I hope you and your spouse never need to know this, but the harsh reality is that some couples have great difficulty getting pregnant or carrying a baby to term. It can be a difficult journey, but reproductive technology may be the only option for a couple to conceive and deliver a healthy baby. It’s expensive, somewhat risky, and fraught with challenges. It’s also an emotional rollercoaster. 

When we talk about reproductive technology, we mean any artificial assistance with getting pregnant. It includes any procedure that handles sperm and eggs outside the body. There are two main reasons why reproductive technology is used: inability to get pregnant by conventional means (i.e. intercourse) and high risk of genetic abnormalities. 

In most cases, fertilization occurs in a lab, not inside the woman’s reproductive tract. However, implantation of the developing embryo must still occur in a healthy uterus for a pregnancy to be successful. After that, it’s up to the uterus and growing fetus to make it to term.

We’ll be brief in our discussion here, since the technology is always advancing and can be quite complicated. The invasiveness is highly variable, depending on the problem with conception that the couple is trying to overcome. We’ll start our discussion with the least invasive.

ARTIFICIAL INSEMINATION

Instead of intercourse putting sperm into the woman, artificial insemination puts it there with a syringe. The sperm is typically from a donor, used to overcome male infertility (abnormal or absent sperm). The donor sperm is injected into the vaginal canal (essentially the same result as intercourse) or directly into the uterus. 

IN VITRO FERTILIZATION (IVF)

In vivo is Latin for “in the living.” In vitro means “in glass.” During in vitro fertilization, the sperm and egg are combined in a lab. For this to happens, sperm and eggs must first be collected from the parents.

Sperm collection is usually easy. However, in the case of a man’s inability to produce enough healthy sperm, the sperm he does have can be pulled out directly from the testicle with a needle (a doctor will do this).

Egg retrieval is more complicated. The woman goes on hormonal medications to stimulate the ovaries to produce many eggs in a single cycle, not just one. Then, under the guidance of an ultrasound, a doctor will insert a needle into the ovaries and suck out the contents of each follicle, each of which should produce a viable egg.

As we discussed, fertilization occurs outside the female reproductive tract. Sometimes this is as simple as putting the sperm and egg together in the same container. If this doesn’t work, a sperm can be injected directly into an egg. 

After the sperm and egg combine, the embryo is allowed to grow for nearly a week before being transferred into a uterus. Many embryos are prepared in the lab, but only one or two are inserted into the uterus in any given cycle. Leading up to embryo transfer, the woman goes on hormones again to make her uterine lining as ready for pregnancy as possible. In the case of a woman with abnormalities in her uterus, a surrogate mother’s uterus may be used.

Ideally, the embryo implants in the uterine lining and a pregnancy occurs. However, after all that trouble, not all injected embryos successfully implant. IVF failure is common.

In vitro fertilization can help a couple overcome a number of barriers to fertility, such as abnormal sperm, problems with the fallopian tubes, and early menopause. 

CRYOPRESERVATION

This brings us to the issue of what to do with unused or unwanted products. Not all sperm and eggs harvested for reproductive technology get to produce an embryo. Similarly, not all embryos created in the lab get used either. A couple may become pregnant on their first attempt at IVF, or limited finances may prevent further attempts. As well, couples may want to save their embryos for a future date when they’re ready for another pregnancy, or perhaps donate them to other couples who cannot produce viable embryos on their own. Whatever the reason, labs often have extra “reproductive material” they need to store for prolonged periods.

It all gets frozen. 

In general, freezing these cells – whether eggs, sperm, or embryos – doesn’t increase birth defects or developmental abnormalities. They can be thawed and used without major issues at a later date.

However, ethics come into play when nobody wants the embryos anymore. If a couple’s beliefs dictate that personhood begins at fertilization, the prospect of discarding unused embryos can be upsetting. Likewise for donating them for research. For this reason, it’s important that every couple goes into the process of IVF with a clear understanding of what will happen with their unused embryos. 

CLONING

There are a lot of movies about cloning, where a person is made from the genetic material of a single parent. In 1996, a sheep named Dolly made history as the first successful clone of a large mammal. She had three mothers: one provided the egg, another the DNA, and a third carried the cloned embryo in her uterus.

Cloning works like this: an egg has its nucleus (with the half-set of DNA from the mother) removed, then a new nucleus from the parent cell is inserted. The parent nucleus originates neither from an egg nor a sperm, but has a full set of DNA, identical to that of the single parent. The egg, now with all the genetic material it needs, starts replicating and forms an embryo. It gets transferred into a uterus and after the pregnancy is complete, a clone is born.

Cloning is terribly inefficient and has many challenges. Dolly was the only successful lamb that survived to adulthood in 277 attempts. Granted, technology has advanced considerably since then, but the whole process is still tedious and risky.

Since Dolly, many other mammals have been cloned, including monkeys, which are genetically similar to humans. However, as far as we know, there is no definitive evidence that a human has ever been cloned. In fact, human cloning is illegal in many countries.

Dolly’s birth also opened the door for stem cell research, which is when cells are produced that have the ability to grow into any type of tissue. That’s essentially what embryos are – undifferentiated “anything” cells. Stem cell technology can potentially cure type 1 diabetes. Future development may allow for the treatment of heart disease, blindness, dementia, and cancer.

GENETIC SCREENING

Some couples are at high risk of producing children with genetic defects. Before implantation, embryos can be tested and selected for transfer based on their genetic profile. Unwanted embryos, with undesirable genetic profiles, are discarded. 

The ethics here can get murky here. Pre-implantation genetic screening opens up the possibility of having a “savior sibling.” If an existing child requires a bone marrow or organ donor, the parents can potentially select an embryo with a compatible genetic profile. After birth, this new child may have the means to save their diseased older sibling. There’s also the potential to select genetic traits unrelated to disease, such as gender and eye color. This leads to the prospect of “designer babies.” On the other hand, embryos can also be selected that have a disability, such as parents with dwarfism who intentionally want a child with the same condition. Furthermore, DNA within an embryo can be edited to modify its genetic makeup in virtually any way. This is generally prohibited by law, as gene editing may have unintentional consequences later on in development.

As you can see, genetic screening opens up a whole can of worms that many people, both in science and religion, are uncomfortable with. But is it morally wrong? Hard to say.

SUMMARY

Infertility is a heart-wrenching struggle for many couples. Many women (and their husbands) in the Bible suffered from infertility, including Sarah, Rebekah, Hannah, and Elizabeth. Rachel, the wife of Jacob, felt like she would die if she continued to suffer from barrenness (Gen 30:1). 

Her agony is not unique.

Advice on reproductive technology is beyond the scope of this book. Many couples have been able to parent their own biological children because of these advanced procedures, when a generation ago it would have been impossible. It’s far from a sure bet, but reproductive technology can at least provide an option to overcome infertility. Indeed, most couples who struggle with infertility will try just about anything to have children of their own.