Should Christians Use IVF?

Darrell: 

Welcome to The Table. We discuss issues of God and culture. I'm Darrell Bock, Executive Director at the Hendricks Center at Dallas Theological Seminary, and you have landed at The Table. We discuss issues of God and culture. And today our topic is the ethics that surround and the topic of in vitro fertilization, IVF. I've told someone today, if you can't live with initials in our modern world, you're in real trouble. And we have three guests today. I'm going to let them introduce themselves and then we'll dive in. Scott Rae, who, I guess we'll do this at the very, very start, he and I have known each other since we were five years old. So we go back further than we care to remember. Let's just put it that way. And so, Scott, welcome to the table. We're glad you could be with us. 

Scott: 

Thank you. 

Darrell: 

And then the other person by Zoom is Jeff Barrows, who I didn't give your position. I'm going to let you do that later. I'll go through and go around. And then Christina Crenshaw is here on my right. She's an associate at the center, formerly taught at Baylor University. So with that in mind, I'm going to ask the question I normally ask that leads off a podcast, and how did nice people like you get into a gig like this? And Jeff, I think I'll start with you since you're the doc in the room. 

Jeff: 

Well, I guess the short answer is I answered an email, but the long answer is that I serve as a Senior Vice President for Bioethics and Public Policy at the Christian Medical and Dental Associations. I've been in that role now about two and a half years. Prior to my life in CMDA, I was an OB/GYN practicing in a relatively rural area of Ohio, northwest of Columbus. I did practice infertility, did not practice IVF well, not trained on IVF, but did do a fair amount of infertility in my practice. So I think that probably helped get me to the table here today as well. 

Darrell: 

Well, thanks Jeff and Scott, give us your background, how you got into this. 

Scott: 

Yeah, I've been on the faculty, Professor of Christian Ethics at Talbot School of Theology, Biola University for 34 years, have a ThM from Dallas Seminary, and then a PhD in ethics from the University of Southern California. And I spent about 15 years as a hospital ethics consultant for a variety of both non-profit and for-profit healthcare systems here in Southern California. 

Darrell: 

Right. And Christina? 

Christina: 

Yeah, so my PhD is in education and woefully prepared me for this IVF conversation, but I do have personal experience with the IVF journey, so that is what brings me to The Table today 

Darrell: 

Today. All right. Well, thank y'all. First of all, I'll give you great thanks for giving us of your time and expertise as we do this. I'm going to start with the doc since he said he was an OB/GYN and that is, so you're there in rural Ohio, just practicing your medicine and trying to apply the oath that you swore as a doctor. And you said you sometimes work with infertility. Tell us about that and why this leads into the other discussion. 

Jeff: 

Well, infertility, unfortunately, is very common. And in fact, I think it's increasing in incidents. When I was practicing, the statistics that I would quote my patients would be that on average between 10% and 12% of couples would qualify as being infertile. And by the way, I'll give the definition of that. That usually means a couple attempting to become pregnant over a 12-month period of time without success. If the woman, the wife is over the age of 35, sometimes we'd cut that down to six to nine months so that it wouldn't shorten it the time that she'd have to wait, but very common. 

So I would have patients that would come in and I would begin an infertility workup with them. And if I was successful in diagnosing, for instance, an ovulatory problem where they were not releasing an egg on a regular basis, I would begin treatment or some of the other types of problems in infertility that I could treat, I would do that. But then a lot of times there were instances where I could not find the problem using the usual infertility tests, and then I would send them down to typically Columbus where they would see an infertility specialist, not necessarily to jump right into IVF, but certainly IVF was and always is an option that would increase that couple's odds of being able to achieve pregnancy. So it was a relatively common thing that I dealt with when I was in full-time practice. 

Darrell: 

And how equipped did you feel like you were to go there as a doctor? I mean, is this something they did discuss in your medical school preparation or is this something… Sometimes in ministry we encounter stuff that we didn't do class on, so how did they help prepare you for what it is you were facing? 

Jeff: 

My training was solely in the science of infertility. And in fact, I did my residency in OB/GYN in the early eighties, and the first in vitro baby born in the United States was 1981. So I was being trained right as in vitro was coming into being. And so it was clear it was going to become fairly widespread across the country as it did. But in terms of the ethics on surrounding infertility and especially surrounding IVF, I had absolutely no training until I went into my master's program at Trinity in the Center for Bioethics and Human Dignity. And I have to make a confession up front, my thinking was far too utilitarian and not enough Christian until I went through that program. And it changed a lot of the ways that I now think about IVF. 

Darrell: 

Okay. So we go from the doc to the ethics theologian. He shows up in your program, I mean it's not your program, but theoretically, it's in your program. And what kinds of questions are you thinking about the go beyond the kind of question that is, well, we're a couple and we seem to be unable to have a child. 

Scott: 

Well, first of all, we want to acknowledge that, and I'm sure Jeff would agree with this too, there's much more than a medical side involved here. There's a pretty significant spiritual and emotional side to this. And Christina and you can speak to that too, I'm sure. But the reason I got into this was that basically my wife and I were in the middle of a four to five year period of infertility ourselves about the same time that I started studying this. And I soon discovered that in this field, what I study had a way of following me home. And it certainly did in this case. 

I started studying this about the time that IVF was maybe 10 years old. And that the stuff of these surrogacy arrangements that often used IVF, that's the stuff of TV miniseries. And it was about that time that my wife and I began our own very painful journey. What we discovered quickly is that for people who hadn't been down this road, it was really easy for them to seriously underestimate the degree and intensity of pain that was felt by infertile couples. We went to our church. Our church did virtually nothing on Mother's Day or Father's Day to commemorate people for whom those are two of the worst days of the year. So there's a pretty significant pastoral and spiritual side that I would want to address to first and foremost before going into the ethical issues. 

Darrell: 

Okay, that's great to raise because it's with a lot of areas, there's what you believe and what you think about it, but how you actually relate to people is a pretty important part of the equation. 

Scott: 

Well, and I think to the degree that you have pastors and church leaders listening here, I challenge them to think really hard about all of the couples for whom Mother's Day and Father's Day are just terrible days for a variety of reasons, infertility being one of those. And so at least to acknowledge that, I think has a chance to bring some people in to the ministry of the church that might otherwise stay home on those days. I know my wife and I stayed home from church on those days regularly during that time period. 

Darrell: 

Interesting. And obviously the other side of that equation is the people who go through miscarriage and what that's represented for them as well, so that's a good word to open up with, Scott. Let me ask you secondly then, when I think about my own training, which predated in vitro, but still even afterwards thinking about the kinds of things that I would hear about in pastoral settings and that kind of thing, there wasn't very much help coming from the theological side on this that I can recall. 

Scott: 

Well, we at Talbot do have a course on this that almost all of our students are required to take. And I tell them right at the very beginning, my goal for this is for the people in your church to call you instead of me when they face some of these issues. And my job is to equip you to deal with this at the level of a local church because these folks, you walk through life with them, you are far better equipped relationally to deal with them than anybody coming in from the outside. 

Darrell: 

Okay. So that's the pastoral side. The next level of questions is what are some of the ethical issues that we need to consider? And we're going to loop back and talk about those down the road, but I just want to get them out on the table before I talk to Christina. 

Scott: 

Well, I think there are a handful of things that you need to wrestle with. One is probably the most basic one and that is there anything unethical or unbiblical about conception taking place outside the womb? And I think this is the objection that I think most of our Catholic brothers and sisters raise. Well, we'll get into the resolutions in a minute. That's one. Second is the standard of practice in IVF is to harvest as many eggs as possible, fertilize as many as possible, plant two, maybe three at most, and then freeze and save the rest for later use. But if you hit the jackpot on the first try, you may have eight, 10 embryos, children left over in storage. And so the disposition of those embryos, what to do with those is another significant ethical issue. 

A third one has to do again with IVF being maybe too successful and you may have all the embryos that are implanted actually form successful pregnancies and then clinics will usually offer the option of some sort of selective termination at that point. Fourth ethical issue has to do with freezing embryos per se, regardless of things like attrition rate and success rate and thawing them out. Is it morally justifiable to freeze a human person in any case? Because I think most people would say we wouldn't do that to our two-year-old regardless of the reasons. And if we consider embryos, fetuses and two year olds persons, but on just a different place of maturity, then I think some of the same ethical issues apply to embryos as they would to fetuses in two year olds. 

Darrell: 

So they're actually behind all those questions. It strikes me, there's a premise that's pretty important and that is when conception begins and when is a person, a person? 

Scott: 

Well I think for one, I scripture's pretty clear on this in the first place, but I think this is something actually that science can tell us. I think you have a living human being from the point of conception that's a separate entity genetically and biologically from the mother. I think we ought to distinguish between the fetus being a part of the woman's body and being dependent on the woman's body. Those are two different things. The fetus is not a part of the woman's body. It's a genetically distinct entity that is housed there and dependent on the woman's body. But it's different fundamentally than being a kidney or a liver or a piece of tissue. 

Darrell: 

Okay, that's helpful. And like I said, I think that's an underlying premise behind all the other questions that you've asked that's actually pretty important. So we'll rotate. We'll come back to that because that's the starting point for all the conversations ethically, it seems to me. So Christina, after that wonderful brief exposition of the ethical challenges, we come to the whole personal side of the story, et cetera. So I'll let you fill that. Let's talk about some of the things that we've already raised, how personal this is and how this works at a human level. 

Christina: 

Yeah. And Scott, thank you for sharing a little bit of your journey. I think that that gives it more of credibility and clout that you are studying something that you have personally, you and your wife, have wrestled with. And I would say that bioethics is not something that I was particularly interested in my late twenties, but by the nature of struggling with infertility, I was thrust into a lot of these conversations. And to summarize my story and journey, I would start by saying to anybody who's listening, who's going into pastoral ministry and encounters a couple who are struggling with infertility, to know that this is not usually anyone's first choice, that people typically find themselves at the doorstep of fertility treatment by way of trying all other methods of conception. 

So for us, it was a four year journey, similar to Scott's. We ended up having to go out of town. Waco, Texas didn't really have a robust clinic for the sort of treatment. And we did IVF and it was a very rigorous, expensive process. That's another ethic we could get into, that this typically costs anywhere from $20,000 to $30,000 to do a round of infertility treatment. We had prayed about adoption, we went through adoption training and we realized that our window for fertility was very short, that adoption window is as much whiter and broader. We did a round of IVF and we harvested five embryos, which I think given the ethics of that IRB and that ethics committee at the hospital was a respectable number. Part of what happens behind the scenes that you don't really have control over is how many they decide are viable. And so a lot of prayer went into that as well. We implanted two, which is standard if you are under 30, particularly if you're under 35. And we ended up conceiving, but then we miscarried, which was heartbreaking. 

So we had three that were frozen. At that time, I was finishing a PhD program and I had landed a tenure track job in California. My husband landed a position doing mergers and acquisitions in California, and we knew we were leaving, but we had these three frozen, so I won't say the name of the hospital, but we had to go before the ethics committee and we begged, can we please implant three because we don't want to just implant two and come back for one? And transferring from the embryos is a whole nother industry and facet that you have to consider to the IVF process. So they gave us permission to implant three and only one took, and that was our firstborn. 

And I remember the doctor saying, "You have unexplained infertility. We can find nothing wrong with your husband. We can find nothing wrong with you, but based on the four years that you've been trying and the three rounds of IUI and the two rounds of IVF, we give you less than a 1% chance of ever being able to conceive on your own." So we, again, started the adoption process after that. And this is a different conversation, but I just want to say as a place of a miracle and praise, we did end up conceiving my second more naturally after that. So I want to give anybody listening, not a false sense of hope, but that just because you are infertile so to speak, doesn't mean that you will always be in fertile. 

Darrell: 

Interesting. So I'm going to go back to the doc, Dr. Jeff. In what you heard is sounds like what you heard on the one hand and secondly, how prepared are most doctors for what you are hearing? 

Jeff: 

Well, I assume you're going to want me to answer in terms of OB/GYNs that are dealing with infertility patients? 

Darrell: 

Well, let me start elsewhere first because OB/GYN probably has more likelihood of coming across this and being prepared for it than other doctors. So let's say you're in your normal internist or general practitioner doctor who you might see for a physical or something like that. How prepared do you think they are for something like this? 

Jeff: 

They're not going to be very prepared to talk in depth about not only the science and the workup, they would just assume refer to someone in their network in terms of the workup. But even to answer the ethical questions that Scott raised, very unlikely that they'll be able to do that and have really thought much about it frankly. And so even family physicians, I think most that are not doing it directly have probably not thought in detail and depth about what are the ethics. And many of them frankly will probably have differing views on when life begins and differing views of what I call the sanctity of the body, which is really what Scott got to. And the fact that God designed our bodies where fertilization would occur inside the woman. 

And the other ethical issue that Scott didn't raise that I think also needs to be brought up and that is the use of gametes outside of the marriage. Do you use a donor sperm? In surrogacy, you might use donor eggs. Is that ethical? And I would say that's far beyond the average, not only the average physician that doesn't deal with infertility, but it was not something I thought about as an OB/GYN, as I said, until I got into the bioethics degree at Trinity. 

Darrell: 

That was embedded in the surrogacy that he raised as he went through the questions. And that actually was something I saved in my cache to come back to. So I'm glad you raised it. 

Scott: 

Yeah, comment on one thing that Jeff said. Raising the issue of egg and sperm donors I think is right. That's another significant ethical issue that doesn't affect every couple, but it does affect quite a few, especially if the woman is a bit older. She will often get really strong suggestions to have an egg donor because, for example, I consulted with a couple two weeks ago where the woman's 46 and they're on their second round of IVF and the physician basically wouldn't do IVF unless they were willing to have an egg donor be a part of it. 

But I think it's true that physicians, they're just not trained in some of the ethical issues with this. And I think it's interesting, Jeff, you had mentioned you defaulted to a utilitarian position on a lot of these things in your practice. And the couples do that too because most of the couples that I've talked to, a lot of times they're just not open to any kind of ethical discussion that would put constraints on their likelihood of having a baby. I mean, their goal is to get out of this thing with a healthy baby and they'll deal with the ethics later or not at all. 

Christina, you had mentioned the financial stuff, they're willing to take out second and third mortgages on their homes and to do all sorts of, in my view, financially irresponsible things simply to achieve the goal of getting a baby. 

Darrell: 

So Jeff, I'm back to you. So we've put several levels of doctor under the bus. What about the gynecologist? 

Jeff: 

The OB/GYN 

Darrell: 

OB/GYN. 

Jeff: 

Yeah. I think that I was fairly representative even as a devoted Christian. I mentioned earlier before we got on that I was preaching at churches. When I wasn't on call on the weekend, I was preaching. And so I was studying a lot of scripture, but the whole concept of IVF I had in my mind separated out and I hadn't asked the difficult questions. And really the coming down to is this the right thing to do? I mean, that's the essence of ethics is science says this is possible. Ethics tries to answer yes, it's possible, but should you do it? 

And I hadn't really answered that even as, I would say, a very committed Christian OB/GYN until I got into my bioethics degree and was forced to really start thinking about it. And by the way, it's interesting because in my class at Trinity, we had an IVF specialist who came in and he was doing IVF without thinking about it as well. And through the course of his studies in our classes, he came to realize I have been doing something that is unbiblical and I have to hand it to him. He stopped practicing IVF in the middle of taking this degree. So I don't think it's common even committed Christian physicians to think in depth on this issue until they're forced to ask these questions. 

Darrell: 

Interesting. So Christina, I'm going to come to you next and ask it this way. And that is, how much did you give thought to these ethical questions that we're beginning to raise and that are on the table for us to be thinking about? 

Christina: 

I would say that I give a great deal of thought given what I had resources to think about because we did this process 10 years ago and this was in the throws of Octomom. Your listeners can Google if they're not familiar with her, but I think she's pretty mainstream. People know that reference. There was a TV show, John and Kate Plus Eight and they had their, I think, sixtuplets through IVF. And I did my research, I'm a pretty research-oriented person by nature. 

Darrell: 

I know that. That's true. 

Christina: 

So I was actually seeking medical journals, which is probably not the typical response, but because I was a doctoral student and I had access to medical journals, I started researching the first successful IVF baby was done in England. And then as I think it was Scott who relayed America two years after that. And so I knew that I was about the same age as the only successful IVF babies. And so I gave it a great deal of thought. I think the way I'm wired, I remember rereading Mary Shelley's Frankenstein and really wrestling with the Lord, when does life begin and what is an interference in creation? But I think what was helpful for us and the older we've gotten, my husband and I, and the more we've matured spiritually, the more we've surrounded the contextual conversation with some ethics. 

But the big rocks for us were what do we believe about conception? What do we believe about using our own bodies versus a surrogate that was not a road that we had to cross and what do we believe about human flourishing? And so we came to a conclusion that if we believed in implanting all of the embryos that belonged to his sperm and my egg, that we were enhancing our fertility journey more than we were interfering with the Lord's plan or will. And so I think that every situation has more nuance or different situations would have more nuance in that we didn't have to use any donor eggs or sperm, we didn't use a surrogate. I think those raise, as we've discussed, an entirely different set of ethics when we're bringing in a third party to the marriage. 

But I would highly suggest anybody in the throes of infertility or anybody who is pastoring a couple or discipling a couple through medical infertility to ask the couple to come up with the big rocks, look at scripture, look at the whole of what we believe about life and to not compromise on those convictions that you're feeling the Lord is speaking to you. That was helpful for us. 

Darrell: 

Okay. Well, I appreciate you sharing that. Scott, so now I'm going to you and how many people did you meet who were couples who gave as much thought to that as is Christina and her husband apparently gave to this? Is that exceptional or unusual? 

Scott: 

It's pretty rare. 

Darrell: 

Okay. 

Scott: 

Most of them don't give serious thought to it until after the fact. And by that time, the proverbial horse is out of the barn and in some cases it's too late to make the kinds of decisions that they should have made beforehand. 

Darrell: 

So that's actually raising a good pastoral point. So let's pause there for a second. What can be the fallout, let me say it that way, what can be the fallout of the pursuit of this that someone may or may not have considered before they stepped into it? 

Scott: 

I'll give you an example that may illustrate this pretty well. We have very close friends who they tried and tried unsuccessfully, had IVF done and conceived with triplets. And they figured at that point their childbearing days were over. And especially because she developed lupus after that, which her physicians told her then further pregnancies were a pretty bad idea, but they had five embryos left in storage. And so they came to me and just said, "What do we do with these?" Because they hadn't thought about that beforehand. I said, "Well, you have a handful of options, most of which are not good ones. One, is that you can discard them, which is the moral equivalent of aborting fetuses. You can allow them to die naturally, which is unethical to do if it's possible to save them. You can donate them to another infertile couple, which I think is morally acceptable." But as my friend put it, he said, I don't like the idea of my progeny running around the area without my knowledge. 

And so really the only option that they had available was to keep them in storage indefinitely. And I think that's what they chose to do, which all that does is kick the can down the road and force them to make a decision later. The only one of those options I think is acceptable is to put them up for adoption to another infertile couple. In the last 10, 15 years, embryo adoption has become a thing that's actually a viable option. And for couples who are considering a sperm or egg donor, and I think Christina, you're right about your hesitation to bring a third party into the matrix of marriage for procreation purposes. I always suggest that they adopt embryos instead because they get a lot of what they value out of natural procreation, which is the experience of being pregnant, giving birth, the bonding with the mother. There's no break in the relationship at birth when the child's handed off to someone else and that's not a knock on traditional adoption, but it does have some differences that I think are to the benefit of both the parents and the child. 

Darrell: 

So for clarity, when you adopt an embryo, what does that actually mean? 

Scott: 

Well, I would encourage your listeners, if you Google the Snowflake program. Christina, you're nodding your head, you're familiar with that? That's the largest embryo adoption agency in the world. They facilitated more than 400 or 500 of these in the last 20 years. And essentially, you take possession of embryos that another couple had left over and had left frozen. And you implant to however many is safe to do or however many children you want to have, although that's not always in your control and you implant them and then you formally adopt the children and go through all the same legal arrangements that you would in a traditional adoption. 

Darrell: 

It's just earlier in the process basically? 

Scott: 

Much. 

Christina: 

And a lot less expensive I would add too than going through the entire IVF process. But Scott, you could probably talk to this more than I could, aren't there a significant amount of frozen embryos available for adoption? Because that is part of the ethical dilemma as well. 

Scott: 

Yes it is. It's a good point. The demand exceeds the available supply. And the reason for that is because most couples don't designate their embryos for donation. Well, in fact, most couples who have embryos left over in IVF have this profound ambivalence about what to do with them. Because they know that the embryos, especially if they've had children successfully, they know that there's a big continuity between the embryos in the lab and those bouncing children that they're holding in their arms. But they also say, "Well, this is just cells that you have to look under a microscope to see." And there's something counterintuitive about calling embryos persons, even though I think they are. So most couples choose to simply keep them in storage indefinitely, which just shifts the ethical decision from the couple to the clinic about what to do with all these. Last count, they're probably close to a million frozen embryos in infertility clinics around the country. 

Jeff: 

I think that's right, Scott. They're about a million the last I read. And the estimates are that about 15% of those are really now getting into the category of being unclaimed. A lot of the infertility clinics, I've had these customers stop paying for the annual fee for the freezing and the clinics are struggling what to do with these. And that's really where I'm glad to see that some of these clinics are setting themselves up as donation clinics. So they'll take and do all the legal work to accept the embryo as a donation that then later can be put into an infertile couple. 

Darrell: 

I don't know who answers this question. It's a technical question. And that is, I'm going to use probably a crass illustration to ask it. And that, is there an expiration date on this? Is there good until 6/28 or something like that? 

Christina: 

I have heard about 20 years. But I will let somebody with a medical degree answer that. 

Jeff: 

I don't think anybody knows, nobody knows. There are embryos that have been frozen for 20 and 30 years and there have been live babies that have come out of those frozen embryos. So I don't think we have an answer to that. I was just going to say part of it depends. The freezing technique has changed as well over the last decade, especially. And the initial 20 to 30 years, they were using a slow freezing technique that had a mortality of about 20% to 30%. But in the last 10 years, they have perfected in a better way. I'm still opposed to it. I want to make that clear. But they use a fast freezing technique that's also associated with a process called vitrification that dries out the embryo. And so the mortality is actually less than 5%. And so that process has only been in use, as I said, for the last five to 10 years. And who knows how long those embryos will remain viable in that frozen state. 

Darrell: 

Scott, I think I heard you trying to comment. Go ahead. 

Scott: 

The longest time span that I'm aware of for a successful live birth from a frozen embryo is 13 years. Christina, you mentioned 20 years, that's probably the upper limit, I would say. 

Darrell: 

Okay, so this is the other side of the conversation in some ways. You've got all these embryos that are frozen, unclaimed sitting around, and if they've gone 20 years, I dare say they're likely to be sitting around. I mean, the idea that someone's going to claim them 20 years afterwards, not great. So that's another dimension to the question. I haven't been keeping count of how many questions this raises, but I think I'm on my second hand if I can say it that way. And so there are a lot of questions that are associated with this. We've got about 10 minutes left and our time is flying. So let's dive into the ethical parts of this. I've almost heard in the midst of the exchange that we're having that people tend not to think about the ethical dimensions of what's going on here. I'll just ask that as a simple question to start off with and then we'll go from there. So fair, most people don't think about the ethical dimensions of what's going on here? 

Jeff: 

I think that's true. 

Scott: 

I think that's fair. And I think most of their physicians have not thought seriously about it either. 

Darrell: 

Okay. That's fair. So let's assume… Now you gave a list at the start, Scott and I'm going to put a little bit of onus on you, but then you know I do this on a regular basis because of our friendship. So I see that little gleam in his eye. Here it comes again. Anyway, I owe you. You're right. Okay. We'll take care of that conversation first. So let's go through the list of questions that you raised and give us some help on how to think about each one of these in a pricey kind of way. 

Scott: 

Okay. First one was, is there anything intrinsically unethical about conception taking place outside the body? I don't believe there is. I view infertility as a result of the general entrance of sin into the world. It's not the way God intended, and therefore it's an appropriate area for medicine to be involved in. And even though IVF doesn't really treat anything, it's an end run around a problem, there's lots of medicine that's an end run around problems too, things like dialysis. It doesn't treat anything, it just is an end run around kidney disease. So I don't think there's anything immoral about that, as long as you follow certain guidelines, which are no throwing away embryos. 

In fact, I would often encourage couples to limit the number of embryos that they create. And there are clinics that do this with things like what they call minimal stimulation IVF, which limits the number of eggs that the woman produces. I'm also aware of clinics that will do IVF one egg at a time, which guarantees you won't have leftover embryos. It may also guarantee that you don't have any pregnancies either, so that's a risk too. But I think it's on the couple to adhere to the principle that every embryo you create in the lab deserves an opportunity to be implanted. 

Darrell: 

So is there a way to do that in such a way that you say, "I'm going to preserve five embryos and if we conceive after the first two, the other three are available for adoption," is that how you do that? 

Scott: 

That's one way. The other way is just to limit the number of eggs that you would have harvested from the woman so that in your best estimate, you're not going to have any leftover. That's a bit more of a crapshoot. 

Christina: 

I think, Scott, what you're saying is that a couple should go in not planning on doing embryo adoption, but implanting all of the eggs that are created. 

Scott: 

That's the better option. 

Speaker 1: 

Okay. So the other would be a fallback option to prevent embryos from being left over. 

Scott: 

Right. 

Speaker 1: 

Okay. So that's question one. Let's keep going. 

Scott: 

So second one had to do with selective termination of pregnancies, that can be avoided just by the decision that you make. You just never implant more embryos than a woman can safely carry. And so that one is easy to avoid. Third one has to do, I think, with freezing embryos. Jeff, I'm encouraged to hear the new technology has significantly decreased the mortality rate on those. I'm not thrilled about freezing embryos per se, even if the mortality rate is real low. I suppose one way to think about that is that the reason, and I'll defer to your judgment on this, correct me if I'm wrong on this, but the reason that embryos don't thaw out successfully, I've heard this from our own OB, usually is because there's some sort of genetic abnormality in the embryo that would highly likely cause it to miscarry once it's implanted. 

Jeff: 

I think it raises the odds that there is a genetic/chromosomal problem. I agree. 

Scott: 

But not a sure thing. 

Jeff: 

Correct. 

Scott: 

Darrell, just to be honest, I'm ambivalent about that one. The standard of practice is that every egg gets fertilized, every embryo gets frozen. And whether they're viable or not is that is often a physician's judgment. I'm not quite sure what that's based on, but I don't think that has anything to do with the obligation to implant every embryo that's created in the lab. The other ethical issue has to do with the use of third party donors. And I think the scripture tilts for skeptically against that because bringing third parties into the matrix of marriage for procreation purposes, I think is a big problem biblically and theologically. 

Darrell: 

I call it the Abraham solution. Go ahead. 

Scott: 

Well, because yeah, the Abraham solution was the old fashioned way. 

Darrell: 

Exactly right. 

Scott: 

Which some of the early cases of surrogacy were done the old fashioned way too. 

Darrell: 

Right. 

Scott: 

But I think that's a problem that I would encourage couples not to consider that. Does that cover them all? 

Darrell: 

I think that covered the ones we were… Of course, the other premise that we raised at the beginning that we probably do need to come back to is the premise that's underneath all this, which is that when you have an established embryo, and I want to tackle this scientifically and theologically, because I think this is a very important question for a whole lot of reasons, even beyond in vitro fertilization. And that is that all the potentiality for life exists from the moment that you get an embryo. Most people debate that, but that's true both scientifically, as well as being a theological view. Now am I right about that? I'm going to ask Jeff first. Is that the right way to see the science? 

Jeff: 

Exactly. In fact, if you ask embryologists, regardless of their faith, lack thereof or whatever, about 98% of embryologists, people who study the embryo as their life mission, will say life begins at fertilization. 

Darrell: 

And that's because all the potentiality for life is already residing in the embryo. Isn't that the basis for that judgment or is that a way… That may be a poor way to state it, but is that- 

Jeff: 

I would say it's partly that, but more that this is a genetically unique individual. The genetic makeup of that embryo is different than any other individual in the universe. And so that's a unique individual. The only caveat to this is that it's possible for an embryo to divide, you get identical twinning, that throws a mess into all of that. But aside from that, that embryo is a unique individual genetically and has the capacity to grow and develop into, now I don't want to say into a human being, but as a human being from that point forward. 

Scott: 

The way I'd put it is the embryo matures into a fetus, which matures into a newborn, which matures into a two-year-old and so on. 

Darrell: 

The point that I'm making is everything that you needed to get to what everyone sees as life is already there in the sense of the material necessary to produce life. 

Scott: 

I'd put it like this, that from the moment conception is complete, the embryo has all the capacities it needs to mature into a full grown adult. 

Darrell: 

Yeah. Okay, so that's actually important. To me, that's the fundamental conversation in all this is you ask the question, life doesn't begin when it looks like life as we know it now, life begins much earlier than that, if I can say it that way. 

Christina: 

Yeah. And I think to Jeff's point, most embryologists don't disagree on that. 

Jeff: 

No they don't. 

Christina: 

It would undermine their entire field of medicine if they did. I think where the ethical dilemma is usually found is the wrestling on how then do we treat these embryos as potential human life for human flourishing. 

Darrell: 

Yeah. I know when I came across this, I'm on the board at Wheaton and we were in the midst of deciding what as a school we would cover as board of trustees, what we would cover in terms of medical care and medical treatment. And we ended up being, I don't remember the technical legal term, but we ended up being a supporter of another suit that was being made that was asking the same question from another school. And in the midst of doing the research for that as board members, we came across this embryological definition of life as a way of thinking about morning after pills and that kind of thing. 

And I found myself going, well, this is something I hadn't thought about before, not really, not from a scientific point of view for sure. So I knew theologically the idea that conception starts at birth, but the science behind it, I had no idea about. And it really does, I think, it makes a difference in thinking about the question. So the distinction you made earlier on, Scott, between, what was it? It's not a part of a body, I don't remember exactly. 

Scott: 

Not part of the woman's body, but it's dependent on the woman's body. 

Darrell: 

That distinction is really an important distinction to be thinking about. Well, that seems artificial, but then I remind people we have children who are born on the other side of birth who are very dependent on their parents for their survival. 

Scott: 

That's correct. 

Darrell: 

Okay. And we don't blink about that. So I think that's the point of the distinction. 

Scott: 

Right, because after birth, the child is only just minusculey less dependent on the mother than before. 

Darrell: 

Right, exactly. 

Scott: 

It's just in a different location. 

Darrell: 

So I think all of this is important as we think about it. Believe it or not, our time is gone. So I want to thank you all for taking the time to discuss it. I think we've covered this as an initial foray into the space reasonably well. Certainly it's raised questions, some of which I hadn't even thought about before, so this has been informative to me. So I appreciate that very much. I'm assuming be informative to the audience and I just want to thank each of you for taking the time for being a part of this today. 

Jeff, thank you very much for giving us a doctor's perspective. 

Jeff: 

My pleasure. 

Darrell: 

And Scott for the ethicist/theologian/been there, done that perspective. 

Scott: 

Something like that. 

Darrell: 

And Christina, for the same been there, done that perspective and in a thoughtful way, which is a really appreciative. One of the things I think Christina's remark shows is it's possible to be thoughtful about this as you go through it, which I think is an important point to be making. So thank you all very much and thank you for being a part of The Table. We hope you'll join us again soon. If you're interested in other podcasts that we do, you can see them at voice.dts.edu/tablepodcast. And we hope you'll join us again soon.