". . . and having done all . . . stand firm." Eph. 6:13

Commentary

Can Christians Pursue IVF Ethically? A Doctor Shares His Experience (Part 1)

July 6, 2024

Recent misleading media coverage has promoted the mistaken impression that pro-life, conservative Christians categorically oppose in vitro fertilization (IVF). The truth, however, is quite different and far more nuanced. What most pro-life, conservative Christians actually want is for IVF to have ethical guardrails like any other medical practice — guardrails that will preserve the dignity of human life, even in embryonic form. Some pro-life, conservative Christians have even pursued IVF for their own families while aiming for this high ethical bar.

One such family is that of Dr. Dana Onifer, a family medicine practitioner in North Carolina. He and his wife Jewell pursued IVF as one step in a decades-long struggle with infertility, and in recent years Dr. Onifer has spoken publicly about his experience.

“I think a lot of Christians assume that medicine is good because it’s about helping people, and saving lives, and making people well when they’re sick, and healing, and stuff like that. Those are all good things. Reproductive technology, in particular, is good because having children is good,” Onifer told The Washington Stand in a recent interview. However, although “technology allows me to do certain things,” he cautioned, “just because I can do them doesn’t mean I should do them.”

Clinical Diagnosis

When Onifer wedded his wife in January of 1992, they weren’t yet believers. Initially, Jewell didn’t want to have children, and they had no immediate plans for a family. After a few years, however, the couple discontinued any contraceptive practices. “We were just, you know, being married,” said Dana, but “she wasn’t getting pregnant.”

The Onifers were both converted in the year 2000 as Dana was preparing to go to medical school. “We are now both 33, 34 years old,” Onifer described, “and we are starting to be more deliberate about wanting to have kids.”

“We went through the full evaluation of our infertility,” he narrated, “and came back with a diagnosis of ‘idiopathic infertility’ … which means … there’s no obvious clinical reason why we shouldn’t be getting pregnant.”

Less Invasive Treatments

But they still weren’t getting pregnant, so the Onifers started to explore ways to treat infertility. “We started with … what we considered the least invasive or artificial method, which was just hormone enhancement, taking Clomid,” Onifer began.

Although still relatively young believers, Dana and Jewell endeavored to apply their faith directly to their struggle with infertility. At first, they considered even natural hormone enhancement to be a step worthy of careful consideration. In one conversation, Onifer recalled, “I said, ‘Would Abraham have trusted God? Or would he have used Clomid?’ And my wife put her hands on her hips, looked at me, and said, ‘You’re not Abraham.’”

“Okay, that’s legitimate. I don’t have God’s direct promise of being the father of nations [Genesis 17:4]. So I don’t have a specific promise from God that I’m going to have children,” he reflected. “I have a general cultural human command to fill the earth and subdue it. And [I] have all of these biblical principles that children are a blessing from God, that family, fatherhood, carrying on generations of offspring — and particularly for believers — these are all not just good things, but important and necessary things.”

Even after working through these biblical principles, Onifer did not lean on his own understanding (Proverbs 3:5). “I just kept continuing to lay my prayers before God,” he said. “There’s lots of emotion involved in it. But I wanted to make sure that my thoughts and my emotions were coalesced into a theologically sound and biblically appropriate request of God. I didn’t want to come to him with either silly or selfish or sinful prayers.”

After Clomid proved unsuccessful, Dana and his wife next tried intrauterine insemination (IUI), which also proved unsuccessful.

Researching IVF

While the Onifers were open to trying progressively more invasive procedures, they also recognized there were moral and ethical limits. “We didn’t go as far as we could have,” said Onifer. “I didn’t hire a surrogate. There are some things that are … completely beyond the pale. Because Abraham did try a surrogate, and that didn’t work out. That’s why we have Islam.”

After receiving the promise of offspring from his own body, Abram listened to his wife’s sinful advice and slept with his wife’s Egyptian servant Hagar (Genesis 16:1-4). The resulting child, Ishmael (Genesis 16:15), is traditionally thought to be the ancestor of the Arabian tribes.

Having exhausted less artificial means, the Onifers began to consider whether they wanted to pursue IVF. One conversation in particular stuck in Onifer’s memory. “If I had cancer, you would want to treat that, right?” Jewell asked. ‘Well, I have infertility. Why can’t we treat that?” “These are reasonable arguments,” Dana reflected, “but there are ethical and unethical ways of doing all of these things. Is IVF a biblically ethical way of treating infertility?”

“So we began to explore that,” he said. “I’m naturally just a nerd. So I’m just reading and thinking about this stuff,” both “books from Christian authors and thinkers as well as secular and even medical literature on IVF.”

When considering the ethics of IVF, it becomes even more important than usual to affirm that life begins at conception — fertilization — rather than at implantation or any other point. “I became a physical, practical reality when my father’s sperm met my mother’s egg, and those two things fused,” said Onifer. “By saying at fertilization, I am beginning at the beginning. I am beginning at the moment when a new organism’s DNA is formed.”

“Anything after that is in an arbitrary definition” that might be convenient, but that lacks “a strong scientific or theological foundation,” he added. “I can take that embryo, fertilize it in a test tube, [and] I can create an environment where that embryo will continue to grow and develop well past the stage of implantation. … So, if that’s the case, then when does life begin?”

Theologically speaking, Onifer added, God has known every individual human being since before the creation of the world. He cited Revelation 13:8, which speaks of the names “written before the foundation of the world in the book of life of the Lamb who was slain.”

Based on these considerations and more, the couple eventually decided they could, in good conscience, proceed with IVF — within certain ethical boundaries. “It was a really wonderful moment in our marriage,” Onifer recalled. “We were standing there in the kitchen, and I said, ‘I think we should do two embryos.’ And she said, ‘I agree. I think that’s the right decision. But you’re my husband, and I’ll trust your decision.’”

“So we agreed, but there was still her placing her trust in me, that I was making a good decision,” he said, attempting to describe a nearly indescribable quality of marriage. “That was really important to me because she’s the one that’s going through all of the risk and the difficulty … and I needed to make sure that this was something that she was not just willing to do, but was fully accepting of.”

Embryo Adoption

The Onifers’ first attempt at IVF was through embryo adoption, which is where an infertile couple adopts and implants “embryos left over from someone else’s IVF procedure that are just in cryo-storage,” Onifer described.

This invasive procedure is more complicated than it may at first appear, he explained. The prospective mother takes hormone injections that “hormonally hijack” her regular cycle “to make sure that she is at the right point in her ovulatory and menstrual cycles on the day that she shows up” for implantation. This is necessary because “these embryos get transferred from storage facilities, potentially around the country. They bring them to the hospital, they thaw them, and they’ve got a limited time window” in which to perform the procedure.

Through the Christian Medical and Dental Association (CMDA), they connected with a Baptist hospital in Tennessee that did embryo adoption. “If this worked, [Jewell] would end up being the birth mother of our adopted children,” said Onifer. “On one hand, I thought that’s kind of cool. And then, on the other hand, I was thinking, ‘This isn’t right. This is just kind of out of control.’ At this time, we hadn’t done much beyond what I would say is like mild enhancement of reproduction.”

Oh, if only the complexities and ethical quagmires ended there! Yet a greater conundrum was still to come.

“We were very clear in our interview that we wanted two” embryos implanted, Onifer recalled. This decision was motivated by both financial and safety considerations. “The risk from doing a single to twin gestation is bigger, but it’s not great. Going from two to three [embryos] really significantly increases risk to the mom,” he explained.

On the day of the transfer, the Onifers learned that the hospital had thawed three frozen embryos for implantation, instead of the two they requested. This forced them to choose between adopting and implanting all three embryos, at greater risk to Jewell, or letting one of the embryos die. “I said, ‘We talked about two,’” said Dana. “The embryologist … said, ‘Well, you know, the likelihood that all of them survive is really small. We typically expect only one, maybe two to survive the transfer.’”

At this point, “I was starting to get a little upset,” Onifer admitted. “One of the things that really upset me” is when people “don’t consider that embryo as a living human being [but as] a probability. … When you talk about likelihoods and probabilities, these are just demonstrations of our ignorance.”

“I think a lot of Christians have a naive and uninformed assumption that all of this stuff should be okay,” Onifer pointed out. The three embryos they adopted were from a Christian couple — a Baptist pastor and a Christian school teacher. This couple “had three of their own children through IVF and still had three leftover embryos,” said Onifer, “which tells me they didn’t think through this properly.”

“That would be my criticism, if you will, of most Christians when they approach this stuff,” he elaborated. “I don’t think they have bad intentions. I don’t. It’s just that I don’t think that they’ve done the hard thought work of not just, ‘Is this okay?’ but, ‘Is how I’m doing it okay?’ Because I still think that IVF is an acceptable technology. It just needs to be controlled.”

“The reproductive technology in the United States is the absolute wildest west of anywhere in the world. … People from other countries come on their IVF holidays to America because they know that they can do what they want,” Onifer declared. If “it’s not going to be regulated by our government like it should be, then we as Christians should regulate how we do it.” He added that this is “the nature of what our country is supposed to be. … Internal government is the most important because if you have strong internal government, you need less external government.”

“He who finds a wife finds a good thing and obtains favor from the Lord” (Proverbs 18:22), and on this day Onifer’s wife restrained his passions with a timely word of biblical wisdom. “God’s going to give us the grace for what he’s going to give us,” she said. “Again, that’s a sound argument,” he reflected. The Onifers proceeded with the three-embryo transfer; sadly, not one survived.

Trying IVF

The Onifers made one last attempt to cure their infertility through artificial means. They connected with the advanced reproductive technology program at an Adventist hospital in Okinawa, where they were stationed. “I talked to people who had gone through their program,” Onifer recalled. “The hospital had a good reputation. … Compared to how much you can pay in the U.S., the cost there was pretty manageable.”

At the initial interview, “again we were clear about the two embryos. They can harvest as many eggs as they want, but we’re only going to fertilize two eggs, two embryos to transfer,” reiterated Onifer. “They harvested seven eggs. And my recollection is that, on the day of harvest, I said, ‘Okay, but we’re only going to fertilize two.’ We came back three days later with the transfer, and they told me that they successfully fertilized all seven eggs.”

“I wanted to punch somebody in the throat!” Onifer exclaimed. “Because, in my mind, I now have seven children. Yes, they’re 12 cells old, maybe 18 or 16 cells old, but those are going to grow up and be my children, if things go according to plan. … I wasn’t planning for that.” Not everyone shares Onifer’s perspective — certainly not the hospital staff — but this is a logical outcome of believing that life begins at conception. These seven children, for whom Onifer feels and bears responsibility, are “going to come quick,” he thought. “I’ve got to figure out finances. So, all of these things are now spinning in my head because I’m about to be the father of seven, when I was planning on being the father of two.”

A principle that has held throughout all of human history is that, when someone fathers a child, he is directly responsible for each child that his actions directly produced. But, in Onifer’s case, what could he have done differently to avoid having seven children — beyond never seeking any children through IVF in the first place?

“All of the things that I deliberately sought to avoid ended up happening — despite the fact that I had said two. They just went through their process,” reflected Onifer. “It was very disturbing to me for the second time now that people … who declare themselves as Christians involved in health care have a very secular idea about what they’re doing in the most fundamental aspects of life. … They haven’t thought through the theology of the things that they’re doing.”

The Onifers chose to implant two of their seven embryonic children right away and put the rest in cryostorage, to have another chance at pregnancy later. Sadly, these two children did not survive. “When the first pair didn’t survive, I was very upset. I was the one in tears telling my wife the lab results … and she was kind of cool with it,” said Onifer. “But then later that night, like, we were in bed, I’m asleep, and I wake up to her crying, and I remember her saying to me, ‘I can’t stop thinking about the dead baby inside me.’”

“We went through with two more transfers” with no success, Onifer recounted. Finally, his term of duty at Okinawa was drawing to a close. Instead of proceeding with another two transfers, the Onifers decided to transfer all three remaining embryos, despite the additional risk if they all implanted successfully. “I wasn’t going to leave my last child in frozen storage in another country,” he explained. “None of those seven children survived implantation. So, my wife never got pregnant with our babies.”

Epilogue

By the end of this disheartening process, “we had kind of almost committed to the idea that this wasn’t going to work,” Onifer admitted. “I wasn’t going to allow myself the danger of being hopeful.”

Only a fellow sufferer can know the pain of such repeated devastating loss. It would be difficult for anyone to blame the Onifers for slipping into ungodly ways of thinking or pursuing unbiblical practices that diminish the personhood of the unborn.

Yet there is one “Man of Sorrows” who “has borne our griefs and carried our sorrows” (Isaiah 53:3-4). He has the power to restore all that is broken in this world, so that “the children of the desolate one will be more than the children of her who is married” (Isaiah 54:1). He will restore and comfort those who trust in him, so that their joy will swallow up their former sorrow.

Onifer related one final nugget of wisdom from his wife. “In the midst of our tears, she said, ‘No, God has intended this for our good and his glory, and we’ll find a way to be joyful.”

There is a happy ending to this story, just as there will be an even happier one in the resurrection. For the former, await Part Two of this story, to appear in The Washington Stand. For the latter, await the return of our Lord Jesus Christ.

Joshua Arnold is a senior writer at The Washington Stand.