In 46 years since the first human couple relied on IVF to conceive a child, the procedure has become the principle tool of assisted reproduction. Some religions embrace it enthusiastically for couples who would otherwise be childless. Others tolerate it but may impose restrictions on how the procedure is practiced and who can benefit from it. A few religions condemn IVF and urge their infertile adherents to forego it. The wide range of religious attitudes about IVF reflect how the human embryo is viewed with regard to the inception of personhood and when ensoulment occurs. These are philosophical concepts that science can neither prove nor refute. This article discusses dominant themes that have emerged in determining how different religions view IVF.

Neaves WB (2024) The Ethics of In Vitro Fertilization. JSM Sexual Med 8(4): 1144.

Philosophical ideas and religious beliefs around the status of IVF have been documented for less than five decades. Louise Joy Brown, the first child conceived by IVF, was born in 1978 [1]. She resulted from the pioneering research in assisted reproduction conducted by Robert Geoffrey Edwards, a British developmental biologist at the University of Cambridge, and Patrick Christopher Steptoe, a gynecologist and surgeon working at Oldham General Hospital in Oldham, England [2].

Fertilization requires both capacitation of spermatozoa, a biochemical process that permits greater affinity to the ova, and maturation of oocytes. In 1965, after he succeeded in completing in vitro human oocyte maturation, Edwards designed strategies to capacitate spermatozoa [3]. In natural human reproduction, sperm are capacitated by exposure to the chemical and physical environment of the female reproductive tract. Edwards designed diverse methods to induce capacitation outside the human body without success. He speculated that placing sperm in the fallopian tubes and then retrieving them might result in capacitation [4]. However, he could not imagine how to recover spermatozoa from fallopian tubes without causing trauma.

In 1967, Edwards happened upon an article describing the new uses of a medical instrument called a laparoscope, which could be used to examine organs and tissues in the abdomen. Biopsies with a laparoscope meant only minor incisions and no long-term hospitalization. The article ignited Edwards’s imagination. He reasoned that the laparoscopy technique might help retrieve spermatozoa from fallopian tubes with little pain or harm. He soon phoned the article’s author, Patrick Steptoe, a gynecologist working at the Oldham General Hospital, in Oldham, England.

Steptoe agreed to collaborate with Edwards. They established a laboratory in Oldhom and Steptoe began soliciting volunteers who would allow him to retrieve sperm from their fallopian tubes using his laparoscope. Edwards moved to Oldham so he could conduct his research as soon as human ova and retrieved spermatozoa became available [5]. Meanwhile, Edward’s Ph.D. student, Barry Bavister, developed a culture medium that Edwards used to mature ova in vitro. He was able to fertilize ova in this medium by adding capacitated spermatozoa. Edwards, Bavister, and Steptoe published this breakthrough on 15 February 1969 in a Nature paper entitled “Early Stages of Fertilization in vitro of Human Oocytes Matured in vitro” [6]. Soon they realized the procedure worked best when using mature ova retrieved from donors.

This is how IVF came to be a successful medical procedure. Edwards and Steptoe began testing their strategies in clinical settings with real patients suffering from infertility. In due course, Louise Brown was born.

Now that 46 years have passed since the birth of Louise Brown, IVF practitioners have learned many ways of improving the procedure. Some fertility physicians focus exclusively on assisted reproductive technology, and among them is one who has devoted his clinic to IVF. This innovator in St. Louis has worked with a colleague in Japan to perfect a new mini-IVF procedure that uses reduced hormonal stimulation for the partner providing the egg. He reports the method yields better results than conventional IVF and costs less [7].

The objections discussed here refer exclusively to clinical IVF for the purpose of producing offspring. Experimental IVF to yield material for laboratory studies is not included. Some blurring of this useful distinction occurred early in the practice of IVF, when clinical programs produced more embryos than could be transferred to the mother’s uterus, and some excess embryos became subjects for experiments.

To facilitate systematic review, objections to the clinical practice of IVF are grouped according to commands implicit in the alleged wrongfulness, regardless of rationales.

Objections derived from a variety of philosophical perspectives join in support of the traditional method of human reproduction.

*IVF is wrong because people should not usurp God’s role in the conception of human life [8]

Religious people throughout the ages have given God credit for their offspring. Examples from the Old Testament include Eve’s bearing Cain (Genesis 4: 1), Sarah’s conceiving in old age (Genesis 21:1-7), Hannah and Samuel (Samuel 1: 19-20), and Samson’s mother (Judges 13:1-24). Women knew, of course, the role of sexual intercourse with men. Whether it was fruitful or not and what kind of child was born, however, was considered to be due to God’s influence.

Besides sexual intercourse, people have tried for millennia to help the process of conception by prayer, vows, and sacrifice. Less traditional participation has been viewed as an inappropriate intrusion into the origin of human life [9]. Hence, the Roman Catholic Church has declared IVF to be “immoral and absolutely unlawful.” Although Catholicism generally embraces the idea that people may overcome natural obstacles to achieve God’s will on earth, such a liberal view has not yet extended to human assistance in the extracorporeal union of oocyte and sperm.

Does IVF diminish God’s role in human conception? The coming together of sperm and oocyte in a Petri dish needs entail no less randomness and generic unpredictability than conception by sexual intercourse. As IVF is routinely practiced, it leaves as much biological latitude for the exercise of God’s influence on offspring as does natural conception. In any event, to object to IVF because it limits God’s involvement in the beginning of human life is to challenge the concept of an Omnipotent Creator capable of participation in any initiation of life, even one contrary to prevailing mores. After all, Jewish society considered the circumstance of Mary’s pregnancy “immoral and unlawful” [10].

*IVF is wrong because science does not have the right to manipulate nature [11]

An absolutist negation of IVF does not have to be founded on the doctrine of an established religion. Even an atheist could subscribe to the objection that IVF is contrary to the “laws of nature.” Such a conviction usually entails misapprehensions, including the erroneous belief that IVF “creates” life in a test tube,and often reflects a pervasive suspicion of progressive science in all its manifestations. Adherents may range from nescient Luddites to sincere nativists. To be consistent in this belief, proponents must reject not just IVF but all medicine.

*IVF is wrong because it separates “lovemaking” from “babymaking” and this will destroy marriage by replacing the conjugal act with manipulations of a scientist [12]

Several writers have rejected IVF because it sunders what God has united, namely, the procreative and unitive aspects of sexual intercourse. Catholic dogma uses elements of the same rationale in objecting to contraception. Contraception made it possible to have sex without making babies; now IVF has made it possible to make babies without having sex. These are two sides of the same coin, and consistent opponents of IVF might be expected to reject contraception for the same reason.

However, not all who are concerned about IVF find contraception equally objectionable. By enabling couples to develop and extend the unitive function of sexual intercourse without the encumbrance and inhibition of untimely pregnancies, contraception may actually strengthen marriages. Hence, a utilitarian may approve of contraception but object to IVF because of apprehension that the latter may diminish the incentive for sexual intercourse.

There is no evidence that couples resorting to IVF have abandoned the unitive practice of conjugal sex. In only one instance early in the practice of IVF does the record reflect voluntary abstinence from intercourse during the treatment cycle [13]. In fact, early scientific critics of IVF cited the continuing sexual activity of patients as grounds for dismissing claims that pregnancies resulted from the new technology [14]. On the other hand, there is abundant evidence that persistent infertility places severe strains on marriage in general and on the unitive function of sexual intercourse in particular. By providing an alternative route to parenthood for couples deeply troubled by their infertility, IVF may liberate intercourse from frustrating preoccupation with vain attempts at procreation and allow it once again to unite the marriage partners in love.

*IVF is wrong because it may, as a result of improvement in technique, offer more efficiency and control so that it eventually comes to replace natural conception [15]

In the US currently, about 2% of births result from IVF, and over 8 million babies worldwide have been born using IVF [16]. The moral objections to IVF raised earlier in this discussion have been based on its application to the small minority of married couples who cannot otherwise conceive. We now consider an objection that casts a much wider net. Could IVF realistically compete with natural conception among normally fertile couples in our society? The suggestion is not as improbable as it may seem.

When Edwards and Steptoe achieved the first successful pregnancy by IVF in 1978, they had already tried it unsuccessfully in 79 other patients. Forty-six years later, several groups around the world report successful implantation of an IVF embryo in one of every five or six attempts. This compares favorably with the success rate of natural human reproduction, where only one of every four or five embryos is believed to become properly implanted, resulting in a pregnancy [17]. Such rapid improvement in the technology of IVF may well enable it to equal or exceed the efficiency of natural conception. Higher efficiency per attempt at pregnancy could ultimately result from IVF’s ability to collect and fertilize several oocytes at once, to select only the normally cleaving embryos, and to transfer more than one of them to the uterus at the optimum time in the reproductive cycle.

The success rate for IVF is measured by live births. Citing data from the Society for Assisted Reproductive Technology, Dr. Natalie Crawford, a fertility physician in Austin, Texas, says the general success rate is about 60-65% for genetically healthy embryos [18]. Hanson notes how IVF success rates decline according to the mother’s age.

Women 35-37 38.3%

Women 38-40 25.1%

Women 41-42 12.7%

Women >42      4.1%

Even more remarkable than the prospect of better-than- normal efficiency is the possibility of control. IVF already has the ability to select embryos for uterine transfer using criteria that extend far beyond microscopic observation of normal cleavage. Male embryos can be eliminated in the Petri dish by exposing them to antiserum against a male specific H-Y antigen without harming female embryos [19].

Whether this kind of control should be exercised over human reproduction is the subject of another category of objections of IVF reviewed later in this paper. The premise of the objection currently under consideration is that the popular appeal of such control through IVF would largely eliminate procreational intercourse. Having sex to make a baby would presumably be relegated to the status of a quaint, atavistic impulse, driven by the same sense of nostalgia that motivates a tiny minority of our society to construct antique cabinets using only hand tools or to stalk deer with bow and arrow.

Clearly, the eventual impact of IVF on procreational sex is highly speculative. Like IVF, Caesarean birth can be said to offer some elements of efficiency and control not found in natural parturition. Although Caesarean section has undoubtedly been used in occasional situations where natural delivery would have sufficed, it has never seriously threatened the status of the vagina as the birth canal of choice. Even if IVF should make some inroads on procreational sex among normally fertile couples, there is no apparent basis for believing that it would decrease the frequency or quality of unitive sex. *IVF is wrong because it loosens the biological tie linking mother and infant and the psychological and social tie linking mother, infant, and father [20]

This argument presumes that procreational sexual intercourse cements the family relationship among parents and children. Without intercourse at the time of conception, proponents of this view believe that family bonds are weakened. Accordingly, they fear IVF may mitigate against personal intimacy and human contact and, ultimately, human community.

This objection discounts the effectiveness of those ties linking mother, infant, and father that remain unaffected by IVF. Years of effort to achieve pregnancy and the joint decision to resort to IVF testify to the psychological bond between husband and wife. The husband’s sperm are used, so his biological paternity is intact. The wife’s fertilized ovum is transferred to her uterus where she gestates it as would a normal mother-ro-be. Throughout the nine- month pregnancy, the wife and husband may appear at the usual social occasions that allow them to be recognized as prospective parents. Normal delivery of the baby provides the wife with the same subjective experience of motherhood felt by any woman giving birth to a child conceived by sexual intercourse.

A more serious problem with the reasoning behind this objection to IVF is illustrated by the experience of human society with adoptive children. The success of families with adoptive children shows that intimacy and human community can develop in the absence of biological ties. Surely the mother’s gestation of a fetus is a stronger biological and social tie than the procreational sex act at the time of conception, yet adoption succeeds in the absence of both.

Several objections founded on a similar rationale come together under this shared prescription.

*IVF is wrong because of the possibility of producing a damaged human being [21].

Concern about the possibility of producing malformed children was widely expressed in the early years of IVF. However, no one offered a hypothesis to explain in mechanistic terms why fertilizing oocytes and manipulating early embryos in Petri dishes should result in children with birth defects. Inevitably, some oocytes and some early embryos were damaged by these procedures. However, experience with IVF in laboratory animals had already indicated that only healthy, undamaged embryos survive the rigors of intrauterine injection to become securely implanted as successful pregnancies.

Louise Brown, the first baby conceived by IVF technology, is now a healthy 46-year-old woman in England. Among the 590 babies conceived by IVF and born between 1978 and January 1984, only one was afflicted with chromosomal abnormality [22]. Considering the age of the mothers in this series, this was a reassuringly low incidence of abnormality and is certainly no higher than in natural conceptions.

No one contemplating IVF should deny the possibility of producing a damaged baby. However, 46 years’ experience with the technique has resulted in more than 8 million births and suggests that the risk of an abnormal child is no greater with IVF than with natural conception. People who still object to IVF for this reason should find natural conception equally objectionable.

*IVF is wrong because it was undertaken in humans before sufficient animal studies were done, and it therefore constitutes unethical experimentation [23].

Although rendered obsolete by the clinical experience with IVF described above, this objection is not trivial and should not be dismissed lightly. Not infrequently, medical procedures and practices have gone forward to widespread clinical application with insufficient prior evidence of their efficacy and harmlessness. Vasectomy is a case in point. More than a million vasectomies per year were being performed in the U.S. during the 1970’s at a time when researchers were belatedly discovering autoimmune consequences of the operation [24]. Fortunately for many millions of vasectomized men, the harmful autoimmune effects discovered in some experimental animals seem not to occur in humans. In IVF as in vasectomy, good luck rather than foresightful research must once again be credited with the avoidance of harmful consequences in human beings.

In fairness to the pioneers of IVF and its clinical application in humans, it must be acknowledged that some of society’s most effective agencies for supporting medical research were foreclosed to them. In the U.S., political pressures prevented the National Institutes of Health from funding any research directly relevant to IVF for many years [25].

*IVF is wrong because the lives of children so conceived will be overshadowed by the possibility of unknown problems yet to come from this unique genesis [23]

The view argues that we should not prematurely discount the possibility of adverse side effects from IVF. However, it taxes the imagination to envision any physical problem, absent in infancy and childhood, that could appear later in life as a result of IVF. Perhaps with sufficient encouragement from others, an IVF child might be caused to worry about unknown and unlikely possibilities so that its life truly becomes “overshadowed.” This too seems improbable, but it does lead to another theoretical concern for IVF children, the risk of psychological trauma.

*IVF is wrong because a child so conceived might receive publicity that would preclude normal development [26]

This risk may be more acceptable to prospective IVF parents because it is now entirely within their power to control it. Early in the practice of IVF, this was not always the case. Indeed, the fact that we know of Louise Brown illustrates the reality that motivated this objection to IVF. However, now that well over 8 million babies have been born by IVF, the novelty has disappeared, and parents find no barriers to privacy and anonymity. However, parents must cultivate their own attitude toward IVF children to ensure normal psychological development.

Even more than excessive publicity, the parents’ attitude in the home environment could threaten normal development. Because parents of IVF children have tried so long to conceive and have ultimately resorted to a costly and novel therapy, they are particularly susceptible to the “premium baby concept” [27]. Their IVF baby represents such a hard-fought triumph over infertility that they may extend excessive protectionism into childhood. It would indeed be a tragedy if the product of IVF conception were treated by its own parents as a valuable freak.

The following three objections relate to the welfare of the couple contemplating IVF.

*IVF is wrong because the screening process denies the therapy to some couples and, in effect, decides that their claim to bear a child is inferior to that of another couple [28]

In contrast to the first few years of practice when only a few IVF clinics struggled for success and only a tiny fraction of infertile couples who met the medical criteria for IVF could be accommodated, commercial clinics have proliferated throughout the world. The availability of IVF has increased to the point that medically qualified couples who can afford to pay for the procedure can get it. The “screening process” has become a financial means rest. This may make IVF even more objectionable from an egalitarian perspective.

Whether IVF becomes a medical procedure provided by society for all its members, regardless of ability to pay, or whether it remains available only to those with adequate financial resources depends on the medical status of infertility. The debate includes concern about allocating scarce medical resources on an elective procedure like IVF [9].

Some argue that infertility is merely the unsatisfied desire to have a child rather than an illness in the usual sense [29]. Paul Ramsey [30], an outspoken critic of IVF, insists that infertility is not a medical need, and even R. G. Edwards, the originator of clinical IVF, concedes that the physical health of patients does not demand that their infertility be cured [31]. Can society agree that infertility is a disease, or at least a significant dis ability [32], and that IVF is an appropriate medical therapy? If not, IVF, like cosmetic surgery, may remain beyond the reach of many.

*IVF is wrong because unsuccessful patients will suffer disappointment and bitterness [9] .In the early years of IVF, the probability of success was quite low. Indeed, Edwards and Steptoe achieved one pregnancy among their first 80 patients. Critics naturally wondered if the high likelihood of failure justified raising the hopes of a patient by acceptance into an IVF program. Now that the odds of success have improved to 1-in-4 or even 1-in-3 per attempt, a patient willing and able to make repeated attempts at IVF has a reasonable chance of pregnancy. Whether this makes the inevitable persistent failure of the technique in some patients more or less bearable will depend on the individual. At least the percentage of IVF patients experiencing the frustration of failure has decreased as the technology improves.

*IVF is wrong because it places patients under intense emotional strain

The crucial difference between IVF and natural reproduction for some patients has nothing to do with the relative odds of success. Instead, it has to do with the patient’s awareness of events. In natural reproduction, a couple trying to become pregnant will be looking for the same feedback, a positive pregnancy test, as a couple using IVF. However, they will not know the status of their efforts to conceive during each cycle. For them, a negative pregnancy test may mean either failure to conceive or failure of an early embryo to implant successfully in the uterus. On the other hand, a couple trying IVF will know when embryos are produced and when they are transferred to the uterus. The few days waiting for a pregnancy test following embryo transfer may produce unusual stress because of the realization that embryonic life is at stake. After negative test results, an IVF patient may feel grief and guilt more characteristic of a miscarriage than an unsuccessful attempt at pregnancy.

To reject IVF because of the differential emotional toll that it may exact in comparison to natural reproduction is a rational decision for individuals contemplating personal use of the technology. It cannot be a valid reason for denying IVF to others, who may make little distinction between conception and implantation or who may prefer any stress to childlessness.

*IVF is wrong because parents resorting to IVF will feel guilt if the child develops health problems that may be the result of the unique genesis [23]

This objection simply extends to the parents the consequences of any harm that IVF might cause the child. An earlier section of this paper discussed the improbability of harmful consequences of IVF. As long as IVF entails no more risk of defective birth than natural conception, feelings of guilt specific to IVF are unjustified. Even so, IVF parents may still be troubled, since parents of birth- defective children resulting from natural conception frequently find reasons to feel guilt. The point is that consistent proponents of this objection will not discriminate between IVF and natural conception.

Objections in this category concede that current application of the technology is morally acceptable but reject IVF on the grounds that it will inevitably lead to wrongful manipulation of human genetics. The appeal of each objection will depend on whether one agrees that the envisioned consequences of IVF are both wrongful and inevitable.

*IVF itself is not wrong, insofar as it is used as a therapy for infertility, but it makes possible eugenic “improvement” of the human species, and this is clearly wrong [15]

The concept of improving the human species through the control of hereditary factors in mating acquired a distasteful reputation in the hands of Aryan racists in the 20th century. Nevertheless, some have cynically argued that the old eugenics died only because it was ineffective [33]. They fear its resurrection in a more threatening form through gene therapy practiced on early embryos resulting from IVF.

To understand the potential for genetic manipulation that IVF may soon enable, consider the commonest genetic disease in humans, familial hypercholesterolemia (FH). Most people with this disease have one defective gene and one normal gene limiting the concentration of cholesterol in their blood [34]. Because two normal genes are required to keep blood levels of cholesterol from rising so high that arterial disease occurs, people with FH frequently have heart attacks in the 30’s and 40’s. If one parent has FH, one-half of the offspring will be affected. If both husband and wife have FH, three-fourths of their children will have the disease, and one-third of the affected children will have a more severe form of disease that causes heart attacks before puberty. Gene typing techniques will soon enable physicians to detect the defective gene for FH in the infant shortly after birth or in the fetus through amniocentesis. Eventually, IVF technicians will also be able to detect the FH gene in embryos prior to transfer into the mother’s uterus.

Should the detected presence of the FH gene in an IVF embryo be grounds for rejecting the embryo in favor of one not bearing the defective gene? Should this potential technology, when available, enable parents with FH to ensure the absence of the disease in their offspring and in their family lineage henceforth? The power of the new eugenics will be astounding. The morality of its use depends on the status of rejected embryos, the definition of bad genes, and the perceived risk of tampering with genetic variability in the human species.

On March 6–8, 2023, at the Francis Crick Institute in London, the UK Royal Society and Academy of Medical Sciences, the U.S. National Academy of Sciences and National Academy of Medicine, and UNESCO–The World Academy of Sciences held the Third International Summit on Human Genome Editing. An effective procedure for editing a person’s genes is CRISPR- clustered regularly interspaced short palindromic repeats. It may be applied to an individual with a disease-causing gene, and that gene can be removed for the lifetime of the person. This is somatic human genome editing, and the cells being altered are 

non-reproductive cells—as a result genetic changes cannot be passed on to future generations. CRISPR has already been used on IVF embryos, but the changed genome resides in all the cells of the embryo, including reproductive cells. The third day of the summit at the Franscis Crick Institute broadened the discussion to include heritable human genome editing, in which genetic changes could be passed on to a person’s descendants. This is controversial and has generated considerable public opposition [35]. Because of opposition to the use of CRISPER technology in IVF embryos, the practice has diminished.

The destruction of embryos, either deliberately or inadvertently, has distressed many critics of IVF. It constitutes a major category of objection to IVF discussed in a following section of this paper. The objection to gene therapy might be eliminated in the more distant future when, instead of discarding embryos with defective genes, normal genes are spliced into them. In either case, the effect will be elimination of genes considered undesirable. Many would agree that the FH gene deserves elimination. Much human suffering results from the prevalence of the gene, and no one has identified an advantage afforded by the gene in contemporary societies. If ever a gene could qualify as “bad”, FH seems a sure candidate. On the other hand, elimination of the gene would reduce human genetic variability. What if a bizarre epidemic should sweep the world, and only people with high blood cholesterol levels could survive? As improbable as the scenario may be, it illustrates a reason to be cautious in declaring specific genes undesirable and advocating their elimination.

*IVF is wrong because it will result in selection of sex and other characteristics of children according to parental preference [33]

The technology for selecting IVF embryos according to sex has been perfected in animal experiments. Other criteria for selecting embryos, including cosmetic factors like eye color, may ultimately be available through IVF. This kind of selection would not seek elimination of defective genes, so it should not be equated with eugenics. Instead, it attempts a more trivial control over human reproduction according to the tastes of the parents. The only serious threat to human population genetics is the unlikely possibility that sex selection might eventually cause departure from the normal ratio of males and females. However, employing sex selection may have more detrimental consequences for human society. Sex preselection, particularly when it results in destruction of embryos of the unwanted sex, has been called the most stupendously sexist act in which it is possible to engage [33]. One does not have to believe that destruction of embryos is murder to feel uncomfortable about selectively eliminating them for a reason as discretionary as sexual preference.

*IVF is wrong because it will lead to cloning of human beings [9]

IVF does indeed make the theoretical possibility of cloning more feasible in humans. Cloning entails the replacement of the nucleus of a fertilized egg with the nucleus of an ordinary body 

cell from the individual being cloned. If the substitution works, the developing embryo would become a genetically identical copy of the individual who contributed the nucleus.

The concept of creating multiple copies of a human being deeply unsettles many people, who feel it challenges the integrity of the individual. Personal worth is closely tied to the belief that each human being is genetically unique from the moment of conception. To duplicate an individual seems to cheapen personhood, in spite of evidence from monozygous twins showing that the value and richness of human life is not diminished by the existence of another genetically identical person.

*IVF is wrong because it will allow human-animal hybrids to be produced [31]

The idea of human-animal hybrids is an ancient one, with minotaurs and mermaids reflecting its grasp on people’s imagination. Could a living creature, representing mixed animal and human inheritance, actually result from IVF technology? Novel creatures have been produced by mixing the cells of two different early IVF embryos and allowing the reformed single embryo to gestate in a compatible uterus. The resulting offspring’s body is a patchwork mixture of the physical characteristics of the two species whose embryos were mingled. Such chimeras have already been made between goats and sheep; a thriving example appeared on the cover of Nature in 1984, and several more were produced subsequently [36].

In some situations, cross-species fertilization by ordinary sexual intercourse can produce hybrids; the mule is perhaps the most familiar example. IVF, by avoiding certain physical and behavioral barriers to cross-species fertilization, may allow the generation of hybrids never before seen in nature. Would anyone attempt either a human-animal chimera or hybrid? Apparently, the latter has already been tried.

A Russian biologist, Ilia Ivanov, attempted to create chimpanzee-human hybrids during the 1920s using artificial insemination [37]. The feasibility of obtaining a viable hybrid seemed probable on strictly biological grounds. Chromosomally and genetically, humans and chimpanzees are more similar than horses and donkeys. Heterosis, the vigor seen in interspecific crosses, predicts a hybrid that would be stronger than a human and more intelligent than a chimpanzee. However, as R. G. Edwards observed, such a hybrid would condemn the human component to a situation unworthy of it [31]. But when no ape- man materialized, Ivanov’s research was forgotten.

As a basis for serious moral concern, the production of human-animal hybrids dwarfs other potential consequences of IVF. Although biologically intriguing, the Ivanov experiments aroused in progressive scientists as well as laymen a sense of having gone too far. It should be noted, however, that this offensive endeavor did not rely on IVF technology but on artificial insemination. For more than 30 years, artificial insemination has been an established clinical procedure for infertile couples, and no comparable incident of misuse has occurred. Any medical procedure can be perverted in a moral vacuum; atrocities committed by Nazi physicians during the Holocaust prove the point tragically.

Medical procedures subject to misapplication should be regulated rather than expunged. Society may wish to take appropriate precautions with regard to IVF, particularly in the areas of human cloning and human-animal hybridization.

The objections under this heading are founded on premises about the moral status of human embryos. The first objection is more technical than substantive. The second deals with the most widely shared public concern yet raised in the IVF debate. This issue, the wrongfulness of destroying human embryos, is the question upon which many people’s opinions of IVF will hinge.

*IVF is wrong because consent cannot be obtained from the embryos whose lives are at risk [38]

Contemporary medical ethics demands that informed consent be obtained from human subjects before they undergo a risky medical procedure. Regardless of how it is practiced, IVF entails the death of a majority of embryos produced by the technology. Some who believe that human embryos possess the rights of personhood object to their exposure to this risk without informed consent. Because embryos cannot possibly give consent, proponents of this objection reject IVF as immoral. However, consistency also requires rejection of natural human conception, since the odds are that any single embryo so produced will die unconsentingly rather than implant successfully in the uterus [17],

*IVF is wrong because of the loss of human life that accompanies the production of each healthy baby [39]

No matter how scrupulously it is practiced, IVF is more wasteful than natural reproduction; it consumes more embryos per successful pregnancy. Its rate of success per attempt, measured by cycles required to become pregnant, is now only slightly behind natural reproduction, but typical programs produce four or five embryos per attempt and transfer on average about three to the uterus. Hence, although natural reproduction entails the death of four or five embryos for each one successfully implanted, IVF uses 15 to20 embryos per pregnancy. Is this too high a price in human embryos to pay for a healthy baby?

The answer to this question depends on the status of the early human embryo. Much of the public debate over IVF has gone to arguments about the beginning of human life, ensoulment, personhood, and rights before birth. Many of these arguments apply as well to the abortion debate. Public consensus may be unattainable on these issues. Indeed, one of the more novel objections to IVF is that it brings further trauma to a nation already deeply divided on the morality of abortion [21]. The deep division of society over the status of the human embryo and fetus reflects deeply held personal convictions.

The IVF debate is actually much simpler than the abortion debate because the latter encompasses all stages of human development from conception to birth, with acquisition of varying degrees of sentience and potential autonomy complicating moral analysis of fetal life. As practiced in a clinical setting, IVF addresses a relatively simple and short segment of human development between conception and implantation. Here the embryo consists of one to a few dozen undifferentiated cells. The biological substrate for self-awareness, a nervous system, has not begun to form in the preimplantation embryo.

People who believe protectable human life begins at or after implantation are unlikely to object to the loss of embryonic life that accompanies IVF. This does not mean that preimplantation embryos are considered inconsequential or unworthy of respect. It simply means that no moral wrongfulness is associated with the expenditure of these embryos in a sincere effort to enable one among them to become a baby. Just as sperm and oocytes may be dissipated in efforts to conceive an embryo, embryos may be consumed without remorse in attempts to achieve a pregnancy.

On the other hand, people who believe human life is sacred from the moment of conception may have difficulty accepting the greater loss of embryos with IVF as compared with natural reproduction. Perhaps the realization that significant loss of embryonic life, albeit sacred, is a natural concomitant of human reproduction could make IVF more acceptable. More likely, however, comparing rates of embryo loss between natural reproduction and IVF misses the point for a large group of people who believe personhood begins at conception. Their focus will be not so much on relative numbers as on responsibility for such deaths as occur. The crux of their view is that death in the course of natural events is morally neutral but death at the hands of people is morally reprehensible. Consideration of motives hardly softens this position and only serves to qualify the crime of homicide; one is left with manslaughter if not murder.

Much hinges on whether one believes conception, implantation, or some later event is the morally significant landmark in human development. It will be helpful to consider two contrasting examples of religious thought on this subject.

The Roman Catholic Church teaches that the embryo is either human or incipiently human and infusion of the soul at conception is at least probable and cannot be disproven [40,41]. Hence, to kill an embryo is to risk killing a human being. In fact, the Catholic Church views the killing of an embryo or fetus as a more heinous crime than homicide, because it deprives the young human of baptism, and hence, eternal life [41]. It is this reasoning that motivates the Catholic Church to preserve the fetus and let the mother die during difficult childbirth; after all, the mother has presumably been baptized, but since the fetus has not, it will suffer perdition [42].

The Catholic claim to absolute protection of the human embryo from the moment of conception is a relatively recent moral tradition daring only from the mid-nineteenth century. Its appearance then was motivated by medical advances making abortion easier and safer [41]. An earlier Catholic view of ensoulment was provided by the poet Dante:

Open thy breast to the truth that follows and know that as soon as the articulation of the brain is perfected in the embryo, The First Mover turns to it, rejoicing over such a handiwork of nature, and breathes into it a new spirit full of power, which draws into its own substance that which it finds active there and becomes a single soul that lives and feels and revolves upon itself [43].

In contrast to the current Catholic emphasis on Concepcion, the Jewish metaphysical tradition teaches that human life begins at birth; before that, there is life, but it is not the life of a human person [42]. The embryo has value, and the fetus has value, but it is not the same value as a person. Similarly, the embryo and fetus deserve respect, but it is not the same respect due a person. In traditional Judaism, the life of the fetus and the life of the mother are not deemed of equal value until the major portion of the infant has been delivered [44]. Throughout gestation, the welfare of the mother takes precedence over that of the fetus.

Jewish scholars trace the status of the fetus to the text in the Book of Exodus (21:22) implying that the destruction of an unborn fetus is not culpable as murder and that the fetus does nor therefore have the same absolute right or life as an already born human being [45]. Nevertheless, Judaism insists that the embryo or fetus, in different stages from the moment of conception, enjoys a right to life which can only be set aside under exceptional circumstances.

In Jewish teaching, increasing reverence for life, as it progresses through the stages of human development before birth, does not begin abruptly at conception. The oocyte itself is accorded a degree of respect unknown in other traditions. The Israeli Ministry of Health forbids recovery of human oocytes unless they will be fertilized with the husband’s sperm and transferred to the wife’s uterus [46]. To our knowledge, nowhere else is the human oocyte protected by law from experimental manipulation.

In contrast to the Catholic dogma that IVF is immoral and unlawful, Judaism considers IVF of no ethical concern. If a woman’s infertility can be relieved by IVF, “it would be classified as a mitzvah (a good deed), and nothing more” [47-52].

The common reasons why IVF has been considered morally unacceptable cover a wide range of theological, philosophical, social, psychological, biological, and medical concerns. This review organized these concerns under five categoric headings:

• The ethic of preserving the traditional roles of God and sexual intercourse in human conception
• The ethic of protecting future offspring from harm
• The ethic of sparing infertile couples further frustration and guilt
• The ethic of preventing genetic manipulation of the human species
• The ethic of saving human embryos from destruction There is no compelling reason why IVF should diminish

either the influence of God on conception or the benefits of sexual intercourse on marriage. Sufficient evidence already exists to reassure critics that IVF causes no higher incidence of physically defective births than natural conception. Infertile couples must decide for themselves whether any additional emotional toll exacted by IVF is an acceptable burden. The most serious potential dilemmas raised by IVF concern its possible future application in eugenics, sex selection, cloning, and hybridization. These are capabilities associated with IVF that will undoubtedly provoke intense public debate, and ultimately, some degree of governmental regulation. The principal dilemma of currently practiced IVF is the accompaniment of a good effect, helping infertile couples have babies, with a bad effect, excessive death of human embryos. Whether the dilemma is serious or trivial depends on individual attitudes toward the relative value of babies and embryos. If the intrinsic worth of an early human embryo is no less than that of a newborn infant, IVF cannot be justified. On the other hand, if the principal value of a human embryo derives from its ability to become a baby, IVF may be seen as a moral way of awakening this potential where it would not otherwise exist.

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