My Honest, In-Depth Review of "Walking Through Infertility"

Disclosure: I was given a free digital copy of the book in exchange for an honest review.

Note: This is by far the longest blog post I have ever written. I felt it was important to include everything here. So if you’re game… grab a cup of coffee or an iced tea, and get read to read for awhile!

I recently read an advance copy of “Walking Through Infertility: Biblical, Theological, and Moral Counsel for Those Who Are Struggling,” by Matthew Arbo. The book is published by Crossway, a major Christian publisher, and Matthew Arbo holds a PhD from the University of Edinburgh. He is an assistant professor of theological studies and the director of the Center for Faith and Public Life at Oklahoma Baptist University.

I have mixed feelings about this book. I have no doubt that the intentions behind this book are to comfort, counsel, and encourage people who suffer from infertility. I was extremely pleased and encouraged by the majority of this book. However, I disagree with much of what he has to say about assisted reproduction.

Arbo is obviously a legitimate theologian, not just a Christian blogger who decided to write a book. (No shame in that– I did it myself!) He has significantly more theological education than I do, and probably more than most of my readers do. I want to be clear that I write this blog post in a spirit of humility (because who am I to challenge the conclusions of someone much more educated than me?) and grace. Grace for the author, because any book about infertility by a major Christian publisher is a huge victory for more infertility awareness in the Church. And grace for potential readers of the book, because I recognize that there are a variety of views on infertility and assisted reproduction within the Kingdom of God. We can hold these different viewpoints and still love and respect each other as brothers and sisters in Christ.

I also believe it’s important to read because it outlines some of the moral and ethical dilemmas readers may not be aware that they will have to face if they choose assisted reproduction. If you choose to disagree with him and any of his counsel (as you’ll see that I do), you will at least be spared the possibility of being surprised by decisions you didn’t know you’d have to make.

Finally, I hope you will see that I don’t write this blog post in order to convince you to believe one way or the other. I certainly don’t want readers who disagree with him to respond with hateful or disrespectful comments. Towards the end, I voice some pretty strong misgivings about one particular piece of counsel he gives. But I hope that you will see that I have tried my best to remain respectful and I don’t do it from a spirit of anger or a “my-side-versus-his-side” mentality. I am protective of my readers and all that hurt they’ve been through, and when I see something that I feel is particularly dangerous or unwise, I feel an obligation to speak up.

So here are my thoughts…

What I Loved

Arbo advises couples to consider all the biblical, ethical, and theological considerations of assisted reproduction when making a decision about whether or not to proceed.

Despite the fact that I disagree with some of his conclusions about assisted reproduction (which I’ll outline in the second part of this post), this is very wise counsel. Many of us are not fully aware of the decisions we will have to make when we choose IVF or surrogacy. I have written before that I do not regret that choice we made, but my husband and I are living with the consequence of not really understanding that we would have to make very difficult decisions as a result in the future.

He acknowledges the pain of infertility and reminds us that God understands.

“Here’s the central idea of this book: the Creator and Redeemer of life has not forsaken the infertile but has instead given them a slightly different way of being family, and thus of participating in the life and mission of God. In God is life. He is the only final source of human consolation, for fertile and infertile alike. God is infinitely good. He is wise. We worship an almighty God” (p. 20).

“…this book was written to help you see and understand that God is the Giver of life. You are his child. He cares deeply about you. When you hurt, he hurts with you” (p. 21).

He encourages readers to seek comfort in the Lord instead of giving into to self-pity and resignation.

“If God does not gift a couple with children of their own progeny, the task for Christian couples is to wait upon the Lord in faith and obedience. This waiting differs dramatically from fatalistic resignation. Waiting in Scripture is akin to eager receptivity to God and his Word” (p. 21).

He assures readers that infertility is not a punishment.

I recently read a story from a woman whose pastor suggested that her inability to conceive was because something was spiritually wrong with her. I’ve heard countless other stories of women who have received counsel from well-intentioned believers who suggest that there is something they are doing wrong or that they have the ability to fix it themselves. This is tragic and shameful and I am so heartened that there is not a hint of condemnation or suggestion that infertility is a spiritual issue in this book.

“But to all those Christian couples who have not conceived, and who may never conceive, please take the following to heart: you are not being punished, you are not comparably less faithful, you are not failures, and your prayers are not somehow less efficacious. You are God’s child. You are a part of his family” (p. 41).

“If you are without children, please know that God has not forgotten or forsaken you, but has instead, perhaps only for a time, given you a slightly different way of being family and thus of participating in his life and mission” (p. 41).

He presents the idea that childlessness may be a calling- without exhorting the believer to give up or stop hoping and praying for a child.

Learning to submit to God’s calling on our lives isn’t something that always happens overnight. Arbo acknowledges the struggle this may present and compassionately encourages the believer to place their hope in God’s kindness and faithfulness. Submitting to God’s will and actively praying that he will still give children do not have to be mutually exclusive.

“It is entirely possible to rest fully in God’s contentment, to affirm his purposes, and to accept his will, and at the same time to implore him ardently for children” (p. 55).

He encourages the reader to remain committed to and active in their church.

This is a hard one. I’ve written before about my struggles with church during infertility. I don’t think there is anything wrong with taking a break from church during particularly difficult periods, but it’s important to keep those periods temporary.

“Disciples of Jesus aren’t alone. They don’t stand apart as independent or self-sustaining. To be a disciple is to be with other disciples, together following Jesus. In this way belonging implies serving. The metaphors of family and body remind us of what it really means to follow Christ and to live in community with others as though his gospel really is good news. This church is a people constituted by God’s grace and includes fertile and infertile alike” (p. 64).

I do wish he would have included more about how the church can compassionately care for attendees that are experiencing infertility. He doesn’t talk about how the Church often elevates family and children and I wish he would have touched on that. However, I understand that may have been outside the main scope of this book.

He approaches stories of infertility in the Bible as proof that God cares for the childless, NOT as proof that God will give every infertile couple a baby.

Too often, I see well-meaning Christians state that because every story of infertility in the Bible ends with a miraculous conception, then it must be God’s will for every infertility story today to end that way, too. I believe this is dangerous and inaccurate, and Arbo agrees.

“The purpose of these narratives is not to demonstrate why and how our fruitful God always triumphs over infertility, opening what is closed and answering every petition. That is an understandable but misleading conclusion to draw. The purpose, rather, is to highlight God’s covenant faithfulness. He always upholds his side of the promise” (p. 39).

Some Christians also use these stories to assert that receiving any sort of infertility treatment demonstrates a lack of faith. Arbo acknowledges that “God has providentially furnished medical means of opening wombs, means that did not exist in ancient times” (p. 37). Too often, Christian couples are counseled to stay away from any type of treatment and just have faith. I fully believe that God calls some couples to abstain from medical assistance, if only for a temporary time, but He does not require it of everyone. I’m happy to see that Arbo acknowledges that here. However, as we will see below, Arbo has a limited list of which treatments are acceptable.

What I Didn’t Love

Before going into why I disagree about some of his conclusions on IVF, I want to be clear that I respect and support believers who choose not to do IVF. My misgivings about some of Arbo’s conclusions are not that he cautions against IVF, but rather, the reasons he cautions against it. If you have chosen not to pursue IVF because of some of the issues here, I respect and support your decision.

He gets some basic facts and terminology about IVF wrong.

In chapter 4, Arbo writes: “In most instances multiple embryos are implanted, on the presumption it increases the chances of at least one embryo implanting successfully. Birth of multiples is for this reason a relatively common occurrence” (p. 84).

There are several things wrong with this statement. I don’t mean to nitpick one lone sentence, but this sentence builds the basis for some of his major arguments against IVF.

1. During an IVF cycle, embryos are transferred, not implanted. The act of putting embryos back into the mother’s body is a transfer. Implantation happens when the embryo attaches to the uterus and begins to grow. IVF patients can choose how many embryos to transfer, but they cannot choose how many end up implanting (or not implanting). That is still up to God.

2. It is true that when IVF first became available, transferring multiple embryos was the norm. However, the Society for Assisted Reproductive Technology (SART), reports that since 1995, the average number of transferred embryos has decreased from four to about two (the exact figure varies slightly by the age of the woman). In fact, elective single-embryo transfers are becoming increasingly more common, especially in younger IVF patients. In Europe, single-embryo transfer is advocated for in most countries, and is mandatory for patients with good prognoses in Belgium and Sweden (see the Abstract in this paper). Arbo also fails to acknowledge that not all transfers result in a pregnancy and that multiple transfers do not always result in a multiple pregnancy.

3. He states that birth of multiples from IVF is a “relatively common occurrence” (p. 84), but does not cite any sources for this claim. While it is true that the birth rate for multiples have increased, it is in part due to the increase in the amount of women receiving infertility treatment. In fact, SART reported that in 2015, 22% of IVF births resulted in twins and less than 1% of IVF births resulted in triplets or quads. To me, that does not equal “relatively common.”

He hints that IUI and IVF May Break the Sacred Bonds of Marital Sex

Arbo hints that IUI (and IVF) may be morally perilous because it requires the “involvement of a medical technician to facilitate conception, and thus any couple opting for it should consider the deeper theological question of whether the relation between conception and sex is sacred. Is the manner of procreation as God designed open to amendment?” (p. 83).

It seems to me that he is saying that because IUI and IVF involves conception outside of intercourse, it may be morally questionable. Yet, Arbo himself writes earlier in his book that “Christians of the earliest centuries understood friendship to be the highest purpose in marriage. Marital sex may strengthen the bonds of intimacy,loyalty, and friendship, or it may not. The temptation to misuse or exaggerate the capacity of sex to bridge every gap of intimacy is in our time everywhere on display” (p. 27-28). I have trouble seeing how he can state that and at the same time argue that IUI is morally questionable because it doesn’t require marital intercourse. Anyone who has been through and IUI or IVF cycle knows that it has the ability to bring a couple closer together than ever before and increase intimacy and friendship in new ways. The friendship aspect of marriage has to remain strong and intact in order to survive such an emotional and physical challenge.

He counsels couples to limit the numbers of fertilized eggs without acknowledging the consequences of doing so.

I have no issue with Arbo counseling couples to limit the number of eggs that are fertilized to the number they are willing to transfer and/or carry. Limiting the number of fertilized eggs will help couples to avoid the sticky situation of finding themselves with more embryos than they can give birth to and raise. This is a situation I am all too familiar with.

However, I do think it unfair to advise couples to do this without informing them of the logistical, financial, and emotional challenges that will arise when they attempt it. Arbo neglects to mention that many doctors may not want to limit the number of embryos created because it is likely to require more rounds of IVF than normal. He also fails to mention that limiting the amount of eggs fertilized will probably result in a dramatically higher financial cost due to the number of times a woman will be required to undergo egg retrieval and use costly stimulation medications. Finally, with each egg retrieval that is required, a couple must wait another cycle, and the emotional toll may be higher. Even if a couple opts to retrieve a large amount of eggs at once and freeze the eggs, it will still involve multiple rounds of fertilization attempts, which is also costly and time-consuming. One might argue that all these reasons I just mentioned are actually just further examples of why IVF should be avoided at all, and many couples might decide that to be the case for them. But when counseling a couple to take the step of limiting embryos, one must make absolutely sure they understand the consequences.

Arbo advises couples with leftover embryos not to place them up for adoption, but rather, to eventually transfer all embryos and then place the resulting child up for adoption.

“If you have already proceeded with IVF and as a result face a vexing moral dilemma, I advise not to place embryos up for adoption but instead to have them implanted, then, if necessary, place the child for adoption” (p. 93).

Yes, you read that correctly. I read it several times myself to make sure I was correctly understanding what he was saying.

He is telling couples that placing a delivered child up for adoption is a better option than placing them for adoption as embryos and letting the mother who will raise them give birth to them. He states that only under severe situations (like the mother has had a hysterectomy or has died) should a couple place embryos for adoption.

This advice is concerning for many reasons. First, he gives little explanation as to why he feels this way. There are a few paragraphs of warning to potential adoptive parents of embryos about making sure the embryo is not treated as a commodity or property (which I wholeheartedly agree with). However, he does little to explain why he feels it’s better for an embryo to be birthed by its genetic mother rather than it’s adoptive mother.

The one reason he gives is that he believes couples with extra embryos have “children in temporary stasis” (p. 89) that deserve a chance at life. I realize that the belief that life begins at conception (and thus that all embryos are life and “pre-born children”) may very well be the majority belief in mainstream Christianity. However, one must not assume that all Christians believe life begins at conception. The topic is much too large to be addressed here, but it’s safe to assume that some Christians lean more towards the idea that life begins at implantation and that embryos are not the same as an implanted fetus.

And even if the couple embraces the idea that life begins at conception, and that embryos have the same status as an implanted fetus, the idea that a couple should transfer and carry all of them, only to place the resulting child for adoption is so wrought with impracticality and other moral and ethical implications that it’s hard to know where to begin to criticize this.

I would argue that an embryo has a better chance at a full life when it is carried and delivered by the woman who will raise it. Throughout the book, Arbo weaves the story of a fictional couple who experiences infertility and ultimately chooses adoption. It ends with the happy couple smiling as they bring home their adopted daughter, Grace. Traditional adoption is undoubtedly a beautiful and holy thing, but he makes no mention of the trauma and loss that occurs when a child is removed from a mother who carried and nurtured it for nine months, even if the child is removed from the genetic mother’s care immediately after birth.

Arbo certainly recognizes this, since he wrote a wonderful article stating that the separation of immigrant families that is happening at the U.S. border (at the time of this blog post) “is evil.” He even retweeted a tweet that said, “It’s impossible to justify separating children from parents on any scriptural grounds. Quite the contrary: Scripture resolutely condemns the policy.” It’s difficult for me to reconcile the idea that he finds it goes against Scripture to separate an immigrant child from their family, yet advises that it’s better to separate a child and the genetic mother (breaking all the physical and emotional bonds that pregnancy creates) instead of allowing the woman who will ultimately parent the child to form those early, extremely important bonds.

And then, of course, there is the trauma for the woman who has been told to carry, deliver, and then give up the child. (And this is assuming that the woman could afford additional transfers, pre-natal care, and delivery costs. Or that her body would handle multiple pregnancies— especially if she is an older mother. Or that her marriage, other children, and emotional well-being wouldn’t be sacrificed and damaged in order to comply with this type of counsel). Arbo offers no guidance or encouragement for the women he advises to do this, other than, “That may be terribly hard counsel to accept, I realize; and I do not pretend to understand the struggle you have endured to this point. I can only implore you to seek God’s guidance and courage, and to hear again what God has said about his purpose for human beings and their relationships” (p. 93).

My final thoughts:

There are several other reasons why Arbo believes IVF may be unethical that I have trouble agreeing with, and since this article is already too long, I won’t go into them here. He also touches a bit on surrogacy, which he unequivocally labels as “not morally permissible” (p. 95). I agree that surrogacy can sometimes lead to murky ethical waters, but not always. The idea that any form of surrogacy is not morally permissible is, in my opinion, a gross generalization.

I believe that the Lord leads some believers to IVF or other methods of assisted reproduction, and some he calls not to. I firmly believe the Lord provided the resources for us to do IVF, and we saw unexplained, miraculous changes in our embryo quality on our final round of IVF.

I believe God is the creator of all life, no matter if that life begins in the fallopian tubes or in a laboratory. Only God decides if an egg fertilizes. Only God decides if the embryo then grows and is transferred. Only God decides if that embryo then implants and continues to develop until birth. To say that “the process of IVF, begetting is replaced by artificial making” gives human beings too much power. We can no more create life than we can control the moon and the stars. Isaiah 42:5 says:

“God, the Lord, created the heavens and stretched them out.
He created the earth and everything in it.
He gives breath to everyone,
life to everyone who walks the earth.”

A doctor can put egg and sperm in close proximity and we can pump the mother full of drugs to encourage fertilization and implantation. But only God can breathe life into that embryo.

Would I recommend this book?

You may be surprised that I say yes, I would recommend this book. Despite my misgivings about several of his statements, and my HUGE exception to his embryo adoption advice, I believe this is a book that believers who are seeking to educate themselves about the Biblical, ethical, and moral implications of infertility should read. You do not have to agree with it all, but it will help you make more informed choices and to see beyond what is sometimes an overwhelming desire for children.

Updated September 2018: Matthew Arbo was gracious to respond to some questions I had about the points we disagreed on. You can read my questions and his responses here.

If you’re interested in purchasing the book, you can buy “Walking Through Infertility: Biblical, Theological, and Moral Counsel for Those Who Are Struggling” here on Amazon.

Thoughts? Would you be interested in reading the book? Feel free to share your thoughts in the comments. Please be aware that I will remove without notice any comments that are disrespectful, rude, threatening, attack the character or question the salvation of readers or Matthew Arbo.