has occurred. Any medical procedure can be perverted in a moral vacuum; atrocities committed by Nazi physicians during the Holocaust prove the point tragically. Medical procedures subject to misapplication should be regulated rather than expunged. Society may wish to take appropriate precautions with regard to IVF, particularly in the areas of human cloning and human-animal hybridization.
V. “Human embryos must not be destroyed.”
The objections under this heading are founded on premises about the moral status of human embryos. The first objection is more technical than substantive. The second deals with the most widely shared public concern yet raised in the IVF debate. This issue, the wrongfulness of destroying human embryos, is the question upon which many people’s opinions of IVF will hinge.
First, many say that IVF is wrong because consent cannot be obtained from the embryos whose lives are at risk. Contemporary medical ethics demands that informed consent be obtained from human subjects before they undergo a risky medical procedure. Regardless of how it is practiced, IVF entails the death of a majority of embryos produced by the technology. Because embryos cannot possibly give consent, proponents of this objection reject IVF as immoral. However, consistency also requires rejection of natural human conception, since the odds are that any single embryo so produced will die unconsentingly, rather than implant successfully in the uterus.
Second, there is the objection that IVF is wrong because of the loss of human life that accompanies the production of each healthy baby. No matter how scrupulously it is practiced, IVF is more wasteful than natural reproduction; it consumes more embryos per successful pregnancy. Its rate of success per attempt, measured by cycles required to become pregnant, is now only slightly behind natural reproduction, but typical programs produce four or five embryos per attempt and transfer on average about three to the uterus. Hence, although natural reproduction entails the death of four or five embryos for each one successfully implanted, IVF uses fifteen to twenty embryos per pregnancy. Is this too high a price in human embryos to pay for a healthy baby?
The answer depends on the status of the early human embryo. Public consensus may be unattainable on this issue, as the abortion debate shows. Indeed, one of the more novel objections to IVF is that it brings further trauma to a nation already deeply divided on the morality of abortion. The deep division of society over the status of the human embryo and fetus reflects deeply held personal convictions.
I would argue that the IVF debate is actually much simpler than the abortion debate, because the latter encompasses all stages of human development from conception to birth, with the acquisition of varying degrees of sentience and potential autonomy complicating moral analysis of fetal life. As practiced in a clinical setting, IVF addresses a relatively simple and short segment of human development between conception and implantation. Here the embryo consists of one to a few dozen undifferentiated cells. The biological substrate for self-awareness, a nervous system, has not begun to form in the preimplantation embryo. People who believe protectable human life begins at or after the implantation era are unlikely to object to the loss of embryonic life that accompanies IVF.
This does not mean that preimplantation embryos are considered inconsequential or unworthy of respect. It simply means that no moral wrongfulness is associated with the expenditure of these embryos in a sincere effort to enable one among them to become a baby. Just as sperm and oocytes may be dissipated in efforts to conceive an embryo, embryos may be consumed without remorse in attempts to achieve a pregnancy.
On the other hand, people who believe human life is sacred from the moment of conception may have difficulty accepting the greater loss of embryos with IVF as compared with natural reproduction. Perhaps the realization that significant loss of embryonic life, albeit sacred, is a natural concomitant of human reproduction could make IVF more acceptable. More likely, however, comparing rates of embryo loss between natural reproduction and IVF misses the point for a large group of people who believe personhood begins at conception. Their focus will be not so much on relative numbers as on responsibility for such deaths as occur. The crux of their view is that death in the course of natural events is morally neutral, but death at the hands of people is morally reprehensible.
The Roman Catholic Church teaches that the embryo is either human or incipiently human, and infusion of the soul at conception is at least probable and cannot be disproven. Hence, to kill an embryo is to risk killing a human being. In fact, the Catholic Church views the killing of an embryo or fetus as a more heinous crime than homicide, because it deprives the young human of baptism, and hence, eternal life. It is this reasoning that motivates the Catholic Church to preserve the fetus and let the mother die during difficult childbirth; after all, the mother has presumably been baptized, but since the fetus has not, it will suffer perdition.
In contrast to the current Catholic emphasis on conception, the Jewish metaphysical tradition teaches that human life begins at birth; before that, there is life, but it is not the life of a human person. The embryo has value, and the fetus has value, but it is not the same value as a person. Similarly, the embryo and fetus deserve respect, but it is not the same respect due a person. In traditional Judaism, the life of the fetus and the life of the mother are not deemed of equal value until the major portion of the infant has been delivered. Throughout gestation, the welfare of the mother takes precedence over that of the fetus.
Jewish scholars trace the status of the fetus to the text in the Book of Exodus (21:22), implying that the destruction of an unborn fetus is not culpable as murder and that the fetus does not therefore have the same absolute right or life as an already born human being. Nevertheless, Judaism insists that the embryo or fetus, in different stages from the moment of conception, enjoys a right to life that can only be set aside under exceptional circumstances.
In Jewish teaching, increasing reverence for life, as it progresses through the stages of human development before birth, does not begin abruptly at conception. The oocyte itself is accorded a degree of respect unknown in other traditions. The Israeli Ministry of Health forbids recovery of human oocytes unless they will be fertilized with the husband’s sperm and transferred to the wife’s uterus. To my knowledge, nowhere else is the human oocyte protected by law from experimental manipulation.
In contrast to the Catholic dogma that IVF is immoral, Judaism considers IVF of no ethical concern. If a woman’s infertility can be relieved by IVF, the rabbinic scholar Moshe Tendler has written, “it would be classified as a mitzvah (a good deed), and nothing more.”
VI. Conclusion
The common reasons why IVF has been considered morally unacceptable cover a wide range of theological, philosophical, social, psychological, biological, and medical concerns. This review organized these concerns under five categoric headings:
- The ethic of preserving the traditional roles of God and sexual intercourse in human conception
- The ethic of protecting future offspring from harm
- The ethic of sparing infertile couples further frustration and guilt
- The ethic of preventing genetic manipulation of the human species
- The ethic of saving human embryos from destruction
There is no compelling reason why IVF should diminish either the influence of God on conception or the benefits of sexual intercourse on marriage. Sufficient evidence already exists to reassure critics that IVF causes a higher incidence of physically defective births than natural conception. Infertile couples must decide for themselves whether any additional emotional toll exacted by IVF is an acceptable burden.
However, the most serious potential dilemmas raised by IVF concern its possible future application in eugenics, sex selection, cloning, and hybridization. These are capabilities associated with IVF that will undoubtedly provoke intense public debate, and ultimately, some degree of governmental regulation. The principal dilemma of currently practiced IVF is the accompaniment of a good effect, helping infertile couples have babies, with a bad effect, excessive death of human embryos. Whether the dilemma is serious or trivial depends on individual attitudes toward the relative value of babies and embryos. If the intrinsic worth of an early human embryo is no less than that of a newborn infant, IVF cannot be justified. On the other hand, if the principal value of a human embryo derives from its ability to become a baby, IVF may be seen as a moral way of awakening this potential where it would not otherwise exist.