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What about IVF?

The embryo technology that evangelicals don’t oppose

By Naomi Schaefer Riley
October 10, 2010

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The news last week that Robert Edwards won the Nobel Prize in Physiology and Medicine for his work on the in vitro fertilization of human eggs may have seemed a little surprising to some observers: IVF has become so mainstream that we hardly see it as an innovative technology anymore.

It has also stayed largely out of the headlines, with little of the moral controversy that surrounds other reproductive issues, such as abortion and embryonic stem cell research. Since its introduction, IVF has been widely embraced across the religious and political spectrum. This is particularly notable in the evangelical movement, whose leaders have kept abortion and stem cells on the political front burner, but have staked out a variety of compromise positions that allow them to accept this scientific form of family-building.

Behind IVF and embryonic stem cell research, however, lie the same sort of technology, the kind Edwards and his late colleague Dr. Patrick Steptoe developed. Both depend on embryos created in a lab by fertilizing an egg extracted from a woman. And both practices generally result in the destruction of embryos--in the case of stem cells, for research; in the case of IVF, as a common side effect of creating more embryos than a woman ultimately chooses to implant.

Should evangelical Christians accept IVF so easily? No, says Jennifer Lahl. The director of the Center for Bioethics and Culture Network in San Francisco, Lahl has become a lone voice for a message that many of her fellow evangelicals are uncomfortable hearing: If embryos are human lives, she argues, then it is time for Christians to be consistent about their moral objections and unite against IVF.

For Lahl, the regular destruction or freezing of human embryos that occurs during the course of most IVF cycles amounts to ending human lives. And she suggests that the whole process is undermining human dignity. ”The minute the egg comes out of body, it is graded, the sperm is graded, then the embryo is graded,” she says. In addition to determining which sperm and which eggs are most likely to produce a viable embryo, doctors often use a procedure called pre-implantation genetic diagnosis to sort out which embryos may have defects. ”I see the whole enterprise as being highly eugenic,” says Lahl.

To make her case, Lahl travels the country, testifying in favor of legislation that would restrict IVF, or at least regulate it more heavily. She speaks to religious groups and secular ones. And now she has put a part of her message on film. This week, ”Eggsploitation,” a movie that Lahl produced to describe the medical dangers of egg donation, will be shown at Harvard Law School and Tufts University.

In her campaign against IVF, Lahl has found herself with little company among evangelicals. Despite her efforts, most of her coreligionists view IVF as acceptable for couples in need of a doctor’s help to start a family, even as they may fight to stop abortion or embryonic stem cell research. But beneath that broad consensus lies a wide range of often conflicting positions on how science should and shouldn’t be allowed to affect conception.

Where evangelicals stand on IVF, and how much Lahl can influence them, matters not only because evangelicals possess plenty of political power when they do agree, but also because it shows how difficult it can be for a religious community to reach consensus on such complex bioethical issues at all.

It was 32 years ago that the first infertile couple conceived a baby with an egg and sperm in a test tube. Lesley Brown had tried for years to have a baby with her husband, John. Edwards and Steptoe, pioneers at the time in the emerging field of infertility medicine, found her fallopian tubes were blocked. In other words, while she could make eggs, her husband’s sperm could not get to them. The doctors took eggs from Lesley’s ovaries and fertilized them in a dish with John’s sperm; today their baby, Louise, is healthy and married and has had a child of her own. (The first American test-tube baby, Elizabeth Carr, today works for Boston.com and also recently had a baby of her own.)

The technology brought immediate worries: Scientists were concerned about severe birth defects; others were concerned that IVF children would have to live with a social stigma. Neither came to pass, and by scientific and social standards, the technology has grown into a smashing success. As of 2006, 3 million babies had been born worldwide using this technology.

The religious response to IVF was not so neatly resolved. The Catholic Church came out early with its opposition to IVF, staking out a position even before Brown’s birth, and has remained consistently against it. In the 2008 document Dignitas Personae, the Vatican laid out the three major objections to the technologies: that they do not protect the ”right to life and physical integrity of every human being from conception to natural death”; that they do not respect the ”unity of marriage” when outside donors are involved; and that they separate the conjugal act from procreation.

Evangelicals have not as a rule been particularly concerned with the last point. While Catholic doctrine teaches that any time people have sex they must be open to the possibility of childbirth, evangelicals (both the leadership and rank and file) have accepted most forms of contraception. ”The primary purpose of sex is not procreation,” says Richard Land, head of the Ethics & Religious Liberty Commission at the Southern Baptist Convention.

This openness has carried over to IVF as well. When it comes to in vitro fertilization, says Carrie Gordon Earll, the senior bioethics analyst at Focus on the Family (a global Christian ministry), ”evangelicals are all over the map.” Robert Fleischmann, the leader of Christian Life Resources (a Lutheran organization that counsels clergy on family issues), believes that both contraception and IVF are permissible in some circumstances. He argues the ”one flesh” doctrine in Genesis 2:24, cited by some Christians in their case against IVF, doesn’t need to be taken literally--that is, childbirth doesn’t have to be the direct biological result of the conjugal act. Rather, he says, ”The concept is that you’ve got a committed relationship between husband and wife. Your children, generally speaking, come from that relationship.”

Without a central authority like the Vatican, evangelical thinkers parse the IVF issue in various ways. Some oppose using donor eggs or donor sperm or surrogates to conceive. At Focus on the Family, Earll says that she and her colleagues believe IVF is acceptable but advise against ”third party” involvement. (Not only because of the potential for ”exploitation” and ”commercialization” of reproductive processes, but also for the potential problems for a marriage.) But Land of the Southern Baptist Convention is more circumspect. ”I’m not sure we would say that even outside donors are beyond the pale.”

Land does, however, object to the use of pre-implantation genetic diagnosis to determine which embryos will be most viable and healthy. And he objects to the use of cryopreservation--freezing embryos for use later. He says, ”It is never permissible for Christians to create more embryos than they plan to use.” But other evangelical scholars take a more liberal view of that issue as well. Scott Rae, the professor of Christian ethics at the Talbot School of Theology at Biola University in Los Angeles, doesn’t rule out freezing embryos as long it’s not indefinite, and as long as they’re not destroyed afterward.

Whatever their leaders think, evangelicals themselves have been using IVF widely, the numbers suggest. Rising levels of education among the 100 million evangelicals in America have led both to higher incomes and higher age of marriage and birth of first children. So evangelicals are both more in need of artificial reproductive technologies, because women are starting to have children at later ages, and more in a position to afford them. In a 2008 study of more than 1,000 people who had conceived children artificially and had embryos frozen in storage, Anne Drapkin Lyerly, an obstetrician and bioethicist at Duke University, found that 10 percent self-identified as evangelicals or fundamentalist Christians.

Nigel Cameron, an evangelical who believes that his coreligionists have not been very thoughtful about bioethical issues like IVF, guesses that there is ”not one evangelical congregation in the land that doesn’t include people who have had IVF.” Cameron, the founder of the Center for Bioethics and Human Dignity, is British and recalls a trip to the United States in 1985, during which he was invited to speak at a church. ”They wanted me to talk about these technologies,” he said, ”but they asked that I be sensitive.” The organist’s wife, he was told, had just given birth to an in vitro baby.

Cameron traces the relaxed views of evangelicals on the issue back to the 1970s, a time before abortion had really mobilized evangelicals to become involved in public life. ”These pro-life issues only began to click with evangelicals in the ’80s,” but by then, says, Cameron, IVF was already a fact of life, even if not a widespread one.

For Jennifer Lahl, the issue is much simpler: IVF is wrong, and the patchwork of beliefs just goes to show that how inconsistent her fellow evangelicals have let themselves become.

She insists that there is no way to make any of these technologies compatible with traditional Christian beliefs: Paying for eggs or sperm or the use of a surrogate is exploitative and puts a price on human life. The processes involved in creating the embryo are ”eugenic.” Separating sex and procreation violates biblical teaching. And the destruction of embryos in the process is tantamount to abortion. Lahl even questions the money spent on such procedures. ”Is this a good stewardship of our financial resources?” she asks. ”Tens of thousands of dollars, and 70 percent of the cycles fail.”

Last year, Lahl worked with an Oklahoma legislator to pass a bill that would discourage egg donation by prohibiting donors from being paid. Lahl recalls an animated conversation with a woman who was very involved with a local Southern Baptist group. ”She didn’t understand,” says Lahl, ”why this was a pro-life issue.” The bill failed, and according to Lahl, ”The woman just wondered what could be wrong with paying young women to have babies.” Indeed, it can be hard for some to grasp why a technology that helps infertile couples to have big happy families could be anything but ”pro-life.”

Even people, Lahl says, ”who should have a theological perspective on this issue, put on blinders about it. They want to believe that children are a gift and that any way we get children is a good thing.”

When she is offered the opportunity to speak to Christian groups, she is often frustrated by their response. She says, ”I see them dancing around the issue. They want me to say there is a Christian pro-life way to do IVF. They say, ’What if we don’t create surplus eggs?’ ’What if we don’t do PGD?’ ’What if we only use the husband and wife?’ ’Can’t we have it then?’”

In her movie, the women interviewed describe the consequences of egg donation (both the hormones that donors must take and the surgery to harvest eggs) in heart-wrenching detail: They talk about torsioned ovaries, advanced breast cancer, internal bleeding, even paralyzing strokes. These may be extreme cases, but Lahl and the film’s narrative say that there has been little research done on the risks involved in egg donation. ”In a perfect world,” Lahl says, ”we would have a moratorium on IVF so we could do some retrospective analysis.”

Lahl, who has three college-age daughters, spent 25 years as a pediatric nurse and hospital administrator before getting a master’s degree in bioethics from Trinity International University in Illinois. A self-described women’s health advocate, Lahl says her particular concern for the risks posed to egg donors intensified when her daughters began bringing home advertisements from their own school papers that offered money to young women willing to donate their eggs.

For all of her passion and the internal logic of her positions, Lahl is still very much a voice in the wilderness. She is invited much more often to speak to Catholic groups than evangelical ones. She says evangelicals are not used to or interested in hearing any message about IVF, particularly since pastors are reluctant to preach on the subject. ”For goodness sake,” says Lahl impatiently, ”infertility is in the Bible.

”When was the last time you heard a sermon on infertility? Never.”

Naomi Schaefer Riley is a freelance writer in the suburbs of New York. This article was based on research she did as a Templeton-Cambridge journalism fellow over the summer.

Jennifer Lahl Jennifer Lahl
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