¹Reproductive Endocrinology and Infertility, Fort Bragg, North Carolina

Disclaimer: The views and information presented are those of the authors and do not represent the official position of the 82nd Airborne Division, Department of the Army, Department of War, or U.S. Government.

“Woe to those who call evil good and good evil, who put darkness for light and light for darkness, who put bitter for sweet and sweet for bitter!” (Isaiah 5:20, ESV).

“So Jesus said to the Jews who had believed him, ‘If you abide in my word, you are truly my disciples, and you will know the truth, and the truth will set you free’” (John 8:31-32, ESV).

The scientific method assumes the natural world is ordered and functions in an organized manner. Rigorous hypothesis testing yields scientific truth. As Christian scientists, we believe God is truth (John 14:6) and that God has created an ordered world (Genesis 1:1-3 and John 1:1-3). Christians must be committed to the truth, for we worship THE truth. This commitment to truth serves as the foundation for Christians as we navigate our world. Romans 1:18-32 should cause us all to fear and tremble. Our churches, our colleagues and our patients look to us, Christian healthcare professionals, for guidance and discernment on complex medical issues. This is a great responsibility, because one day we will stand before our Maker and give an accounting of our lives. Isaiah 5:20 serves as a warning, and John 8:31-32 serves as a guide.

Considering these foundational assumptions, I hope to present a reasoned argument for seven important truths that affect reproductive medicine. I borrow from an organizational approach used by my friend and colleague, Dr. John Gordon, in his recent article (DOI: 10.1016/1757cebe-c5af-462a-8edc-c90799e9cc13). I commend Dr. Gordon’s article to the reader as you contemplate the following seven claims:

1. Let’s be honest: children are good and necessary.

God’s first recorded commandment to humanity is “…‘Be fruitful and multiply and fill the earth and subdue it…’” (Genesis 1:28, ESV). Yet, from the Garden of Eden to the present day, humanity has rebelled against God’s design. In the modern era, many not only rebel against the natural order but also label their rebellion as progress! In the 1790s, Thomas Malthus posited what is known as the “Malthusian Catastrophe,” where overpopulation leads to suffering marked by war, famine and plague. Neo-Malthusian ideology influenced numerous feminists to advocate for widespread contraception and abortion (Feminism and Neo-Malthusianism | EHNE). Along similar lines, some totalitarian nations enacted forced sterility (e.g. Communist China’s One Child Policy). What is the result? China is facing a population collapse (China’s birth rate hits record low as population continues to shrink). Likewise, in the United States, the birth rate has fallen below replacement after widespread utilization of contraception and abortion (How have U.S. fertility and birth rates changed over time? | USAFacts). Population decline creates significant challenges for economies and national welfare systems like Medicare and Social Security that rely on a continued influx of new workers to remain solvent (Hannah’s Children by Catherine Pakuluk). Our society views children as an inconvenience to be avoided (or at least limited), but children are a great good and are necessary for a nation to thrive.

2. Let’s be honest: children are a gift, not a commodity.

“Behold, children are a heritage from the Lord; the fruit of the womb a reward” (Psalm 127:3, ESV).

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

—The Declaration of Independence.

Our nation, from its founding, recognized that people have certain rights granted by God. These rights are not derived from the government (which could then take them away), but rather, such rights are granted by God and therefore should be recognized by a just government. Each child is a gift: a unique human person with unalienable rights. This uniquely Judeo-Christian perspective forms the basis for all rights Americans possess because it informed our Founding Fathers’ understanding of the purpose of government—to protect the rights of the individual. Unfortunately, modern reproductive medicine views each child, at least before birth, as a commodity, managed under property law. The “Reproductive Justice Framework” proposed by the intersectional, feminist organization Sister Song was recently described in an article used in the 2026 maintenance of board certification for diplomates of the American Board of Obstetrics and Gynecology (DOI: 10.1097/AOG.0000000000005354). According to this ideology, rights are viewed through the lens of the intended parent(s), not the child. When children are rightly viewed as a gift, couples will welcome children as the blessings they are. When viewed as a commodity, adults routinely violate children’s foundational rights.

3. Let’s be honest: every child has a mother and a father.

When the American Society for Reproductive Medicine changed the definition of infertility in 2023, it intentionally moved away from a definition that recognized biological reality in favor of “a condition shaped by circumstance and access to reproductive resources” (From Guidance to Global Impact: How ASRM’s Updated Definition of Infertility Helped Shape Policy in Australia | ReproductiveFacts.org). Critics of this change rightly recognize that it “appears to be rooted in Western secular liberal ideals” rather than science, it “may lack multicultural sensitivity and inclusivity toward various diverse ethnic and religious communities” and it “will also be particularly problematic for medical professionals with strong religious beliefs and religiously affiliated medical institutions” (DOI: 10.1016/j.fertnstert.2023.12.019 ).

Perhaps the greatest problem with this new definition is that it further reinforces current practices in reproductive medicine (e.g. the use of “donor” gametes) that focus on the desire of adults with almost no consideration for the rights of the children that are produced. Every human child is the result of the successful fertilization of a human female’s egg by a human male’s sperm. Therefore, each child has a biological mother and father. Children have a natural right to their mother and father that should only be infringed in extreme cases (i.e. abuse or neglect of the child). Adult desires matter, but a just society does not infringe upon children’s rights to satisfy adult desires. Several find the reality of human reproduction inconvenient and inconsistent with Western secular liberal ideals; however, that reality exists nonetheless.

4. Let’s be honest: IVF can help some patients, but it cannot solve our impending population collapse.

The American Society for Reproductive Medicine recently celebrated 100,000 births from IVF in a single year (For the First Time, More Than 100,000 Babies Born Through IVF in the U.S. in a Single Year | American Society for Reproductive Medicine | ASRM). This is a remarkable achievement, and I celebrate several of the technological advances that make these births possible. However, while IVF can benefit some infertile couples, at a population level, our society must address the underlying issues driving what has been termed the “birth dearth.” Our population collapse is inevitable unless we acknowledge the reality that falling marriage rates, later age at first live birth and the widespread adoption of contraception and abortion have resulted in our current fertility crisis (Get Married: Why Americans Must Defy the Elites, Forge Strong Families, and Save Civilization by Brad Wilcox and Hannah’s Children by Catherine Pakuluk). A woman has her highest natural fecundability in her late teens and early 20s. Any serious attempts to address our impending population collapse will advocate for earlier marriage and earlier childbearing.

5. Let’s be honest: Restorative Reproductive Medicine (RRM) may benefit some patients; however, claims such as “success rates for RRM are similar to or better than IVF” (pdf) are inaccurate.

It is difficult to quantify the difference in efficacy between RRM and IVF, largely due to a paucity of data comparing the two treatment modalities; however, the point can be illustrated easily by comparing one aspect of “RRM” that I offer patients as part of my practice as a reproductive endocrinologist. Consider a “RRM” approach to a patient with endometriosis. There is good evidence that surgical resection may result in a live birth with a number needed to treat of 12 (Endometriosis and infertility: a committee opinion (2012) | American Society for Reproductive Medicine | ASRM). This means for every 12 women with endometriosis I operate on, I will have one patient who has a subsequent live birth because of the surgery. By contrast, a healthy 25-year-old woman with infertility due to endometriosis has a 51 percent predicted chance of a live birth from one IVF cycle (sartcorsonline.com/Predictor/PatientV2Input). Surgery may be appropriate for some patients, but it is disingenuous to assert surgery is more effective than IVF for such a patient. While I disagree with the widespread opposition toward RRM that many reproductive endocrinologists profess, it is essential to be honest about relative efficacy.

6. Let’s be honest: pre-implantation genetic testing (PGT) is both scientifically and morally problematic.

For those unfamiliar with reproductive medicine, there are various forms of PGT used in IVF. PGT-A (aneuploidy) and PGT-M (monogenic disorders) are the most commonly utilized iterations, and all forms of PGT involve the removal of some cells from the trophectoderm of a blastocyst-stage embryo. At this point in development, the human embryo can contain over 100 cells. The cells that make up the inner cell mass are what develop into the baby, while the trophectoderm cells develop into the placenta. Following the removal of several cells from the trophectoderm, the embryo is frozen and the biopsy specimen is sent to a genetic testing lab for analysis.

PGT-A is currently used in approximately half of IVF cycles performed in the United States, and it’s utilization is increasing exponentially (The use of preimplantation genetic testing for aneuploidy: a committee opinion (2024) | American Society for Reproductive Medicine | ASRM). Most studies show that PGT-A lowers live birth rates for women under 38 years of age. For older women (≥ 38), PGT-A may shorten the time to pregnancy resulting in a live birth (DOI: 10.1016/j.fertnstert.2025.04.006). PGT-A is an expensive “add-on” to IVF that can be quite lucrative for physicians who typically charge a per-embryo biopsy fee in addition to the per-embryo fee charged by the PGT testing company. PGT-A has been prematurely adopted in clinical practice often without validation studies or robust clinical trials (DOI: 10.1016/j.fertnstert.2025.05.152). This technology has harmed patients because potentially viable embryos have been discarded. Indeed, healthy live births have been reported for embryos with chaotic (DOI: 10.1016/j.xfre.2022.10.003 External Link) and aneuploid (DOI: 10.1016/j.fertnstert.2025.06.033) PGT results. A recently presented double-blinded, multicenter nonselection study demonstrated that embryos with segmental aneuploid PGT results had a 27 percent live birth rate (DOI: 10.1016/j.fertnstert.2025.07.093 ). The use of PGT continues to rise despite evidence that PGT-A is harming some patients, and there is an ongoing class action lawsuit regarding PGT-A (IVF Patients Sue Providers of the Controversial PGT-A Test).

In my opinion, the use of PGT is incompatible with a Christian worldview. PGT is presented to patients as a way to avoid suffering. Suffering that results from a failed treatment cycle, a miscarriage or the birth of an “undesirable” child with a genetic abnormality. PGT promises patients the illusion of perfection, but the only perfect man died for our sins 2,000 years ago. Since Christ’s resurrection, Christians have been at the forefront of saving “undesirable” children from death. Just as Christians saved “undesirable” children abandoned to die by a pagan Roman culture that viewed children as commodities, so too modern-day Christians must advocate for the “undesirable” human life our culture says we can (and should) destroy.

Using PGT-A and PGT-M to avoid transferring “undesirable” embryos (e.g. embryos with Trisomy 21 or cystic fibrosis, respectively) is eugenics. Eugenics is incompatible with the Christian faith and is an affront to the Imago Dei. We must heed Isaiah’s warning, “Woe to those who call evil good and good evil, who put darkness for light and light for darkness, who put bitter for sweet and sweet for bitter!” (Isaiah 5:20, ESV). PGT is a complicated topic that could easily warrant its own article, but I would be remiss if I did not provide a cursory overview of this scientifically and morally problematic technology.

7. Let’s be honest: the claim that more lives are lost in IVF than abortion is unfounded and inconsistent with the scientific literature.

To properly consider this claim about IVF and abortion, it is important to consider the loss that occurs in vivo, naturally. The loss rates in the lab seem to be similar to what occurs in nature, particularly when comparing women with infertility to each other. There was a relevant (albeit ethically concerning) study published in Human Reproduction in 1990 by Formigli et al. (DOI: 10.1093/oxfordjournals.humrep.a137099). Women underwent artificial insemination or intercourse and had uterine flushing performed five to six days after ovulation. This study showed that 42 percent of ovulated eggs are captured by the fallopian tube in natural cycles (of course, it is possible the rate is higher due to limitations of the study methodology), at least 72.9 percent of those eggs fertilize (there were also degenerated eggs that could have been fertilized and failed to develop so the number could be higher) and approximately 41 percent of those fertilized eggs progress to blastocyst stage. This number is approximate as some may progress further over the next few days as several of the earlier stage embryos that were transferred in the study resulted in clinical pregnancies. It also could be lower if some of the degenerated eggs had fertilized.

Attrition further continues from there. Approximately 25 to 30 percent of women in their 20s and early 30s attempting conception will become pregnant per menstrual cycle (Evaluating Infertility | ACOG), and the miscarriage rate is 10 percent to 15 percent for young women (<35 years old) (Maternal age and fetal loss: population based register linkage study – PMC). Another consideration in the discussion of course is that several women pursuing IVF are older (NASS average age for ART in 2022 was 36.3) with higher natural loss rates among older women. Furthermore, it is unknown what the natural loss rate (calculated from the moment of fertilization) is for women with infertility; however, it is logical to assume it would be higher than for women without infertility. This is a consideration as well when trying to compare the loss rate in nature to the loss rate in the IVF lab.

From the Formigli et al. study, it appears that approximately 40 to 50 percent of fertilized eggs progress to blastocyst stage in vivo. In IVF, approximately 50 percent of fertilized eggs progress to blastocyst stage. From there, in vivo, perhaps 50 percent will implant. Using the Formigli et al. study, this would give an implantation rate from fertilization of 20 to 25 percent. This approximates the commonly reported 25 to 30 percent rate I cited earlier for young women attempting conception. From the point of implantation, it is challenging to calculate the loss rate. We know approximately 25 percent of clinically recognized pregnancies end in miscarriage. It is estimated this rate might be as high as 50 percent because many women will miscarry before realizing they are pregnant. Given this uncertainty, we can assume the live birth rate from fertilization in vivo is somewhere between 10 to 20 percent. Again, this will be higher in younger women and lower in older women.

For women using ART, the published live birth rate per blastocyst transfer varies depending upon factors such as age and grade. For untested blastocysts in young women (under 35), the live birth rate per fresh embryo transfer according to SART is 44.4 percent. Incidentally, it is 46.6 percent for frozen embryo transfers. This means that for young women the live birth rate per blastocyst may be higher than in vivo at 22.2 to 23.3 percent. At the very least, it appears comparable, although it is difficult to know how many fertilized eggs are subsequently discarded or indefinitely frozen. Indeed, it is unknown exactly how many human embryos are currently frozen in the United States.

Some opponents of IVF report that 7 percent (or fewer) of embryos created in IVF lead to a live birth, and they also claim IVF is responsible for a greater loss of human life than abortion (https://thembeforeus.com/wp-content/uploads/2024/09/IVF-Handout-1.pdf; https://breakpoint.org/the-latest-executive-order-about-ivf-calling-it-pro-life-does-not-make-it-so/). However, these conclusions are difficult to establish when comparing IVF to what occurs in nature with unassisted conception. While I agree there are concerns regarding certain aspects of reproductive medicine, claims about comparative loss of life with abortion and IVF do not withstand scientific scrutiny.

Christian physicians must practice medicine in a manner that acknowledges the inherent dignity of all human life. Science is clear that life is present once a human zygote has successfully formed. In the realm of reproductive technology and IVF, we should eschew eugenic practices like PGT (in all forms). Physicians and patients should not pursue IVF protocols that intentionally create supernumerary embryos (embryos in excess of the number of embryos a patient is ultimately willing to transfer). Indefinite freezing of embryos should be opposed, and each viable embryo must be afforded the opportunity to implant. Because successful fertility treatment results in the live birth of a human child, we must ensure all treatments respect that future child’s natural rights, including the child’s right to both biological parents.