Some brief Christian reflections to mark the birth of 5 million children by IVF

Over 5 million children have been born through IVF. The figure comes from a study, the first of its kind, into IVF statistics from countries around the world.

According to Bioedge, Researchers scoured government archives for information about how many women had used the procedure since its introduction and estimated that 900,000 children had been born after IVF in China alone.

Of all children in the world born by IVF, an astounding one-third of these children have been born in the past six years.

A lot of this has to do with increased success rates. IVF has enabled babies to be born to couples who would not otherwise have been able to conceive.

But on the other hand IVF has also opened what many regard as a Pandora ’s Box of genetic engineering, cloning, pre-implantation diagnosis, embryonic stem cell harvest and animal-human hybrids. 

The demand has also been fuelled by the rising levels of infertility which are exacerbated both by sexually transmitted disease (leading to tubal damage) and women delaying attempting to have children until such time as their natural fertility starts to drop off. Women wrongly assume that IVF is a good fallback solution when in fact the success rates are 40-50% for the under-35s, dropping to 20% for the under-40s and just 5% for women aged up to 43.

There are over two million infertile couples in the UK (one in seven) and infertility can carry real stigma. Infertility can result from defects in the production, release or transport of egg or sperm and successful treatment depends on accurate diagnosis. The range of treatments and their speed of development is bewildering, and not all couples need IVF: other common treatments include artificial insemination (AI), intracytoplasmic sperm injection (ICSI) and gamete intra-fallopian transfer (GIFT).

In IVF (in vitro fertilisation), sperm and eggs are brought together in a petri dish, and resulting embryos are then transferred into the womb. There is a high failure rate (75-85% per cycle overall) and the treatment costs of £2,500 per cycle will exhaust the resources of many of the couples who are unable to get NHS treatment. As highlighted just last week a couple is likely to have spent something of the order of £15,000 for the three cycles it is likely to have taken should they be fortunate enough to become pregnant. IVF heartbreak is real.

The emotional roller coaster of raised hope and dashed expectation is another important cost to be counted; but I believe the most important decisions Christians need to make involve honouring embryonic life and upholding the marriage bond. We should not seek a child at any cost (Romans 3:8).

Some IVF programmes involve the production of spare embryos, which are then used for research, disposed of, or frozen for future use. Freezing compromises embryo survival and there is a high chance that frozen embryos will never be used. Other programmes involve screening out embryos or fetuses with congenital disease either before implantation or later in pregnancy.

Our society thinks that because human embryos are small, weak and physically insignificant they are expendable. But this is at odds with the God’s loving grace, which sees even the weakest of human beings as precious, and worthy of wonder, love, respect and protection.

The other key question to consider is whether the use of donated eggs or sperm somehow violates the marriage relationship. Clearly using donor gametes does not involve sex outside marriage nor the cheating nor lust aspects of an adulterous relationship.

But marriage is a spiritual, emotional and physical union in which two become one and donor eggs or sperm inevitably introduce a third person that will be genetically related to the child, but play no part in their upbringing. And the child will be biologically related only to one, or perhaps neither of his or her parents.

So my own guidance is that prospective parents considering IVF should carefully count the economic and emotional cost and seek treatments that both respect the human embryo and also honour the marriage bond.

Some infertile Christian couples will go on to conceive, either naturally or with ethical infertility treatment, after a period of waiting. But this does not happen for all, and God in his wisdom has left some couples childless despite good treatment and patient prayer. 

Perhaps this is to ensure that there are couples with a strong desire to be parents, who can either adopt children, serve others’ children in some way or be freed up for some other special purpose which God has for them.

These comments are based on a longer article in Nucleus, which can be accessed here

Those wanting a more in depth review of the issues can’t do much better than Fertility and Faith by Brendan McCarthy (IVP, 1997, ISBN: 0851111807)

The Evangelical Alliance Home for Good campaign on adoption and fostering is well worth supporting. 

See also 'A new IVF milestone' by Philippa Taylor

IVF for gay couples financed by the tax payer is actually the next logical step

The Telegraph this morning reports that more gay couples and women over the age of 40 are to be given fertility treatment on the NHS, despite claims that the health service cannot afford it (See BBC report here)

According to the Telegraph, under an expansion of NHS-funded fertility treatment, the National Institute for Health and Clinical Excellence (NICE) will recommend that lesbian couples be offered six cycles of artificial insemination and, if that fails, IVF.

There were just over 1,000 cycles of insemination performed for women in same-sex relationships in 2010, resulting in 152 babies. The number of cycles of IVF for this group rose from under 100 in 2009 to 561 in 2010, resulting in 215 babies. Most of these couples however paid for treatment privately, where a cycle of IVF can cost them £8,000.

Given that the NHS is having to find £20 billion of efficiency savings over four years because flat-rate budget increases are not enough to cope with increasing demand, this means that local clinical commissioning groups, which make the final decision on fertility provision in hospitals, will be unable to afford the extra treatment without making drastic cuts to other services.

Does it strike you as odd that in a time of economic recession NICE is recommending that our tax money through the National Health Service, pays for a lesbian woman, who is suffering from no illness, is not infertile and wants to become pregnant but does not wish to have sex with a man, to have artificial insemination or IVF?

This latest move has, perhaps understandably, generated a lot of controversy, but in fact is the next logical step following from presuppositions that we have already accepted as a society.

Having turned our backs on the Judeo-Christian worldview and ethical framework, decisions in healthcare are increasingly now taking place in an ethical vacuum where the principle drivers are autonomy, technology, commerce and relativism.

Autonomy says ‘we want it’. Technology says ‘we can do it’. Commerce says ‘there are purchasers and providers’ and relativism says ‘why not?’

The Human Fertilisation and Embryology Act 1990 started from two ethical presuppositions.

First there was the assumption that human embryos are not human beings and so can be used as a means to an end – meaning that they can be experimented upon, frozen or destroyed.

Second was the belief that gametes (egg and sperm) need not be used only within the marriage bond but can be bought, sold, shared with and given to others.

If we combine these ethical starting points with the beliefs that marriage, gender and reproduction are simply arbitrary social constructs which can be reshaped and redefined by social consensus then human demand, economics and technology become the only limitations on what can be done in human reproduction.

Equality law will then ensure that everyone who wants a given technology, regardless of marital status, gender or even degree of infertility, must be treated equally.

If married women whose husbands are infertile can use donated sperm then why can’t single women or lesbians? If married women who can’t produce their own eggs (for whatever reason) can used donated eggs then why can’t single women or lesbians? Similarly why can’t gay men use both donated eggs and a surrogate to carry the baby? 

And if lesbian women, who are fertile, choose to use donated eggs and IVF, then what is to stop single and married women, who wish to avoid either sex or pregnancy from dong the same? And if married couples can have a certain ‘treatment’ funded by the taxpayer, isn’t it discriminatory to bar others, whether gay or straight?

As technology develops further, and egg and sperm can be artificially manufactured from ordinary body cells, it will be possible for lesbian couples to generate their own sperm and eggs and produce babies that are genetically related to their parents. And gay couples will be able to do the same with the help of a surrogate, or perhaps even transplanted, uterus. We should expect these extensions of practice now and not be surprised when they occur.

If these things alarm us, then rather than simply reacting to the latest developments we should be going back to examine the set of presuppositions that brought us to this point and examining those.

In this connection I have previously put forward a Christian framework for infertility treatment which I believe respects both the sanctity of human life and the integrity of the marriage bond.

But the other real questions we should be asking are about the real drivers of this new technology. 

Why are levels of infertility increasing so dramatically and why there are so few babies available to adopt? It's not rocket science.

Egg donation mania – probing beneath the journalistic hype

There are two stories about egg donation in the papers this week.

First is the HFEA’s drive to recruit sperm and egg donors. Apparently it is bringing together a National Donation Strategy Group to look at how to ‘raise awareness’.

The BBC gives an advertorial gloss to the story but the Daily Mail tells us that the payment to women donating their eggs for use in IVF has tripled from £250 to £750 this week and that the extra money on offer is said to have led to a five-fold increase in women approaching clinics to donate their eggs to infertile couples.

Under the change, egg donors will be given free treatment to retrieve the eggs plus a payment of £750 per cycle, no matter how many eggs are collected. Tempting during a recession and the question has to be asked, ‘how many of these women would choose not to take the risk if it were not for the money?’

It is noteworthy that the infertility industry in the United States has now grown to a multi-billion dollar business, its main commodity being human eggs. Young women all over the world are solicited by ads—via college campus bulletin boards, social media, online classifieds—offering up to $100,000 for their ‘donated’ eggs, to ‘help make someone’s dream come true.’

Second is the news that scientists in Edinburgh are intending to seek permission from the HFEA to fertilise eggs grown in a laboratory from stem cells. The tests are understood to be aimed at eventually generating an unlimited supply of human eggs that could assist women to have babies later in life.

Stories like these of course make alluring headlines and journalists reproducing uncritical press releases from those with vested interests seldom ask questions about the deeper ethical issues around egg donation – such as the health dangers of egg harvesting, the huge numbers of human embryos destroyed in the process of refining new techniques and the problem of children with confused identities and parentage as a result.

Even less do they ask the ‘elephant in the room’ question of why there is such a huge demand for donated eggs in the first place, but it is precisely that which I want to shed some light on.

The primary problems driving egg donation are the rising incidence of infertility and the huge decrease in babies available for adoption.

Infertility is the most common reason for women aged 20–45 to see their GP, after pregnancy itself. It is estimated to affect around one in six or one in seven UK couples – approximately 3.5 million people – at some point.

Around 1.5% of all births and 1.8% of all babies born in the UK are the result of IVF and donor insemination and 45,264 women had IVF treatment in 2010. These women had 57,652 cycles of treatment, an increase of 5.9% on the previous year. There were 12,714 babies born in 2009 as a result of IVF treatment using women’s own fresh eggs.

There are of course many different treatments for infertility depending on the cause and only a small percentage of these use donated eggs but there were 1,506 treatment cycles with donated eggs in 2010 - and 593 children were born from donated eggs in 2009.

The latest figures (2009) show that 25.2% of IVF treatments using a woman's own fresh eggs resulted in a live birth but infertility in women is strongly linked to age.

The biggest decrease in fertility begins during the mid thirties. For women who are 35, 95% will get pregnant after three years of having regular unprotected sex. For women who are 38 the equivalent figure is 75%.

The following figures give the average success rate for IVF and ICSI treatment using a woman’s own fresh eggs in the UK in 2009.

•32.3% for women under 35
•27.2% for women aged 35-37
•19.2% for women aged 38-39
•12.7% for women aged 40-42
•5.1% for women aged 43-44
•1.5% for women aged 45+

Add to that the fact that women are delaying childbirth and having babies later and later and we see why there is such a high demand for IVF and donor eggs. In England and Wales, the average age at first birth was around 24 during the 1960s, compared with around 28 in 2009 (see graph of maternal age at birth in 2010).

Along with the increase in infertility there are fewer and fewer babies for adoption for two main reasons – abortion (which kills babies that might otherwise have been adopted) and state support for single parent families (which means that babies that would have previously been given up for adoption now are not).

There is currently only one baby adoption in the UK for every 2,235 abortions.

The new adoption tsar has tried so far unsuccessfully to promote adoption as an alternative to abortion but an in depth examination of UK adoption data reveals the following:

Total adoptions in England and Wales fell steadily from 22,502 in 1974 to 4,725 in 2009. Adoptions involving babies under one year fell from 5,172 in 1974 (23% of all adoptions) to just 91 in 2009 (2%). That is a huge reduction in baby adoption.

During the same period abortions on UK residents rose from 119,123 in 1974 to 203,444 in 2009.

The number of abortions on UK residents in 1968, the first full year after legalisation was 23,991. I can’t find an adoption number for that year but suspect it was considerably higher than 22,000.

There are also now three million children living in a single parent household (23% per cent of all dependent children).

Just over a quarter (26 per cent) of households with dependent children are single parent families, and there are 2 million single parents in Britain today. About half of these had their children outside marriage.

In 1971 just 8 per cent of families with children were single parent families but this had increased to 24 per cent by 1998 and 26 per cent by 2011.

So when you next read about egg donation, before jumping on the bandwagon and trumpeting it as a wonderful advance remember the deeper ethical issues (embryo destruction, health risks of harvesting, confused identities and commercial exploitation) and the societal changes (abortion, delayed childbirth and single parenthood) which have contributed to the demand.

Japanese stem cell sperm study opens Pandora’s box of unethical possibilities

Fertility experts are hailing a mouse study in which working sperm cells were created from stem cells as ‘hugely exciting’.

A Kyoto University team were able to turn stem cells into early sperm cells called primordial germ cells (PGCs).

When these were transplanted into infertile mice, the animal played ‘host’ as the stem cells developed into normal-looking sperm. These were then used to father healthy, and crucially fertile, pups, Cell journal reports.

Dr Allan Pacey, senior lecturer in Andrology at the University of Sheffield said that ‘this may one day lead to a clinical application whereby we could make sperm for infertile men’ although he added that ‘clearly more work needs to be done to refine this process’.

The Japanese team, led by Mitinori Saitou, used both embryonic stem cells (derived by destroying embryos) and induced pluripotent stem cells (created ethically from body cells) to produce the sperm precursors.

However, in keeping with the BBC’s obsession for hyping embryonic stem cell work, the latter are not mentioned in the BBC report but only by others.

However the researchers actually suggest that the same procedure could be carried out using stem cells derived from adult skin cells, a claim consistent with the results of other recent research.

Should we be welcoming this advance?

On the one hand it would be a significant breakthrough if the process could be refined to the degree that it could be used to help infertile men father their own biological children.

But in the wrong hands such technology might conceivably be employed to produce male sperm from female skin or female eggs from male skin.

This could open the way to two male or two female homosexuals having children who were biologically related to both of them (eg. two biological mothers), or to people knowingly (or unknowingly) having sperm or eggs derived from their skin, bone marrow or other tissue.

In other words people might be able to ‘donate’ eggs or sperm without donating real eggs or sperm or even knowing that they had done so. Or we could have reproduction without men, or without women, being required to contribute genetically.

As with many infertility treatments, an advance that might be used ethically to help a small group of people, also opens a Pandora’s box of other unethical possibilities.

Any research and therapies would need to be very highly regulated, but one cannot see that happening in Brave New Britain which already has amongst the laxest fertility laws in Europe and already accepts embryo experimentation, disposal and destruction and sperm/egg donation (all of which are unethical in my view).

The research to produce sperm from stem cells is still at a very early stage and there are still huge technical difficulties to overcome prior to it having any application in human reproduction. But it also raises huge ethical issues.

I can’t help thinking that, rather than embarking on yet more expensive highly technological solutions to childlessness, our key priorities should be to reduce abortion, promote adoption and prevent infertility.

The infertility crisis is in large part fuelled by the fact that there are very few babies available for adoption (primarily because of abortion) and rising levels of infertility (in large part because of sexually transmitted disease and women delaying having children).

Some brief Christian reflections on infertility treatments to mark Robert Edward’s receiving the Nobel Peace prize in medicine

The decision to award the Nobel prize in medicine to Robert Edwards(pictured), the British scientist who developed IVF, has met with a mixed reaction. On the one hand there have been 4 million babies born to couples who would not otherwise have been able to conceive. On the other IVF has opened what many regard as a Pandora ’s Box of genetic engineering, cloning, pre-implantation diagnosis, embryonic stem cell harvest and animal-human hybrids.

I’m not intending to comment on the appropriateness of Dr Edward’s award or weigh the perceived benefits of his research against its downside but rather to use the occasion for some brief Christian reflections on infertility treatments.

There are over two million infertile couples in the UK (one in eight). Infertility can result from defects in the production, release or transport of egg or sperm and successful treatment depends on accurate diagnosis. The range of treatments and their speed of development is bewildering, and not all couples need IVF: other common treatments include artificial insemination (AI), intracytoplasmic sperm injection (ICSI) and gamete intra-fallopian transfer (GIFT).

In IVF (in vitro fertilisation), sperm and eggs are brought together in a petri dish, and resulting embryos are then transferred into the womb. There is a high failure rate (75-85% per cycle) and the treatment costs of £2,500 per cycle will exhaust the resources of many of the couples who are unable to get NHS treatment. The emotional roller coaster of raised hope and dashed expectation is another important cost to be counted; but I believe the most important decisions Christians need to make involve honouring embryonic life and upholding the marriage bond. We should not seek a child at any cost (Romans 3:8).

Some IVF programmes involve the production of spare embryos, which are then used for research, disposed of, or frozen for future use. Freezing compromises embryo survival and there is a high chance that frozen embryos will never be used. Other programmes involve screening out embryos or fetuses with congenital disease either before implantation or later in pregnancy. Our society thinks that because human embryos are small, weak and physically insignificant they are expendable. But this is at odds with the God’s loving grace, which sees even the weakest of human beings as precious, and worthy of wonder, love, respect and protection.

The other key question to consider is whether the use of donated eggs or sperm somehow violates the marriage relationship. Clearly using donor gametes does not involve sex outside marriage nor the cheating nor lust aspects of an adulterous relationship. But marriage is a spiritual, emotional and physical union in which two become one and donor eggs or sperm inevitably introduce a third person that will be genetically related to the child, but play no part in their upbringing. And the child will be biologically related only to one, or perhaps neither of his or her parents.

So my own guidance is that prospective parents considering IVF should carefully count the economic and emotional cost and seek treatments that both respect the human embryo and also honour the marriage bond.

Some infertile Christian couples will go on to conceive, either naturally or with ethical infertility treatment, after a period of waiting. But this does not happen for all, and God in his wisdom has left some couples childless despite good treatment and patient prayer. Perhaps this is to ensure that there are couples with a strong desire to be parents, who can either adopt children, serve others’ children in some way or be freed up for some other special purpose which God has for them.

These comments are based on a longer article in Nucleus, which can be accessed here

Those wanting a more in depth review of the issues can’t do much better than Fertility and Faith by Brendan McCarthy (IVP, 1997, ISBN: 0851111807)