For many Christian families hoping to have children, in vitro fertilization has long been an uneasy position. To maximize the chances of successful conception, IVF typically involves creating more embryos than a couple is likely to use. But for couples who see each embryo as an individual human life, discarding surplus embryos, donating them to research or permanently freezing them can go against their fundamental beliefs.
Instead, some couples turn to options such as compassionate transfer, in which surplus embryos are released into the patient’s body at a time when the woman is unlikely to become pregnant. Others choose to fertilize only a few of the eggs produced. And a process called minimally stimulated IVF (mini-IVF) uses fewer drugs than traditional IVF cycles to limit egg production.
As legal challenges to IVF continue, these methods may become more standard and perhaps the only option for many couples, as the ethics of fertility treatments continue to mount. 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 are currently considering bills that would codify the legal rights of embryos. The Catholic Church Repeated The country expressed its longstanding opposition to IVF in a letter to the U.S. Senate, and this spring the Southern Baptist Convention, the nation’s largest Protestant denomination, passed a resolution opposing IVF.
Rejoice Fertility in Knoxville, Tennessee, has perhaps gone further than any other clinic in its explicit mission to value this type of treatment and to perform IVF in a way that takes into account the religious concerns of patients. The clinic has become a destination for Christian parents seeking to understand the morals and ethics of IVF. Typically, during one round of IVF, patients receive up to 90 injections over a two-week period to help develop their ovaries, which release dozens of eggs in one menstrual cycle. Rejoice offers traditional IVF but more routinely performs mini IVF. In mini IVF, patients receive oral fertility medications and low-dose hormone injections for only a few days. The clinic also offers natural cycle IVF, in which a woman fertilizes and implants a single egg that she ovulates each month. According to the clinic’s medical director, John David Gordon, at least 85 percent of the clinic’s patients come in for mini IVF and natural cycle IVF.
The history of natural-cycle and low-stimulation IVF dates back to the 1970s, when the method was first introduced. Fertility clinics in Europe and Japan have been using low-dose IVF for years. The lower dose of hormone is thought to reduce side effects for patients. It also reduces the risk of ovarian hyperstimulation syndrome, a rare, potentially life-threatening condition that causes the ovaries to swell. Sean Tipton, chief advocacy and policy officer for the American Society for Reproductive Medicine, said the majority of clinics in the U.S. prefer traditional IVF because of its higher success rate. (Monitoring and new injection protocols have also reduced the risk of severe ovarian hyperstimulation syndrome.)
Gordon’s religious beliefs led him to focus on treatments that limit embryo production. He designs treatment protocols based on the family each patient envisions and how many embryos they’re comfortable producing. For example, if a couple wants two children, he walks them through the math: Fertilizing six eggs will probably result in two or three viable embryos, with one or two of those having the potential to become children. If a couple isn’t comfortable with six, they could start with four.
“You don’t want to be in a position where you have to have 18 embryos in the freezer,” he said. “For some patients, even having one extra embryo in the freezer is too many.”
When Rachel and Lauryn Mays chose to see a fertility specialist in 2022, they had been trying for a baby for eight years. Lauryn, a pastor at a church in College Station, Texas, had long wondered whether she should accept that God didn’t have a plan for them to have children. But Rachel, who serves as a pastor at a church serving students at Texas A&M University, wanted to find a way to undergo fertility treatments without compromising her religious beliefs, and the couple ultimately came to ReJoice for a mini-IVF treatment.
The Mays knew from the start that they wanted to honor their religious beliefs over maximizing outcomes. “We’re not trying to take the high ground here in terms of, ‘This is how you should do it,'” says Rollin. “I think broadly, it’s important for couples, especially couples of faith, to understand the process and make sure their ethics are aligned with the technology.”
While there are no large-scale studies directly comparing the success rates of mini-IVF to traditional methods, a 2017 study showed that live birth rates peaked in patients who had 15-25 eggs harvested. With mini-IVF, the number is closer to 3-8. Many proponents of mini-IVF argue that even though fewer eggs are harvested, those eggs are of higher quality and more likely to lead to pregnancy. The theory is that traditional IVF may be ignoring the body’s natural selection to release the most viable of a woman’s eggs in a month. However, while some studies have found no correlation between the dosage of drugs administered in an IVF cycle and egg quality, it is true that the number of viable eggs does not increase in proportion to the number of eggs harvested.
“Many of the eggs that are ovulated don’t get fertilized, don’t develop into embryos, and don’t become healthy embryos that can implant. The whole premise of IVF is to overcome that problem by starting with as many eggs as possible,” says Lucky Sekhon, a reproductive endocrinologist at RMA Fertility Clinic in New York City. For patients who aren’t comfortable creating multiple embryos, Sekhon recommends the traditional protocol for egg retrieval, but leaving some eggs unfertilized before freezing.
Limiting the number of embryos isn’t the only potential attraction of mini IVF. Gita Nargund, medical director of Create Fertility and ABC IVF in the UK, told me that mini IVF could be a lower-cost option that allows more patients to undergo IVF. Couples who do mini IVF usually know from the start that there may be more cycles than with traditional IVF. But the cost per cycle is lower, $5,000-$8,000 compared with $15,000-$30,000 for traditional IVF. Thawing just a few eggs or embryos at a time could make these costs even higher, depending on the clinic’s pricing structure.
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 in Tupelo, Mississippi, said that when she asked clinics about mini-IVF as a first-line treatment, they treated her as if she had made an odd request. “They thought I had two heads,” she said. She eventually ended up with Rejoice, and is now pregnant with her second baby after her third round of mini-IVF.
When Knox began her IVF journey, she told Gordon she wanted to retrieve three to five eggs from each cycle and create two to three embryos. She was nervous about freezing the embryos because she was worried that if anything happened to her or her husband, they would never have a chance to come to fruition. Gordon’s practice was in line with her wishes. It’s also a no-waste facility, meaning that any viable embryos that are produced are either implanted with the patient who requested them, frozen for future use by the patient, or, in rare cases, donated to an embryo adoption agency.
Gordon told me he believes Rejoice is the only IVF clinic in the country with a no-disposal policy, but I couldn’t find any others. But even this set of practices may not answer all the objections to IVF. While Rejoice’s policy reduces the number of embryos that end up frozen, it doesn’t eliminate the possibility that an embryo could be accidentally destroyed, for example by being dropped while being handled in a freezer, as in the case that led to the Alabama court’s decision on embryo personhood. And for some Christians, separating fertilization from sex remains problematic.
The Mays underwent mini IVF at Rejoice for the first time, which produced two embryos, but neither resulted in a pregnancy. Rachel and Lauryn were devastated, but readers of their blog, which writes about their fertility journey for friends, family, and church partners, offered to sponsor another round of IVF. This time, nine of Rachel’s eggs were successfully retrieved. After deciding to fertilize eight eggs, the couple had six embryos. In April of this year, they were blessed with their first child. They plan to use the remaining embryos over the next few years to bring the rest of their family into the world, however large it may become.
