Ethics, Unmoored

My husband and I have been trying to give our son a sibling for nine months. So far, no luck. So we did what many others in our predicament do: seek help from infertility experts.

It looks like we are going to be embarking on an IVF journey soon, something I'd never pondered doing before. Which in turn means I've never given much thought to the sticky ethical issues that can crop up in the course of building a family via medical science.

I now find myself feeling torn and uncertain about where to draw lines about what's morally and ethically OK, and what's not. When I was a practicing Christian, the lines were clear: artificial insemination, creating "petrie dish babies," was an abhorrent concept. Wrong. Evil, even. Treading on God's ground as creator of life. If you were meant to have children, you would have gotten pregnant. In other words, take the hint already. If you want kids, adopt.

Yet here we are. As much as I may believe that adoption is a wonderful way to build a family, I love seeing my husband's features reflected in my son's face, my husband's temperament in his actions. I love seeing the strong resemblance our son has to his cousins. The genetic pull is strong and since I've let go of God, I don't feel divinely judged for taking advantage of medical advances.

So, as a result, we want to try to give our son a biological sibling via IVF. But even if I'm generally cool with using assisted reproductive technologies, IVF in particular presents at least two thorny decisions:

• How many embryos to create from a single IVF cycle. The argument for "as many as possible": some huge percentage of fertilized eggs from women my age become abnormal embryos (I think up to 80% have chromosomal abnormalities?). More fertilized eggs = higher chance of healthy embryos. And extra unused embryos can be frozen and used in a future cycle if the first one doesn't take. The argument against: creating excess embryos means we have to decide what to do with those ultimately not used / not needed. Are these our unborn children?

• Whether to do pre-implantation genetic screening. Pro: Can help identify which embryos have chromosomal abnormalities. Such unhealthy embryos are a leading cause of miscarriage, so identifying which embryos are unhealthy means that only healthy ones are selected for transfer, thus increasing my chances of a successful pregnancy. Downside: is this not creating designer babies at some level, and again leaving unused (unhealthy) embryos in limbo?

I had always identified as pro-life and was never interested in drawing distinctions about when life begins: at conception seemed like an obvious and easy answer. (Easy because it eliminated a lot of gray areas that seemed too hard to parse.) Post-God, I didn't sit down and consciously re-examine my pro-life stance. But when Paul Ryan's Personhood legislation of 2011 was in the headlines (which proposed to give fetuses full personhood from the moment of fertilization), it did not take me long to reject that proposition on its face. Taken to its logical end, any woman who had suffered a pregnancy loss was at risk of being accused of murdering a person. This struck me as patently ridiculous, because at the margins it meant that a woman who had experienced a chemical pregnancy - where an egg is fertilized and implants on the uterine wall briefly, but doesn't "stick," and thus no pregnancy develops - was theoretically at risk of a murder charge. Considering that 50-75% of miscarriages are caused by chemical pregnancies, if such embryos are "persons" then humankind is well and truly overrun with murderous women. As I said, patently ridiculous.

As a few people have explained to me, some (many? most?) chemical pregnancies are the result of chromosomal abnormalities in the embryo - the miscarriage being nature's protective system kicking in. If you believe in God, and further believe that personhood begins at fertilization, don't you then have to grapple with the question of why God is killing babies left and right, not even giving them a chance at life? Is not God himself creating "designer babies" in womens' uteri by virtue of the fact that this biological process of rejecting embryos is occurring every day?

I don't care that much about getting answers to the above - let the believers sort themselves out in whatever way makes sense to them. The real question is - how does this all sit with me, someone now unmoored from that great Christian Morality Play, and having to make decisions about IVF?

It feels like some part of my answer could come from the above: nature is selecting and de-selecting embryos all the time for healthy development in the womb. But it just doesn't compute for me to imagine that actual people are dying every time a chemical pregnancy occurs. This in turn might suggest that my ideas about when 'personhood' begins have started to shift. But to what? I don't know yet; I still squirm at the idea of creating excess embryos and I'm unsure about where the right lines are for deeming an embryo "too" unhealthy to transfer. I know I'm not alone in these discomforts, as even a rudimentary google search will show.

So there's lots more to ponder. Sometimes I really wish for the good ole black-and-white days.