A Version of IVF Could Withstand a Religious Reckoning

For many Christian families who desire children, in-vitro fertilization has long held an uneasy position. To maximize the chances of a viable pregnancy, IVF usually involves creating more embryos than a given couple is likely to use. But for couples who consider each embryo a human life, destroying the extras—or donating them for research, or freezing them in perpetuity—can go against their core beliefs.

Instead, some couples turn to options such as compassionate transfer, in which a spare embryo is released into a patient’s body at a time when she’s unlikely to get pregnant. Others choose to fertilize only a few of the eggs they produce. Still others, in a process called minimal-stimulation IVF—or mini-IVF—use less medication than in a conventional IVF cycle, in order to limit egg production.

These ways of navigating the ethics of fertility treatment could become more standard—and perhaps more couples’ only options—amid legal challenges to IVF. Earlier this year, the Alabama Supreme Court ruled that embryos created through IVF are children and cannot be destroyed without “incurring the wrath of a holy God”; more than a dozen states have recently considered bills that would codify legal rights for embryos. The Catholic Church reiterated its long-standing opposition to IVF in a letter to the U.S. Senate, and this spring the Southern Baptist Convention, the country’s largest Protestant denomination, voted to oppose IVF.

Rejoice Fertility in Knoxville, Tennessee, goes further than perhaps any other clinic in its emphasis on this type of treatment and its explicit mission to practice IVF in a way that takes into consideration a patient’s religious concerns. It has become a destination for Christian parents trying to navigate the morals and ethics of IVF. Typically during a round of IVF, a patient receives up to 90 injections over two weeks to help the ovaries develop and release potentially dozens of eggs in a single menstrual cycle. Rejoice offers conventional IVF, but it more routinely performs mini-IVF, in which a patient receives oral fertility medications and only a few days of low-dose hormone shots. The clinic also offers natural-cycle IVF, which uses the single egg that a woman ovulates each month for fertilization and transfer. At least 85 percent of the clinic’s patients are there for mini-IVF and natural-cycle IVF, according to John David Gordon, the clinic’s medical director.

Natural-cycle and minimal-stimulation IVF date back to the 1970s, when the procedure was first introduced. Fertility clinics in Europe and Japan have been using a lower-dose form of IVF for years. Because it involves fewer hormones, it’s thought to lower the negative side effects for patients, including the risk of ovarian hyperstimulation syndrome, which causes the ovaries to swell and can be life-threatening in rare cases. Most clinics in the United States prefer to use conventional IVF because it has a higher success rate, Sean Tipton, the chief advocacy and policy officer for the American Society for Reproductive Medicine, told me. (Monitoring and newer injection protocols have also limited the risk of severe ovarian hyperstimulation syndrome.)

Gordon’s own religious convictions led him to put more emphasis on treatments that limit embryo creation. He devises his patients’ treatment protocols based on the family each one sees themselves having and the number of embryos they’re comfortable creating. For example, if a couple wants two children, he’ll walk them through the math: Fertilizing six eggs will probably yield two or three viable embryos, and one or two of those could turn into children. If the couple is uncomfortable with six, they could start with four.

“You’re not put in the position of having 18 embryos in the freezer,” he said. “For some patients, even one extra embryo in the freezer is too many.”

When Rachel and Rollin Mayes chose to see a fertility specialist in 2022, they had been trying to have a baby for eight years, and Rollin, a pastor at a church in College Station, Texas, had long wondered whether to just accept that God didn’t have plans to give them a child. But Rachel, who leads the church’s ministry for students at Texas A&M University, wanted to find a way to pursue fertility treatment without compromising her religious beliefs, which is how they eventually ended up at Rejoice for mini-IVF.

The Mayses knew, going in, that they wanted to honor their religious convictions, more than maximize their results. “We’re not trying to stand on high ground here in terms of ‘this is how this ought to be done,’” Rollin said. “I do think that it is important, broadly speaking for couples and particularly couples of faith, to make sure that they understand the process, and their ethics are aligned with the technology.”

No large study has directly compared success rates for mini-IVF and traditional methods; one 2017 study did show that the live-birth rate peaked for patients who’d had 15 to 25 eggs retrieved. For mini-IVF, the retrieval numbers are closer to three to eight. Many proponents of mini-IVF argue that, even if fewer eggs are retrieved, those eggs are of better quality and are more likely to lead to pregnancy. The theory is that conventional IVF could be overriding the body’s natural selection of the most viable of a woman’s eggs to ovulate in a month. But some studies have found no association between the dosage of medication given in an IVF cycle and the quality of the eggs, though it is true that the number of viable eggs does not increase proportionally to the number of eggs retrieved.

“Many eggs that are ovulated are not capable of fertilization, growing into an embryo, or being a healthy embryo that can implant. The whole premise of IVF is to try to overcome that by starting with the greatest number of eggs possible,” says Lucky Sekhon, a reproductive endocrinologist at the fertility clinic RMA of New York. For patients who have objections to creating multiple embryos, she still recommends the conventional protocol for retrieving eggs, but will leave some eggs unfertilized before freezing them.

Limiting the number of embryos isn’t the only potential draw to mini-IVF. Geeta Nargund, the medical director of Create Fertility and abc ivf in the United Kingdom, told me that it can be a low-cost option that makes IVF accessible to more patients. From the beginning, a couple doing mini-IVF typically knows they might go through more cycles than in conventional IVF. Each round, however, is cheaper—$5,000 to $8,000, compared with $15,000 to $30,000. Thawing just a few eggs or embryos at a time can add to these fees, depending on the pricing structure of the clinic.

For now, Rejoice remains an outlier in its emphasis on mini-IVF. Kendra Knox, a writer and radio host for the American Family Association, a nonprofit ministry in Tupelo, Mississippi, told me that when she asked clinics about mini-IVF as a first-line treatment, they’d acted as if she’d made a bizarre request. “You would have thought I had a second head growing,” she said. She ended up at Rejoice, and is currently pregnant with her second baby from her third round of mini-IVF.

When Knox started IVF, she told Gordon she wanted to aim for three to five eggs from her cycle to produce just two or three embryos. Freezing any embryos at all made her nervous, because she was worried that if something happened to her or her husband, those embryos would never have a chance to be born. Gordon’s practice was aligned with her wishes. It is also a no-discard facility, meaning that every viable embryo it creates is either transferred into the patient who requested its creation, frozen for future use by that patient, or, in rare cases, donated to embryo-adoption agencies.

Gordon told me he believes that Rejoice is the only IVF clinic in the country that has a no-discard policy, and I wasn’t able to find any others, either. But even this set of practices might not answer every objection to IVF. Though Rejoice’s policies reduce the number of embryos that end up being frozen, they don’t eliminate the chance of one being accidentally destroyed, for example by being dropped when being handled in the freezer, as in the incident that spurred the Alabama court’s decision on embryo personhood. And for some Christians, separating conception from the act of sex is still problematic.

The Mayeses’ first round of mini-IVF at Rejoice resulted in two embryos. But neither resulted in a pregnancy. Rachel and Rollin were devastated, but a reader of a blog they run about their fertility journey for their friends, family, and ministry partners offered to sponsor another round. This time, nine of Rachel’s eggs were successfully retrieved. After choosing to fertilize eight eggs, the couple ended up with six embryos. In April of this year, they had their first child. They plan to use the remaining embryos in the next few years, and welcome the rest of their family, however big it ends up being, into the world.