Wednesday, August 6, 2008

Q&A: "Why didn't we 'just' do IVF?"

I've hesitated answering this question more than I already have because it's so delicate and it's my heart's sincere desire to avoid offending my beloved sisters in Christ, many of whom read this blog and many of whom have made the opposite decision.

But the question is repeatedly asked, so I'm going to attempt to answer it here, treading as lightly as I know how. These were conclusions we made for our family. I do think they were the most ethical choices in our world view, but I also freely admit that I don't hold a monopoly on understanding the will of God and I recognize His power and capacity to work and lead differently in other people. That's all I can really say without sounding either judgmental about others' decisions or weak-minded about my own.

I also wanted to explain my decision because I don't want there to be any misunderstanding about my opinion of people who do IVF or the babies born from it. I cannot explain how or why God would give other parents peace about a decision and me uneasiness about it, but I believe that He can, and I have to trust the sincerity of their faith and decision making when they say that He did. I don't understand it, but I can't question the veracity of their faith, either. And regardless of any method of conception, a child is never evil and is loved completely by the God in Heaven who created her. God knows that we wouldn't have our own precious children if not for the decision another family made to pursue IVF.

I've known for as long as I've understood IVF that it was never a choice I could make. The primary reason was the high number of embryos that are created in most IVF procedures. I knew that much, I made up my mind, and that was that.

Until last fall. When our first test results with DH came back, I was really caught off guard. I reevaluated everything I thought about fertility, medical intervention, family size, and the will of God.

I learned that it's possible to do IVF wherein you instruct the doctor to limit the number of eggs harvested, limit the number fertilized, and transfer all successful fertilizations. I believe this is the most life-affirming way to do IVF.

When we learned that, it really caused me to pause and seriously consider the procedure for us. At this point, my DH strongly wanted to pursue this option. We read literature, talked to other IVF mommies, and went to talk to my doctor, whose opinion I value.

My question for myself, for God, and for the experts I encountered was, "if we do IVF with these constraints, what then are the ethical considerations?" I wrestled with this for a long time. The added dimension was wanting to please my DH, who at that point fiercely wanted a biological child. (That loss was not as significant for me, though others were).

What I did know is that I wanted our minds made up and our lines in the sand drawn before we heard the final prognosis and what our options would be. I didn't want to end up in the position of making a decision based on the emotions born out of ultimatums and desperation.

We decided that we would pursue methods that restored our bodies to proper function (as we'd already been doing for 3 years with my PCOS) and methods that would help deliver things to the proper places (thus we would have considered IUI, and GIFT) but our boundary was actually artificially creating life through fertilization. We also chose to refrain from any procedures that would involve a third party for conception (Donor Egg, Donor In.semination, Surrogate). We didn't feel comfortable introducing that in to our marriage.

But beyond that, the conclusion I, and eventually, on his own, my DH (praise God for harmony!) came to specifically about IVF was that even under all of those constraints, there was a certain Agency executed by us in IVF that created a risk to the embryos that was additional to the risks inherent in spontaneous conception. The embryos are created but there's still only a fair chance that they'll actually implant after the transfer. Our position was that we would be creating these little lives without giving them a realistic chance for survival. We felt in that a culpability that we could not feel peace about.

Some people come to the conclusion that embryos are exposed to the same risk when they're created the good old fashioned way, in spontaneous conception after s.ex. We wrestled with that too, and believe me, it was very tempting to adopt that position. In the end we decided that in spontaneous conception, aside from good health and prenatal care, there is nothing the human can do to prevent or aid the embryo in actually implanting and growing to term. We felt that in IVF, by inserting ourselves artificially in to the creation of life process, we were taking on a moral responsibility for these little lives. Without very good, practically guaranteed odds, we just weren't comfortable with that risk.

Now, had the doctors told us that the odds of survival for an IVF embryo were exactly the same or better than the odds for a spontaneously conceived embryo, I can say it's very likely that we would have made a different decision, or at least strongly considered it.

But the rubber met the road that day in the doctor's office in January when the doctor said "Your only choice for a biological child is IVF." We had so much peace and courage about looking him directly back and saying definitively that we would not be pursuing that option. I don't know if I would have had that same resolution if we'd not already made up our minds, because the temptation for a biological child was strong.

Now, some people ask how EA is different. In our opinion, our Agency in Embryo Adoption has changed, and therefore has our moral responsibility. These little lives already exist. We were not Agents of their Creation, but we will be Agents for their Survival. Somebody must be. Their very existence demands that someone choose to fight for them. Now I must be clear here that we chose this route of great love for these children and a great desire to have them, and not out of some social campaign. But just as with traditionally conceived children in need of adoption after birth, someone must make that choice for them. So in our minds, there is a clear distinction between our opinions about the nature of their conception, and their worth as human beings and our (global) responsibility for them.

Here are a few questions from blog commenters--sorry it's taken me some time to respond.

How will you present these issues to your children. In essence, they will only exist because another couple made what is - to you and your family - an unethical choice.

It is true that they will have been born because someone else made a choice different than we would have made. But our children were always wanted. They were wanted by us and they were wanted so much by their GPs that they DID make the choice to do IVF. The teaching point for our children is that from even before they were born, there were two sets of parents who wanted them with their whole hearts and souls and in fact, God used our position against IVF to bring them TO us.

Me again. Have continued thinking about this. Guess it is no different than the case of an adopted child who was born out of wedlock to a single mom and then put up for adoption. The Christian adoptive parents will necessarily teach that out of wedlock sex is a sin, but they are glad nonetheless that it happened (??) because that bad act brought them their beautiful child.

I guess that's a good analogy. However I'll make the blanket statement that I don't think the nature of a child's conception has any bearing on that child's worth. Planned-for children born from consensual married s.ex are no more valuable or precious than children born from unplanned pregnancies, from unmarried s.ex, from, or from artificial technology (which is not to compare or liken any of those things with each other). So I guess the take-home thought is that LOTS of us (myself included--the child of then unmarried teenaged parents) were conceived in "less than ideal" circumstances and we have equal worth.

I guess what I would say to my kids is that God used less than ideal circumstances (for I'm sure any IF woman out there would prefer having a body that works correctly and conceiving the good old fashioned way too), to bring them to us. And I'd say that I hope that they all always have the opportunity to have as many children as they like, the good old fashioned way, with their spouses. And if something else happens instead, we'll love them through that too.

When we looked at EA we were instantly uncomfortable. I think the main reason for me was that it seemed as I read some of the specific families who were looking for a family for their embryos many of their embryos were created out of wedlock. A donor sperm or egg that went to a married couple. We didn't feel comfortable with this so we are choosing to go a different route for additional children.

Wow, that's really interesting. We didn't really consider that factor exactly, but we did pause to think about whether or not we would accept a match using donor gametes. In the end we decided that the situation was the same--these were still precious little lives, in need of homes. We did pray for a match with a family whose embryos were 100% biologically theirs, primarily because we wanted to have as much historical information about the embryos as possible from a medical, genetic and genealogical standpoint, for the children's own future sake, and God honored that request.

But I can definitely see how you would be uneasy with donor gamete created embryos! I'm so glad God gave you such peace about your decision and that you have your beautiful DD!

If you are interested and/or if you have the time could you post about your views on IVF? Or point me toward a resource you might recommend? My husband and I (during our two years of IF and considering alternatives--including EA-- but God opened the womb in His time, instead) decided against it, but never could come up with any really concrete Scriptural reasons. A good Christian friend is now 12 weeks with their 2nd IVF (the first resulted in an early m/c). I would love to hear what you have to say on the topic.

Because these technologies did not exist then, it's difficult to find explicit teaching in the scriptures. Therefore I think where we are left is to take what we DO know and what it is explicit on and infer from there. I think God is explicit about his view of the sanctity of human life. He declared humans as "very good," the only time He used that superlative when describing His creation. He pronounced then and there a greater degree of pleasure with His Creation of humans than with any other of His creations. We are also the only of His Creation created in His image. By nature of the fact that we reflect and partake in the Divine, we are valuable and indisposable.

Jeremiah tells us that even before we were formed in the womb, we were known and loved by our Creator. That tells me that our worth is not dependent on viability or birth but is inherent from the very earliest moments of our creation.

Biology and science tell me that life begins with fertilization. From the moment the egg and sperm unite, the resulting creation is fully human in species, and is wholly complete in essential makeup within 24 hours when the DNA aligns and activates. At no point during pregnancy does the embryo or fetus change qualitatively. It grows larger, but it is in essence, the same being that it was when it was conceived. Since we know it is a life when it is born, I maintain that it was always a life from its creation, and didn't morph in to one at some point in the pregnancy. The ontological change was from non-existence to existence. I don't believe another one happens later on that would take it from existing but not alive to existing and alive.

Because that being is therefore a human life, I believe it is our obligation to protect it. We are told to "do justly and to love mercy, and to walk humbly with [our] God." I think it is just and merciful to defend an innocent, helpless life that cannot protect itself. We are told to Love God with all our heart, soul and mind. Augustine says something to the effect of "love God, then do as you please." I believe I am loving and honoring Him when I ascribe value to the Tiniest of his Creations and then act accordingly.

For us, choosing to refrain from IVF was the way we could find to best do these things and live according to these principles, as regards fertility treatments.

One resource I recommend for Christians at any point in their IF journey is The Infertility Companion. I reviewed the book in greater depth here. They do a great job of outlining all of the various IF treatments, from medications and therapies, to ARTs. They examine the positives and the negatives, and ask though provoking questions and provide a good evaluation rubric without actually making the decisions for you. It was a tremendously helpful resource to us. It is like an encyclopedia--you can read just the sections pertinent or interesting to you and they will still make sense without having read the whole book.

As I said, I don't presume to have the authority on God's will for ARTs, and it's possible that we're even wrong about His will for us. We think we've been obedient and that we are pursuing the path He has laid for us. I appreciate hearing the the stories of those convicted or led in other directions. In one regard, we all think we're right because why would we believe or behave according to principles we thought were false? But at the end of the day, I also know we are all sinners, at the mercy of the Lord Jesus. All each of us can do is to Love Him and surrender to Him, and then act accordingly.