IVF debates often overlook critical question

Tennessee Right to Life doesn’t usually take a position on legislation addressing in vitro fertilization or contraception. But not taking a position has become harder and harder since the Alabama Supreme Court in 2024 ruled that parents could sue over the destruction of their frozen embryos under the state’s Wrongful Death of a Minor Act.

“It’s been important for me … to explain to legislators that while we do not take a position on IVF, we are fundamentally opposed to the unnecessary destruction of fertilized embryos which we all … would agree are human life,” Will Brewer, director of government relations for Tennessee Right to Life, told WORLD last month. At the time, the legislature had just begun debating a measure to codify a right to “engage in activities associated with fertility treatment and contraception.”

Several days later, Tennessee Right to Life came out against the bill. Brewer told me the group decided to oppose it after the sponsor refused to consider amending it to clarify doctors can be held responsible for the intentional destruction of human embryos.

In the past seven weeks, bills codifying access to assisted reproductive technologies such as in vitro fertilization have breezed through legislatures in two red states. Georgia lawmakers passed a bill clarifying that nothing in state law prohibits IVF. It received only one no vote in the Senate. The Tennessee Senate passed the Tennessee bill unanimously in March. On Thursday, after 40 minutes of debate, the state House agreed 54 to 37 to send it to the governor’s desk.

During Thursday’s debate, none of the House representatives who spoke against the bill opposed IVF wholesale. Their objections focused on the bill’s failure to limit the destruction and genetic testing of embryos—objections that pro-life groups share. But Christian voters divided over IVF have other questions that even many conservative lawmakers appear to have moved past: Is there an ethical way to do in vitro fertilization? Or is the technology always wrong because of the embryo loss inherent to the process?

The debate in Tennessee

The Tennessee bill specifically includes the freezing and genetic testing of embryos among the activities protected in the new right to pursue fertility treatments. Some groups have warned such language could lead to an unrestricted IVF industry that operates at the expense of tiny human lives, and some of the Tennessee lawmakers Thursday echoed those concerns.

Republican Rep. Chris Todd objected that the bill “would make genetic testing—which is used to weed out embryos that might have some disability—it makes that a right.”

Rep. Gino Bulso, also a Republican, called the bill extreme. “It creates a statutory right for anyone to create and destroy human embryos without any limitation,” he said. Bulso proposed an amendment that would have clarified that Tennessee “has a compelling interest in the protection of the life of an unborn child … at every stage from fertilization until birth.”

But he didn’t object to the process of IVF itself. So, when fellow Republican Rep. Johnny Garrett argued Bulso’s amendment would stymie IVF providers, Bulso disagreed.

“There’s some suggestion that there’s an inconsistency between having laws that recognize a human embryo as a child, as a person, on the one hand, and having laws that allow artificial reproductive technologies like in vitro fertilization on the other hand,” Bulso said in response. “It simply is not true.”

Bulso and Todd were among the 37 Republicans who voted against the bill. Eight more were present but did not vote.

Republican Rep. Sabi Kumar had no concern with the industry employees’ handling of embryos. “They do try to preserve these embryos and avoid the creation of embryos that are extra,” Kumar said on the House floor Thursday. “The obligation to keep that number of embryos to a minimum does exist, and I think most of the people, all the people working in this field, are very aware of it.”

A conscientious approach

That sort of conscientious approach to the creation of human embryos is not what Dr. John Gordon, a Christian IVF provider in Tennessee, has heard from many of his colleagues and patients. “I see so many patients who’ve asked their doctor, ‘Hey, I just don’t want to fertilize every egg. Can we limit how many eggs we fertilize?’” he said. “And they’re told, ‘No, you can’t.’”

Before Gordon moved to Knoxville, Tenn., he co-owned a practice in the Washington, D.C., area. He began to have ethical concerns about discarding unused and unwanted embryos and proposed that the clinic limit the number of eggs it would fertilize and stop providing donor sperm, donor eggs, and gestational surrogacy. “I was told … ‘You’re just a religious nutjob,’” he said.

Unlike many IVF providers, Gordon’s current practice at Rejoice Fertility in Knoxville fits Rep. Kumar’s description. Rejoice Fertility offers natural cycle and what’s called “mini-stim” IVF, protocols that involve using less of the fertility medications used to stimulate egg production. While a standard IVF cycle aims to retrieve as many as six to 15 mature eggs, “mini-stim” IVF targets two to five, according to Rejoice’s website. Natural cycle usually yields one mature egg, since it relies on the female body’s natural process of ovulation.

Rejoice does not discard unused embryos and makes clear to patients that if they abandon their embryos, the clinic will donate them to other families. Gordon said many of his patients—largely conservative and Christian—wonder why a clinic would practice any other way since they see embryos as babies.

While Gordon said other IVF practitioners tell him that none of their patients are concerned about producing too many embryos, he said 95% of his patients—including some who come from out of state—use either natural cycle or “mini-stim” IVF. Many of them are concerned about ending up with more embryos than they can realistically give a chance at birth. Others don’t want to freeze any embryos.

For some, the conscientious approach that Gordon takes towards embryos is enough to mitigate any ethical concerns they have about IVF technology.

“I find it very hard to see that a God that would give us all of these medical breakthroughs would say it’s wrong [for] somebody that wants life so badly as what I do, and a lot of other women… to have IVF,” said Sheila Brannan, a mother of two IVF-conceived children in the D.C. area. When Brannan was growing up, her father told her that he prayed every night that she would get married and have children. He died before Brannan married her husband in 2017, though by then it seemed like God was answering her father’s prayers with a yes. But Brannan was already in her late 30s when they married, and she quickly realized that their attempts at becoming pregnant were not working. She and her husband turned to IVF.

Brannan and her husband did not limit the number of eggs the clinic fertilized. But they intended to give each one that continued to grow a chance at birth—regardless of the embryo’s gender or any genetic abnormalities. Using testing to weed out undesirable embryos, Brannan believes, is wrong.

The IVF cycle that resulted in her oldest daughter produced seven eggs. The cycle that resulted in her youngest daughter produced five. “God would not give us five eggs to fertilize if he didn’t want us to at least attempt to try to inseminate all five,” she said of the second cycle. “I believe that as long as we bring God into the entire process and listen to him, I think that the ethical issues go away at that point.”

Inherent embryo loss

Brannan, Gordon, and the Tennessee legislators who spoke out against the state’s bill all espouse views of IVF and of the resulting embryos that are more conscientious than most of the country—and most of the Tennessee legislature, for that matter.

But even these careful approaches to IVF cannot eliminate the embryo loss inherent to the process. On average, anywhere from 50-70% of IVF-inseminated eggs stop growing in the days following successful fertilization, before they are ready for transfer into the woman’s uterus. Some Christians consider those to be natural losses, while others say the people involved in the IVF process are morally responsible for them.

In Brannan’s case, the two cycles that resulted in her daughters each resulted in only one embryo that continued to grow to the point that the clinic could transfer it into Brannan’s womb. The rest stopped growing.

“Even to this day, I cry for them,” Brannan said. “Those embryos, to me, are life, and if they didn’t grow or whatever the case may be, they still mean something to God and to me.”

But she doesn’t see the IVF process as responsible for these losses. God, she said, has a hand in this outcome just as much as he does in the rest of life. “I don’t think that they are a victim of IVF,” Brannan said. “I just believe that that’s God’s plan.”

Gordon holds a similar view. He maintains that anyone who intentionally discards an embryo from a freezer, for instance, has killed that embryo. But the ones who stop growing on their own are different. “Just because an egg fertilizes and doesn’t continue to grow … I don’t think that counts as embryos that are destroyed or lives that are lost through IVF,” Gordon said. “It happens in nature, too.”

He sees those losses as comparable to the naturally conceived embryos that fail to implant or miscarry early on. Gordon pointed to a 1990 study that suggests the arrested development of embryos conceived naturally—also called “in vivo”—is comparable to those conceived in a lab. Even inside a woman’s body, embryos stop growing in the days following fertilization or fail to implant, resulting in miscarriages that she’ll likely never know about. Other times, a positive pregnancy test shows an embryo implanted in the uterine lining, but subsequent bleeding indicates a miscarriage.

“I’m not saying that we don’t have a lot of moral problems in our field,” Gordon said. But he doesn’t see IVF-conceived embryos that stop growing on their own as one of them.

Moral responsibility

Since 2023, Jon Speed has spent a couple of hours a week standing outside of IVF clinics in Texas. He tries to talk to couples who come for appointments and convince them to avoid the reproductive technology. Frequently, he said, people will raise arguments similar to Gordon’s, arguing that the embryo losses in IVF are comparable to those of natural reproduction.

But Speed disagrees. “My contention is that when a couple pays a doctor, signs paperwork … and knowingly creates human lives … they are morally responsible for those lives that they create intentionally,” he said. Even the embryos that die naturally following fertilization he considers to be victims of the IVF process, “since they would not exist apart from IVF.”

Patience Sunne, engagement director at Them Before Us, argues that the conditions in IVF labs automatically put embryos at a disadvantage, exposing them to additional risks that they would not face in the womb. “Every embryo created in a woman’s body has a chance at implantation,” she said. “An embryo created in a lab only has that chance if it survives the process long enough to be transferred.”

Sunne pointed to a 2015 paper outlining the chemical and physical stressors on embryos in IVF labs. Atmospheric oxygen levels, light, temperature, and the presence of perfumes and deodorants in the lab can all negatively affect growing embryos. Even the act of pipetting—necessary in order to handle the microscopic embryos—can also put physical stress on embryos when done too vigorously or too frequently.

Dr. Petra Wale, president of the Fertility Society of Australia and New Zealand and one of the paper’s coauthors, told WORLD that IVF labs have improved significantly over the years to the point that labs do a pretty good job of replicating the conditions in the female body with the help of technology including environment-controlled isolettes and incubators. Technology, she said, is only continuing to improve. But Wale noted there’s still a lot the industry doesn’t know about intrauterine conditions. “We know that it’s just no comparison between in vivo and in vitro,” Wale said.

When an embryo stops growing in an IVF lab, “there’s really no way of knowing if that particular embryo was exposed to unnecessary stress and that’s what was the contributing factor,” Wale said. But she emphasized that the condition of the eggs is a major contributor to embryo loss.

Excluding natural cycle IVF, the process typically involves using hormones to stimulate the production of more than the one egg normally produced when a woman ovulates. “Some of those eggs are potentially substandard to start with,” Wale said. “IVF brings along a large cohort of eggs, some of which probably would never have even gotten there in the first place. And then when they do become embryos, it’s not surprising that they aren’t able to continue to develop.”

Wale doesn’t see these realities as an ethical concern, but to people like Matthew Lee Anderson, an ethics professor and IVF critic at Baylor University, those involved in IVF have a heightened responsibility for the outcome of embryonic lives that people who conceive naturally do not have.

IVF clients and providers “know that … some number of embryos are going to be dead at the end of this process,” he said. “The couple who is procreating through ordinary means doesn’t know whether any one of the embryos that they conceive will miscarry. They’re just in total ignorance.” Anderson notes that any improvements to the technology of IVF have come at the expense of countless embryos, often using research that involves embryo loss.

But he also posed a larger question: Should the discussions of the morality of IVF be focused solely on the moral status of embryos and what happens to them in the process? “The moral status of making human life is very much intertwined with the separation of sex and conception intrinsically,” Anderson said. “I think that we need to think about whether or not it’s right and appropriate to separate those two things, regardless of whether any embryos are killed in the process.”

But Gordon noted that the Bible doesn’t speak specifically to IVF. “If it goes against your conscience, then anything that goes against your conscience is considered to be sin, so then you shouldn’t do it,” he said, referencing Romans 14. “I would say, for every believer, he has to decide, wrestling with their own conscience as to what they are called to do.”