Infertility. A word of broken dreams, of emptiness. A word deriving its meaning from the opposite of what we might consider “good” or “normal.” After all, does not God intend for us to be fruitful and multiply, to be “fertile”? Is it not his desire that we bear biological children with whom we will share our family histories and our faith?
For many couples, these expectations and desires go unmet, producing a unique form of suffering. Consider the woman whom ushers awkwardly bypass as they hand out Mother’s Day carnations at church. The very absence of this flower captures the suffering of “non-presence” experienced by infertile couples. As such, this woman bears a visible announcement of her suffering as she goes through that morning self-consciously flower-less, staring on – perhaps in envy and grief – as the seeming abundant carnations of her sisters in Christ are grabbed, flung about and ruined by joyful children. Think of the man unable to attend something as simple as a father-daughter breakfast. Another isolation.
Many couples have benefited from tremendous medical advances and been able to conceive and bear children. Others have not. Due to the prevalence of the condition of infertility, many of you, if not directly affected by the condition, will have walked with other couples on a journey of infertility. Many have vicariously tasted bitterness and disappointment, occasional joy and relief.
The Mystery of Infertility
Compare the Bible’s treatment of the topic of infertility as mystery to society’s approach – the pursuit of mastery.
As Christians in the Reformed tradition, we heartily and gladly confess that the creator God is from first to last powerful and wise. But this omnipotence does not require Him to explain himself or His ways to us fully, either through Scripture or creation. While the Bible does not spell out scientific details regarding many of the complex questions that relate to infertility, it does address the question more frequently than we might think.
The Old Testament is replete with stories of family, genealogies and childbirth. Think of all those “begats” in Genesis and 1 Chronicles! People in the ancient world generally spoke of fertility in agricultural terms, conceiving of reproduction as the male planting a seed (wherein existed the potential human) into the fertile field of the female (the womb). There, in the womb, the planted human would grow.
In Old Testament poetry we find familiar metaphors of “knitting” (Ps 139:13), and “curdling” followed by “clothing” with skin and flesh (Job 10:10) to describe what happens in the womb. The overwhelming teaching of the Scriptures is that the all-wise God – the one doing the knitting, curdling and clothing – controls the womb. Though firmly in the control of the powerful and wise God, what actually happened in the womb is described through metaphor, not in scientific nor precise language. In the ancient world, the womb remained a place of immense mystery.
We find a surprising number of examples of infertility– barrenness, if you will – in the Old Testament, which does not refrain from painting a stark picture of the resulting emotional and social struggles. We find many examples of barren godly women (Hannah, Elizabeth, Sarah), so barrenness – and this is important to remember—was not inherently a sign of punishment upon an individual. But given the ancient cultural setting, even godly women experienced shame if they could not bear children. Sarah, Rachel, and Hannah pled with God to remove the stigma of barrenness from them.
Think of Hannah’s distress and bitter weeping in 1 Sam 1:4-11. This is a woman persistent in prayer, begging Israel’s God for the blessing of a child, going so far as to offer the child to God’s service if only he would remove her stigma (1 Sam 1:11, 22). She is wholly dependant on God as the sole source of life. We find in Hannah an attitude of humility, not a forgone conclusion that God owes her anything—merely a trust that He can bless her, should He choose to. In other words, Hannah is not attempting to figure out the answer, just move the Almighty! As bio-ethicist C. Ben Mitchell writes, “…trials, including infertility, are sometimes brought into believers’ lives as an encouragement to pray.”
Couples facing infertility can relate directly to these experiences of Old Testament saints. What might the overall story of the Bible tell us about how to embrace the mystery of life and infertility? We can look at this from two angles: the question of God’s identity, and the question of suffering in this world. Does it make any difference, for example, that Sarah, Rebekah and Rachel – the beloved wives of the three protagonists in Genesis – are all portrayed as barren (Gen 16:1, 18:11, 25:21, 29:31)?
While couples facing infertility may take some comfort in the honest depiction of these women, the book of Genesis does not primarily speak to the experience of infertility, but the identity of the God worthy of the readers’ worship. Scripture paints this portrait of Yahweh: we serve and worship a God who mysteriously brings life and promise to death-and-despair situations. Beyond Genesis, how does the God of the Bible culminate his restoration story? In Jesus Christ taking on flesh, coming in weakness to inaugurate his Kingdom through the suffering of the cross, bringing forgiveness of sin, the victory of his resurrection (1 Cor 15:1-4), and sending the Spirit as the certain guarantee of Christ’s final victory (2 Cor 1:22).
What has all this to do with infertility? The story of redemption gives us a new lens through which to view all suffering. The experience of one person or one couple does not define God’s work, however much suffering might tempt us to see it that way. Instead, suffering is an inherent part of the “already/not yet” in which we find ourselves: already experiencing redemption through Jesus’ death and resurrection, and our life by the Spirit, not yet tasting ultimate kingdom victory over brokenness. Of course we cannot expect that every infertile couple will experience the birth of their own biological child. But having this broader perspective of a life-giving God, side-by-side with the present reality of suffering, sets the sting of infertility in a broader context. Mystery and pain remain, but even they are not the final word: that is reserved for our Lord Jesus Christ. A couple’s cries arising from infertility resound with all of creation’s groaning, ironically, in the “pains of childbirth until now. And not only the creation, but we ourselves … groan inwardly as we wait eagerly for … the redemption of our bodies” (Rom 8:22-23).
The Culture’s Need to Have Mastery
In contrast, consider a contemporary and medical view of infertility. Ask young adults in the western world what their dreams of family include and you will find that the majority see themselves becoming parents. Granted, motives for becoming parents are invariably mixed – a need to “pass on life,” a wish to nurture someone, “an investment in the future.” But whatever the motives, most couples assume that they will experience biological parenthood.
Often, a subtle, very modern assumption lies just beneath the surface of these desires and plans: That fertility is a natural, and therefore guaranteed, medical “right.” And why not? If other problems of the human body arise (infection, broken bones, crooked teeth), our society judges the difficulties to be biological and pursues quick and effective medical treatment. If one physician cannot provide satisfaction, we seek a second opinion. More tests, more scans, until we arrive at a diagnosis and secure treatment. Mastery over the disease process becomes the only acceptable outcome. And, insofar as we look to mastery and treatment as the basis of hope, we have placed a “desperate faith in medicine” (Stanley Hauerwas).
We have little patience for the process, even less tolerance for the unknown, and certainly no love for mystery, particularly the dark mysteries of suffering. A solution, please—quickly, the first time, and with little or no pain involved. Has mastery—modernity’s myth of progress—subtly percolated into Christian homes as well? Infertility forces the issue of suffering and mystery back into the lives of many couples and their friends. If Western evangelical culture has come to expect a relatively pain and problem-free life of “blessing,” then perhaps we have lost the ability to endure suffering not only with grace, but also with others.
This is not to say that a modern scientific perspective fails to appreciate the complexities of the human reproductive system. Who could forget the junior high movie detailing the beginning of life? Millions of sperm swimming upstream for a single one’s rendezvous with the tiny awaiting egg. Many may recall the astounding, high definition photographs published in Life magazine, documenting the moment of fertilization. So much knowledge has been gained in the fields of reproductive science in just the past 50 years: Watson and Crick, the double helix, the human genome project, genetic engineering. We absolutely live in a different world from that of our parents. Infertility, however, reminds us that knowledge is by no means equivalent to mastery, and control over the beginnings of human life remains elusive in spite of all our efforts.
Still, with the scientific knowledge that God, in His providence, has allowed humans to discover, we often approach the condition of infertility with the assumption that medical advances should be able to eradicate this common problem. Statistics confirm that almost one out of eight couples in the United States will be diagnosed as “infertile.” The frequency of this situation makes it almost certainly a problem that pastors will encounter within their congregations, and a life situation that many Christians will either experience, or be called on to comfort and counsel friends. Once a diagnosis is made, a couple confronts a staggering array of treatments; there are as many as 38 options for “assisted reproductive technologies.” At our current level of knowledge, specialists claim that 85-90% of fertility problems are resolvable by conventional medical and/or surgical means (everything from clearing blocked fallopian tubes, to induction of ovulation, to the many varieties of in vitro fertilization–IVF). This, of course, is good news. But it is still not the guarantee of natural childbirth we have come to expect, and, more importantly, still not free from suffering or from the necessary soul-searching treatment process. How can the Christian community minister to couples who face infertility?
The Church’s Response: Ministry
Infertile couples face at least two difficult dilemmas: commitment to unborn life and financial cost. These questions require balance and wisdom.
Some forms of treatment present profound ethical dilemmas. For example, couples who begin treatments involving fertilization of eggs outside the uterus face hard questions about the manipulation of embryos, including the storage of embryos not used in treatment. Treatments such as surrogacy introduce emotional and spiritual dynamics that should enter in to consideration of treatments. The Christian community should prayerfully support couples in their search for faithfulness with regards to “promising” medical treatments.
Our 21st century culture has largely offered an understanding of reproduction as explainable and predictable, able to be engineered and maneuvered. Christians considering infertility treatment are well advised not to think immediately of modern medicine or procedures – from which so many have benefited – but to look around at our contemporary culture, and to re-confess as His children that God is the sole author and sustainer of life, mysterious though it is. He does not abandon us in our sufferings, but meets us in them. Resting in this profound biblical truth provides a sustainable foundation for a painful journey through infertility.
Then there are the financial costs. Testing and treatment are expensive, anywhere from a low of $50 or $100 for basic monthly medications, to $5,000-$15,000 per cycle of IVF. Most insurers do not cover the full costs of treatment.
How much expense is justifiable in the pursuit of achieving pregnancy? It’s an agonizing question, and can never be answered with a concrete dollar amount. But it’s worth pondering. Some couples simply do not have financial means to follow their “dreams” very far. And, just because a couple is wealthy, should they have greater opportunity to bear a child? Clearly, children are a treasure given to us by God himself (Psalm 127:3), and their worth is inestimable! However, financial constraints can spell a bitter reality for a childless couple; how will the Christian community respond?
An additional financial question is that of adoption. In light of the potential high cost of treatments such as IVF, couples might consider (1) foster-care adoptions, which involve less cost, and, (2) private or international adoptions, which vary in costs but generally incur expenses within the range of one to three IVF cycles. Individual couples need to consider prayerfully their own financial situations and seek counsel from wise spiritual mentors.
A Community Matter
How should the Christian community effectively engage those suffering from infertility? Isn’t it strange that we talk about “community” here? Infertility is a private matter, isn’t it? Couples who have gone through infertility describe the event as isolating and “identity-dominating.” Millicent Feske writes of infertility coming to “define your whole life. That’s who you become.” This suffering has the capacity to overwhelm a couple, to consume their time, resources, emotional energy and identity. The Christian community must step in to these stories of pain, loneliness and identity-crisis and affirm life—not just the life of the longed-for child, but the lives of those walking through the valley of suffering. We do this when we live out a theology of suffering which does not deny the pain, but puts it in the broader story of redemption.
Moreover, by bearing suffering graciously and in community, we set ourselves against our society’s exaltation of medicine and pursuit of a suffering-free life. David Powlison rightly notes that our culture idolizes youth, health and energy – which for our purposes might be defined as fertility and virility, health to propagate the human race. Infertility is a stark, monthly reminder of mortality and weakness. Infertile couples come to live with an issue that is beyond their control, and their situation is a vivid reminder to us all of the stubborn truth our culture would rather conveniently forget: that humans do not control our lives or the world. Suffering in a godly way, waiting on God to act, can have the effect of producing wisdom, humility and patience (see James 1:2-5) – virtues desperately needed in the world. Infertile couples may have grown in just these areas.
And for the couples going through the suffering of infertility: Remember that our God is One who brings life and promise. An expanded appreciation of the story of redemption, and an understanding of the corporate-ness of our life together in the gospel, may expand our view of how we – even childless – can contribute life to this, our Father’s world.
As one couple wrote, “We might never look to someone and say, ‘She has my eyes.’ But God, please make it so that we might look to someone and say, ‘She has my faith.’” We know this well, because it is taken from our journal in 1994. Through our experience we came to confess more resolutely what we now teach our children from the Heidelberg Catechism: that as our Almighty Father, He truly is “able to turn to our good whatever adversity He sends us in this sad world.” The mystery of grace.
Michael and Shareen Kelly live in Philadelphia, where Michael teaches Old Testament at Westminster Theological Seminary, and Shareen works as a pediatrician. They have three children, Matthew, Joel, and Leah. As a family, they are active in community ministries in their neighborhood. They are members of New Life Presbyterian Church (PCA) – Philadelphia, where Michael has served for many years as a Ruling Elder.
Infertile, But Not Childless
Even in the dark womb of infertility, blessings can be found. Gary and Marilyn Purdy, for example, learned that “infertile” need not be synonymous with “childless.”
When the Purdys married in 1990, Gary was directing the Campus Crusade ministry at Baylor University. They dreamed of having babies and raising a family. Since she was 32, Marilyn was eager to get started, but after a year, she had not conceived.
Three years later, after “lightweight tests” by her physician, consultations with infertility specialists, medication and a series of injections—still no baby. And worst of all, there was no medical explanation.
“Everyone around us was having babies easily, and it became very stressful. It seemed so unfair,” Marilyn admits. In vitro fertilization was the next option, but with their limited financial resources, and given the long odds, the Purdys were reluctant. They began to consider adoption. “The most appealing fact about adoption was that everyone we were aware of who had pursued adoption had gotten a baby,” she notes.
Marilyn, having grown up around adopted children, was far more receptive to the idea than her husband. However, by faith he was willing to proceed.
“I asked myself, ‘Am I desirous of becoming a daddy?’ Since my answer was yes, I agreed that we should try to adopt a child,” Gary recalls.
Five months later, in 1995, the Purdys received a phone call that their son had been born. “The moment we got that call, Gary engaged. It was beautiful to see him bonding emotionally with Davis even before he held the baby in his arms. What a confirmation from God,” Marilyn says. In 1999, mom and dad gave Davis a new sister, ClaraLane, adopting her when she was eight months old.
“Sometimes people used to ask, ‘Are you still trying to have one of your own?’ I can’t imagine having children more our own than Davis and ClaraLane,” Marilyn asserts. “We would never go back and choose to have a child biologically if it meant we couldn’t have them. It fills us with awe to think that before time began, God orchestrated all of the circumstances – even the deep valley of infertility – so we could have the joy of becoming their parents.”
Today Gary pastors North Shore Fellowship in Chattanooga, Tenn., where he and Marilyn have often shared comfort and encouragement with others also coping with infertility.
—By Robert J. Tamasy