written by Christopher Register
Evangelicals and other pro-life advocates have underappreciated reasons to support in vitro fertilization (IVF) and funding for maternal health and reproductive technologies in general.
These reasons stem from the surprisingly high rate of natural miscarriage. I suggest that advances in IVF technology may ultimately lead to fewer total embryos being miscarried or discarded than could be achieved without IVF. This fact should appeal to evangelicals or others who believe that a fertilized ovum has considerable intrinsic moral value.
Since the judicial overturn of Roe v. Wade in June of 2022, opposition to IVF in the U.S. has grown. Just last month, a prominent group of U.S. evangelicals, the Southern Baptist Convention, voted to condemn IVF, even advocating that the government ban the procedure. The central argument of this blog post is that they may be making a mistake, even on their own terms.
Embryo loss through IVF and miscarriage
To review the basics of IVF, it involves a human egg being fertilized outside the body. Over the next few days, the egg develops and divides until—having become a group of cells similar to the embryo depicted above—it is either frozen or implanted into someone’s uterus to continue gestating. Typically, the procedure produces about 5-10 embryos in total in case some are not viable, where the frozen embryos that go unused will ultimately be discarded.
For many evangelicals and other pro-life advocates, the main argument against IVF is the same or substantively similar to the argument traditionally levied against abortion: a fertilized human egg is a human being, a human person, or the morally weighty start of a human “life”, and therefore has the same or similar rights and worth as the rest of us.
Noting that IVF usually involves “discarding” the unused embryos, which then die, those who argue against IVF often assert that it is wrong to destroy or neglect human life, and that it is therefore wrong to create an embryo only later to discard it. For example, speaking in favor of the SBC resolution to condemn IVF, Monica Hall asks, “Most embryos created through IVF die at some point in the process. How could it be considered ethical to create human life knowing death is a probability?” Her answer is that it cannot.
It is understandable that, for people convinced of the value of even early human embryos, the discarding or destruction of such embryos as a part of the IVF process may be genuinely concerning. But, even accepting that concern, there is a surprising but largely unknown fact about human gestation that complicates the picture considerably: that there are many, many unnoticed miscarriages of pregnancy, resulting in the loss or “death” of a fertilized human egg.
Scientists and health professionals estimate that 20% to 80% of all pregnancies end in miscarriage, and the figure is often put at about 50% (for example, here). So, in the natural course of gestation, about half of all fertilized eggs do not survive. So, for every person you know, there was an embryo that was miscarried. As a consequence, if one accepts that a fertilized egg is a “human life” in some meaningful sense, miscarriage ends as many human lives as every other cause of death combined.*
How does this fact complicate the ethics of IVF? To begin, it shows that natural conception is disastrous for human embryos. If a high probability of premature death makes IVF ethically troublesome, then it can make attempts at natural conception problematic too. This is because there is no currently available mechanism for creating and gestating an embryo that doesn’t involve a rather high probability of premature death. If the probability argument–that it’s wrong to knowingly act in ways that have a good chance of bringing an embryo into existence that will soon die–were correct, then it might effectively require anti-natalism, roughly, the view that it is morally wrong to try to conceive and bear children.
Needless to say, such a controversial view is likely not one that pro-life conservatives would seriously entertain, much less accept. So let us put the prohibition from the ‘probability of (premature) death’ against embryo creation aside: perhaps the continuation of humanity is worth repeatedly putting embryos in perilous situations.
Still, the absence of a safe mechanism for creating human life doesn’t mean that a safe mechanism is impossible. And even if a completely safe mechanism is impossible, there may still be reason to pursue safer mechanisms—mechanisms of creating human life that reduce the probability of embryo death. Is a safer mechanism possible? I suspect that safer mechanisms will involve current or future IVF technology, along with improving maternal health in general.
How could IVF be safer than natural conception?
To be safer than natural conception, IVF must reduce net embryo loss. With current technology and practices, IVF almost always results in the loss of multiple embryos, and so it’s likely only a safer mechanism for a subset of the population—individuals who are likely to conceive more than about 5-10 times for each successful gestation. Given that many people try for years without a successful pregnancy, however, it’s not implausible that, even at the current level of technology, IVF is in some cases safer for embryos than technologically unassisted conception. (My own parents tried for about 4 years for me and then about 4 years for my sister.)
Unfortunately, data about rates of embryo loss per attempt at conception is hard to come by, so it’s difficult to estimate how often IVF is safer. Another practical problem is that it’s difficult to identify the relevant cases in advance. Even so, it’s plausible that, if IVF were prohibited and couples were forced to continue trying to conceive without the aid of reproductive technology, many people would lose more embryos than if IVF had been available to them.
If IVF technology can be improved in the future, the net benefits of IVF may be higher, expanding the proportion of cases in which it’s the safest available option. With increased funding for research into IVF and maternal health, more advanced IVF technology create fewer embryos, thereby ultimately reducing the loss of human embryos in the process. Just how this might work is complicated, as it depends on many factors to do with the genetics of sperm and egg, the health of human gametes, maternal health, and the process of IVF. As an example, I’ll consider just one factor and the potential net benefit that future IVF may provide over natural conception.
One way to reduce the number of embryo deaths in IVF involves chromosomal screening. Some estimates suggest that about 50% of natural embryo deaths stem from chromosomal abnormalities known as aneuploidies (having a number of chromosomes that isn’t 46). That amounts to roughly 75 million embryo deaths per year. For comparison, the next highest cause of death worldwide is heart disease, which killed about 30 million people in 2019. If aneuploidies could be addressed during IVF, then IVF could prevent many of these embryonic deaths.
To spell the argument out, then: at present a high proportion of embryo loss in IVF is likely due to aneuploidies, with a high proportion of aneuploidic embryos having an aneuploidy of meiotic origin (that is, at least one gamete did not have 23 chromosomes). The creation of these embryos could in principle be prevented by chromosomal screening prior to fertilization. If aneuploidies in IVF could be significantly reduced, then embryo loss during IVF could be reduced and (potentially) millions of embryo deaths could be prevented. This is simply not possible through natural conception. Thus, if non-aneuploidic (euploidic) embryo loss in IVF could be reduced to, say, 1 embryo per 3 successful gestations, then IVF would be safer than natural reproduction in general.
That is, of course, a very tall order, as it would require other significant reductions in embryo loss during IVF. But with enough investment in IVF research and technology, it may well be achievable. And according to the argument I am making here, this is something that pro-life advocates should therefore welcome and support, rather than oppose, as many currently claim to do.
Other strategies for reducing embryo death may involve other kinds of genetic screening of gametes, improvements to paternal and maternal health, and the development of treatments to facilitate healthy gestation. All that is to say: for those who profess concern about the longevity and eventual welfare of human embryos, there are serious reasons to support investment in reproductive health research and technologies, including IVF, and to avoid prohibiting IVF for those who need it the most.
Other considerations
So far, my discussion has focused on reasons that flow from concern for embryos, while I’ve ignored some other considerations. Most significant among these is the objection that while natural gestation only involves the unintended death (i.e., cessation of development) of embryos, IVF involves deliberately bringing embryos that will die into existence.
However, it’s not clear how morally significant the difference between the cases really is. With IVF, the loss of embryos is not intended, even if it’s foreseen. Just as with the perils of natural gestation, the loss of embryos during IVF is an unintended side-effect of an intention to bring a child into existence.
A second objection is that, unlike with natural gestation, we know that embryos will be lost during IVF. Yet, on further inspection, this difference also turns out to be subtle. Even if we don’t know that there will be embryo loss for each and every natural conception, we do know know that embryos will be lost during natural gestation considered in the aggregate and that it’s not unlikely for any given conception.
Ultimately, the moral weight of these subtle issues must ultimately be compared to the value of embryo loss—a value that I think many pro-life advocates feel is paramount.
Thanks to Nathan Nobis for helpful comments on this post.
*See Ord 2008 and Berg 2017 for arguments about how pro-life advocates should respond to the high rate of natural miscarriage; see Miller 2023 for a critical discussion of those arguments that nevertheless agrees with my numbers. Ord 2008 and Berg 2017 argue roughly that if early embryos matter in the way that developed human people matter, then we should do a great deal to prevent miscarriages such as by investing billions of dollars in research and health technology development. Against this conclusion, Colgrove 2021 argues that because miscarriages have a variety of causes and are therefore hard to prevent, the demand to prevent them is not especially strong. Colgrove’s argument does not address the feasibility of preventing embryo death via IVF.
Greatly enjoyed the blog. Here’s one thought (sorry about length):
Your central claim is that evangelicals who condemn IVF may be making a mistake “even on their own terms” (i.e. their own standpoint provides resources to *support* rather than oppose IVF). Your argument is basically this:
Evangelicals argue against IVF by saying stuff like: “Embryos are human lives in a morally weighty sense. IVF involves a high risk of embryo loss, and we know the risks going in, so doing IVF is knowingly running a high risk of morally-weighty-life-loss.” You point out that natural gestation also involves a high rate of embryo loss (miscarriages), say 50%. There’s no reason to think embryo loss during IVF is morally worse than during natural gestation; if anything, they’re morally equivalent (that is, equivalently morally tragic). So far, the evangelical argument against IVF is simply unpersuasive; we haven’t yet shown that their opposition to IVF is inconsistent with their own principles.
But then comes the kicker: if we invest in IVF research, we could potentially make it *safer* for embryos than natural gestation. You write: “If non-aneuploidic (euploidic) embryo loss in IVF could be reduced to, say, 1 embryo per 3 successful gestations, then IVF would be safer than natural reproduction in general. That is, of course, a very tall order… But with enough investment in IVF research and technology, it may well be achievable. According to the argument I am making here, this is something that pro-life advocates should therefore welcome and support, rather than oppose, as many currently claim to do.” In other words, natural gestation involves an embryo loss rate of 50%, whereas with more investment and research, IVF could potentially reduce that rate to 25%. A 25% embryo loss rate is morally preferable to a 50% loss rate. Therefore, evangelicals, if they really care about embryos, should support IVF investment and research.
This is clever. And I have no idea who Monica Hall is but based on the quote from her that you included, I assume she’d be stumped by your argument.
However, I would point out that you allude to two different evangelical arguments against IVF:
Argument 1: “IVF involves a high risk of miscarriage, and we know the risks going in, so doing IVF is knowingly running a high risk of miscarriage.”
Argument 2: “IVF involves creating and freezing extra embryos, and those that go unused will be discarded. So basically, IVF involves discarding lots of morally weighty lives.”
If you encounter an evangelical who espouses Argument 1, then you can refer them to this blog post, and if they’re open-minded maybe they’ll be persuaded that their own standpoint gives them reason to support IVF research.
But things won’t be so easy if you encounter an evangelical who espouses Argument 2. If embryos are human lives, and if IVF involves freezing 5-10 embryos, most of which will be discarded, then IVF involves intentionally creating and then discarding several lives. This isn’t the same as a miscarriage. A miscarriage is an unintended death (the embryo stops developing), whereas discarding a frozen embryo is just an intentional killing.
From here, there are two concerns this evangelical might have about proposals to “invest in IVF research in hopes of someday achieving a better-than-natural embryo loss rate,” depending on whether they’re a Kantian or a utilitarian. The utilitarian will just worry about the numbers. What are the odds that investment in IVF research really will eventually achieve a better-than-natural embryo loss rate? And how many embryos will be lost in the research process? The utilitarian could probably be reasoned with.
But the Kantian, probably not. The Kantian will say, “Currently, IVF requires creating and discarding extra embryos. Maybe in the future, IVF will improve to the point where we can stop doing that. But in the meantime, ‘investing in IVF’ means ‘killing many embryos for the sake of potentially saving many more future embryos’. As a Kantian, I object to intentionally ending some morally weighty lives for the sake of saving others.”
So, contrary to your thesis, the Kantian evangelical at least is not making a mistake “on their own terms” in opposing IVF.
Hi Luke, thank you for your engagement and your comment!
I agree that Argument 1 and Argument 2 are different and that anyone convinced that Argument 2 is stronger will also be more resistant to the points I make in this post. However, as I suggest at the end of the post, I think it’s too quick to claim that IVF involves an intentional killing. With current technology, it’s true that pursuing IVF involves pursuing a course of action where the actor knows that some embryos will die as a side-effect. That’s not the same as intentionally killing embryos. This general point is an application of the Doctrine of Double Effect, which is familiar from Catholic moral theology.
Considering the medical technician who discards the embryos, it’s also true that they intentionally let the embryo die. An argument could be made that this intentional ‘letting die’ amounts to an intentional killing, but it’s far from obvious.
As for the question of whether research is permissible from the perspective of a Kantian-minded evangelical, a few things can be said. One important datum is that research may still be permissibly performed on non-human embryos. (Ord 2008 makes a similar point.) Another point is that it’s not actually clear that Kantianism prohibits research on human embryos. Suppose someone is already pursuing IVF for the reason that they hope to bring a child into existence. It’s not obvious that the creation of embryos that will be discarded violates the categorical imperative, as it’s not clear that those embryos are being used as a means to an end. We can study and learn from this process already. But perhaps we can permissibly do more — maybe we can even do research on the embryos themselves. Does that involve using them *merely* as a means to an end? Does it involve disregarding their human dignity? Even setting aside the issue that they are not rational creatures and hence do not fall within the scope of Kant’s imperative, I’m not sure it involves disregard or using them merely as a menas to an end. I think, plausibly, one might also have their ends in mind, even if it isn’t ultimately possible to realize those ends.
There’s more to be said, of course! And I think this line of thought deserves more consideration from evangelicals and other like-minded pro-life advocates.
re letting die: imagine that an IVF provider creates 3 embryos, 2 of which are discarded in favour of the eugenically best one which is then implanted. The mother then gives birth to triplets, picks the eugenically best and then lets the other two die by withdrawing care.
How are these ethically different?
In fact, the former is worse precisely because the two discarded embryos could develop into more than two babies!
Hi Andy, thanks for your comment.
On the view under consideration, an embryo has the same moral worth as any other human being. The idea is that, under that assumption, natural conception turns out to very frequently involve the deaths of beings that matter as much as the two aborted triplets you mention. These embryos don’t matter more or less, but the same. Things become considerably more complicated if we allow that potential twinning is morally relevant, and it’s not clear whether the entities in that case should count once, twice, or not at all. (For example, it’s doubtful that a pre-twinning embryo already has two souls, since twinning could in theory be induced or halted.)
Given the assumption of equal moral worth, it seems like we should try to reduce the number of embryos that are lost. A promising way to reduce this number, for some people now and on average in the future, is to pursue IVF.