Brooklyn, N.Y. • Esther Friedman held the Book of Psalms with both hands as she peered over her glasses at the fertility lab monitor. There were eight beautiful round eggs, retrieved from a young woman earlier that day.
“A good number,” Friedman said, nodding.
A technician grabbed a long glass tube, filled it with sperm and, within a few minutes, the eggs were fertilized. Eight potential new lives had just been conceived.
Friedman — an Orthodox Jewish rabbinical observer hired by the prospective parents — took a step back, lowered her eyes and began to pray.
Forty years ago this July, the world’s first “test tube” baby was born at a British hospital in the industrial city of Oldham, heralding a radical change in the creation of human life. Until Louise Joy Brown arrived, hopeful parents had been at the mercy of fate, and a barren marriage could feel like divine punishment.
Afterward, as one of the doctors involved in Brown’s birth put it, it seemed that science — not God — was in charge.
Since then, in vitro fertilization, or IVF, and related technologies have produced some 7 million babies who might never have existed — roughly the combined population of Paris, Nairobi and Kyoto — and the world’s fertility clinics have blossomed into a $17 billion business.
The procedures have amplified profound questions for the world’s theologians: When does life begin? If it begins at conception, is it a sin to destroy a fertilized egg? What defines a parent? Is the mother the woman who provides the egg or the woman who gives birth? What defines a marriage? If a man’s sperm fertilizes an egg from a woman who is not his wife, does that constitute adultery?
The moral questions are rapidly becoming more complex. Researchers are working to advance gene-editing tools that would allow parents to choose or “correct for” certain preferred characteristics; to create artificial wombs that could incubate fetuses outside the body for nine months; and to perfect techniques to produce “three-parent” babies who share genetic material from more than two people.
The risks, both scientific and moral, are enormous — particularly with gene editing, which could be used to produce babies with superhuman eyesight, speed and intelligence. “Off target” effects could result in fundamental changes not just to human bodies but to human nature.
Some religious leaders have objected to using gene editing on embryos or in ways that could affect future generations, arguing the human genome is sacred and editing it violates God’s plan for humanity. The U.S. National Academies of Sciences, Engineering and Medicine has invited religious critiques of the technology, and the Vatican is convening meetings to discuss its moral implications, including one this week in Rome.
On the guest list is Harvard geneticist George Church, who helped launch the Human Genome Project to map human DNA and is part of a team that announced plans in 2016 to use the gene-editing tool CRISPR to create synthetic human genomes to advance medical research. Church said he believes critics from the faith community will come to accept gene-editing technology, just as religious leaders eventually adapted to the discoveries of Galileo, Copernicus and Darwin.
“In the Bible, it says we are given dominion over the Earth,” Church said. “Inventing newer and newer advanced technologies is almost a key component of human nature.”
Most major religions have indeed come to tolerate — and even embrace — IVF, which was originally viewed with equal alarm. But the increasingly commonplace procedure is still condemned at the highest levels of the Catholic Church.
“Technology is a great thing, but technology does change us,” said the Rev. Michael J.K. Fuller, executive director of the Secretariat of Doctrine and Canonical Affairs for the U.S. Conference of Catholic Bishops. “At some point, we need to ask — how much is it changing us, and is that a good thing?”
The Utah-based Church of Jesus Christ of Latter-day Saints, in the end, leaves the decision up to husbands and wives.
“The church strongly discourages in vitro fertilization using semen from anyone but the husband or an egg from anyone but the wife,” it states in its policy handbook for local lay leaders. “However, this is a personal matter that ultimately must be left to the judgment of the husband and wife. Responsibility for the decision rests solely upon them.”
A medical moonshot
The world’s 7.6 billion people practice an estimated 4,200 religions, each with various ideas about the soul and human destiny. So when British scientists Patrick Steptoe and Robert Edwards helped produce the first IVF baby on July 25, 1978, the event was viewed through heavy filters of wonder and suspicion.
Newspaper and TV reports recognized the birth of a child conceived in vitro — literally “in glass” — as a milestone in human history, akin to Neil Armstrong’s walk on the moon. London’s Evening News declared little 5-pound, 12-ounce Louise Brown a “Superbabe.” Newsweek compared her birth with a “first coming.” The New York Daily News wondered, “Test tube birth: a blessed event?”
Some faith leaders, especially Catholics, expressed grave misgivings and concern that the birth was unnatural, immoral and possibly dangerous. Some wondered whether children born through IVF might be superhuman or exceptionally frail or plagued by unforeseen defects introduced by the process.
Brown’s parents, who had been trying to conceive for nine years, saw divine intervention.
“Louise is, truly, a gift from God,” Lesley Brown tearfully told reporters. Her husband, John, added: “I am not a religious man, but I thank God that I heard our little girl cry for the first time.”
Steptoe emphasized the mundaneness of the science, arguing he was neither a wizard nor Dr. Frankenstein.
“We have merely done what many people try to do in all kinds of medicine — to help nature,” Steptoe said. “We found nature could not put an egg and sperm together, so we did it.”
Edwards, who won the Nobel Prize for medicine in 2010 for the breakthrough, was more direct in challenging critics in the religious establishment. In a rare interview in 2003, he told the London Times the experiments were “about more than infertility.”
“I wanted to find out exactly who was in charge,” he said, “whether it was God himself or whether it was scientists in the laboratory.”
He was confident of the answer: “It was us.”
Numerous research teams quickly set out to replicate the breakthrough. Candice Reed, Australia’s first IVF baby, was born in 1980. Elizabeth Jordan Carr, the first American, followed in 1981.
In those early years, scholars from the world’s major religions expressed uneasiness about IVF. Some faith communities were quicker to accept assisted reproduction, including within the Hindu, Buddhist and Protestant traditions. In other places, many couples were left waiting for a signal from religious leaders.
Egypt’s Gad El-Haq Ali Gad El-Haq, a grand imam, was among the first major Muslim leaders to take a clear stand. In 1980, he issued a fatwa, or ruling, permitting IVF and similar procedures, so long as they involved a husband and a wife and no eggs or sperm from a third party.
The grand imam compared sterility with a disease and — noting the prophet Muhammad spoke of the need to seek remedy for disease — concluded IVF is permissible as a cure.
If a “trustworthy physician recommends in vitro fertilization and shall be responsible for its appropriateness, then it is permissible and obligatory as a treatment of a woman who has pregnancy impediments,” El-Haq wrote, according to a translation published by Marcia Inhorn, a Yale medical anthropologist.
Nearly two decades later, Ayatollah Ali Khamenei of Iran weighed in, loosening restrictions further for his Shiite Muslim followers. For example, men were permitted to engage in “mut’a” marriage to egg donors — a temporary union — to take advantage of technological advances without the taint of adultery.
Today, IVF is a widely accepted intervention in the Muslim world, and El-Haq’s fatwa is prominently displayed on many clinic walls.
The Vatican, marriage and sex
The Vatican saw things differently. When Louise Brown was born, Cardinal Albino Luciani, who would soon become Pope John Paul I, congratulated her parents and wished the baby a happy and blessed life. He also said IVF raised many questions that would require a deeper moral response.
Nine years later, in 1987, the church issued the “Donum Vitae” (the Gift of Life), a guidance document on biomedical issues that has become the definitive Catholic teaching on IVF. In it, the church divided fertility treatments into two categories: Those that help achieve pregnancy through sex — fertility drugs, ovulation charts, surgery to remove blockages — are moral. Those that replace sex with technology, including IVF and artificial insemination, are immoral.
The division reflects the church’s view that the physical expression of love within marriage is godly and that sex alone can produce a child who is loved unconditionally as a person independent of the parents’ will and desires. Techniques like IVF end up “producing” a child in a lab where the parents are completely absent.
“The birth of a baby is always reason for joy. But the question was, what did they do to get there, and what does that mean?” said Richard Doerflinger, a scholar who recently retired from the U.S. Conference of Catholic Bishops, where he served for 36 years as a liaison to Congress on bioethics.
The other primary objection to IVF involves the treatment of fertilized eggs as “products” in a marketplace, as well as their routine creation and destruction. The church teaches that life begins at the moment of conception, and it has condemned the destruction of embryos as an evil on par with abortion and euthanasia.
Despite his liberalism on some issues, the current pope has been unwavering on the subject.
“We are living in a time of experimentation with life. But a bad experiment,” Pope Francis said in 2014 shortly after he was elected to his position. “Making children rather than accepting them as a gift, as I said. Playing with life. Be careful because this is a sin against the Creator.”
Much like church teaching on contraception, the guidance on IVF is out of step with public opinion in the United States. The Pew Research Center found in 2013 that, while Americans are divided on the morality of abortion, nearly 80 percent of U.S. adults consider IVF morally acceptable or not a moral issue — a finding that holds regardless of gender, political affiliation or religion.
John Grabowski, director of moral theology at Catholic University, acknowledged “a disconnect between official church teaching and Catholics’ practice.” In interviews, Catholic couples who have undergone IVF said they felt a successful birth had been blessed by God or was otherwise “meant to be.”
Still, many Catholics are troubled by the destruction of embryos.
Ariannet Vanas of Boston struggled with the idea of IVF because she knew the Vatican disapproved. Ultimately, she said, she concluded God would not “judge us because we want to be a family.”
After her twins were born six years ago, doctors told Vanas, 39, she would be unable to sustain another pregnancy. So she removed the laboratory tubes containing her unused embryos from cryo-storage and arranged them next to pictures of grandparents and other relatives who had died.
“It kind of weighs on you,” she said, “the journey that was needed.”
‘Be fruitful and multiply’
Some of the first scholarly writings about IVF from Jewish experts were also negative. Rabbi Eliezer Yehuda Waldenberg, one of the most important authorities of his generation on medical issues, wrote that a baby produced from the procedure was not related to his biological parents. Rabbi Moses Feinstein, known for his writings about women’s issues, raised questions about the waste of “seed,” or semen.
Attitudes began to change with greater understanding of the procedure. And since the soul does not enter the embryo until 40 days after conception, according to some interpretations of Jewish scripture, unused embryos did not raise the same moral questions. Many Jewish leaders began to actively encourage assisted reproduction, viewing it as a way to heed God’s instruction to “be fruitful and multiply.”
Technical worries remained, however: Could a woman’s eggs be joined with the wrong man’s sperm? The solution was rabbinical observers such as Friedman who supervise fertility clinics to make sure they conform to Jewish law and there are no questions about the child’s lineage.
The idea originated in Israel, where IVF is universally covered by national health insurance. Working with Friedman and Rabbi Avrohom Friedlander, the Genesis Fertility and Reproductive Medicine clinic in Brooklyn was among the first American clinics to adopt the practice to meet the needs of its large population of Orthodox and Hasidic patients.
“Religious couples who go through infertility, no matter what religion, suffer because it feels like divine punishment,” clinic founder Richard Grazi said. “And that makes everything more dramatic and painful.”
Monitoring IVF is similar in intensity to certifying kosher restaurants, Friedlander said: Religious observers keep the keys to cryo-tanks where frozen eggs, sperm and embryos are stored and must be present whenever lab technicians handle genetic material. They verify labels and make sure separate surfaces and sometimes equipment are used to avoid mix-ups.
While there are many industry protocols to ensure the integrity of the IVF process, Friedlander said, “rabbis were more comfortable having a divine presence” in the lab.
“When you are dealing with God’s creation, you want to make as sure as possible that things are being done right,” he said.
Friedman, 63, a mother of six, grandmother to 29 and great-grandmother to one, said she got into the work after seeing so many in her community suffer from infertility.
“I believe in a higher being,” she said, “and that he is good and will help us.”
Esther Fixler, who lives near New York, was among the first patients to use the rabbinical monitoring process. Fixler spent a decade trying to get pregnant before coming to Genesis, where she quickly learned her chances of conceiving were abysmally low. In an outburst of emotion, she told Grazi to throw away her genetic material.
Instead, Grazi told her to pray and to have faith. Within a few weeks, she was pregnant with the first of her three children.
“When the pregnancy took, I thought, ‘This is God.’ I had seen it in black and white, whether I had a chance or not,” said Fixler, now 51. “But it wasn’t for human understanding how this happened.”
Her son, now 20, was married in December 2016. Three months ago, he and his wife welcomed their first child, a girl, Fixler’s first grandchild.
The Salt Lake Tribune and The Washington Post’s Ellie Silverman contributed to this story.