Stewarding Fertility

Considerations for Christians regarding birth control, infertility, and family planning

And whatsoever ye do in word or deed, do all in the name of the Lord Jesus, giving thanks to God and the Father by him. Colossians 3:17

Intent and Purpose: The following information was written by members of the HarvestCall Medical Committee and Apostolic Christian Counseling and Family Services to provide information regarding sexuality, fertility, and family planning as viewed through a Biblically based worldview. May this content equip each one to better honor God with his/her own fertility choices and equip the church community to support couples who have questions, concerns, and needs regarding the relational and spiritual aspects of these intimate and important issues. For further dialogue on this topic please seek counsel from your local elder, personal medical provider, or e-mail the HarvestCall Medical Committee at [email protected] or ACCFS at [email protected]

Summary Statements

• Different convictions on these sensitive matters exist in the church body and should be approached with mutual love and respect, knowing that each individual is accountable to God for their own choices and decisions.
• Childbearing and childrearing are blessings according to scripture. It also requires the investment of physical, financial, social, and emotional resources from both parents. Decisions about stewarding fertility should be made seeking to consider one another and honor God – faithfully serving Him while allowing room for Him to work in unexpected ways.
• There are many options for Christian couples to steward their fertility. Each has different trade-offs or considerations. Different approaches may be best for different couples or at different stages of their lives.
• Christians are encouraged to refrain from methods of fertility management that intentionally end a pregnancy or knowingly prevent implantation of a fertilized egg.

General principles and considerations regarding the spiritual, relational, and emotional aspects of fertility

Mutual respect and love for individual convictions in the church body: Fertility, the ability to create, bear, and birth biologic children is connected to many sensitive and deeply emotional areas of our lives. By God’s design, strong feelings are often involved. These topics are usually not appropriate for public discussion, and individuals are encouraged to seek counsel privately from trusted individuals that can maintain confidentiality. General discussions and comments in the church community about these matters should be conducted with loving respect and sensitivity to different convictions in the spirit of Romans 14. Individuals are encouraged to keep in mind that each person will give an account to God for the decisions they make, and He is the ultimate judge¹.

God’s purpose for sexual expression: Sexual expression in marriage is an opportunity for husbands and wives to demonstrate their love and service to each other. It is not merely a means to a procreative end (i.e. to create babies). Nor is it a tool for selfish gratification or manipulation of another. Without the committed loyalty, sacrificial love, and exclusivity of marriage, sexual acts have the power to cause deep pain and lasting scars. Misuse or misunderstanding of God’s good design for sexual expression can be a source of much pain and confusion rather than a good gift of God to be enjoyed within the boundaries of committed marriage.

God intends sexual intimacy in marriage to represent and be a constant reminder of the oneness and mutual love that exists between Christ and the Church². The giving of one’s body wholly to another in joyful celebration of shared love³ and mutual submission⁴ reminds us of the joy with which Christ sacrificed himself for his bride⁵ and the joy with which we (the church) receive that love and give back the gift of our love and exclusive loyalty to him.

God calls fertility good: While sexual expression is not only for procreation, the Bible is clearly pro-family, childrearing and fertility. Propagation, to be fruitful and multiply, was one of the first instructions God gave to Adam and Eve, and to Noah and his family after the flood.  Scripture repeatedly encourages couples to have and raise children⁶.

Parenting is a blessing whether children are adopted or biological. Having and raising children teaches us much about God and his relationship to us. It also provides opportunities for our own spiritual growth and refinement as self gives way for the care of vulnerable others.

However, family size or composition does not indicate one’s abilities or spiritual standing. Those who cannot or choose not to have children because of unique personal situations or convictions can serve the church body in valuable ways⁷ and their contributions should not be diminished nor their situation judged.

Fertility should be stewarded to grow in fruitfulness and service to God, like any other resource: Decisions about fertility should be made seeking to honor God and to be faithful in serving Him. Children are a blessing and require physical, emotional, and spiritual resources in their care and nurturing. Couples are encouraged to live in faith that God can provide for their needs, while also accepting reasonable boundaries to nurture their own, and their children’s, mental, physical, and spiritual health.

Husbands are encouraged to remember that they are accountable to God for how they use their authority. The husband needs to consider his wife’s physical, emotional, and spiritual needs and her unique perspectives regarding this matter. Seeking her good and considering her input is loving her as Christ loves the church⁸. He should also participate in making and managing fertility and childing rearing duties including the emotional, physical, and spiritual care of children God gives them.

Wives are encouraged to remember that fertility is a gift/blessing and not the only thing for which she is created⁹.

Give God room to work: A willingness to surrender the outcome to God and trust in his sufficiency, grace, and love is important for each person regardless of the fertility management methods they may chose. Sexual intercourse may result in pregnancy regardless of human attempts to intervene. Additionally, a couple may not get pregnant despite significant efforts to conceive. Each should allow God to grow them through unexpected, unintended, or even initially unwanted outcomes.

Medical information regarding fertility management

Understanding a woman’s menstrual cycle can help us better steward fertility:  Awareness of when a woman is most fertile can allow couples to time intercourse to either increase or decrease the likelihood of pregnancy. See the appendix at the end if you would like more detailed information on the menstrual cycle.

Human life begins at conception/fertilization: We believe human life begins at conception – when sperm from a man joins with an egg from a woman to create a human zygote (the earliest form of a newly developing human). A zygote contains all the necessary genetic and cellular parts to develop and grow as a human being provided it is nourished and protected. This need for nourishment, shelter/protection, and human relationships/community to develop and thrive continues throughout the entirety of our lives. Weakness, need, and dependance on others does not make one less valuable, or less human, in God’s eyes¹⁰. Because of this, Christians are encouraged to refrain from methods of fertility management that intentionally end a pregnancy or knowingly prevent implantation of a fertilized egg.

Fertility management options: Since most women of reproductive age will conceive if no contraception is practiced, the choice of fertility management should compare the physical, emotional and spiritual costs of pregnancy against those of any method of contraception. The trade-offs between different approaches can be different for different individual women and couples. Grace and respect for each person’s unique needs and circumstances are encouraged.

There are many different options couples can use to space pregnancies. Many couples will combine methods or will use different methods in different seasons of life. The main categories of contraceptive methods as well as their mechanism of action and efficacy are listed in the table below.

Method	% of women experiencing unintended pregnancy in 1st year of use11
	Typical use	Perfect use
No method	85
Periodic abstinence: Couple chooses not to engage in sexual intercourse around the time that a woman is most fertile. Requires an awareness of the woman’s cycle and healthy self-control. Several resources are available for couples using this approach to fertility stewardship. Results vary widely with the symptothermal method being the most effective.	2 -23	0.4-3
Lactational amenorrhea: Ovulation will be suppressed in women who are meeting all their baby’s nutritional needs by breastfeeding. For the first 6 months after delivery this can be an effective means of preventing pregnancy.	Exact numbers are unknown
Coitus Interruptus: also called the withdrawal method. Requires the husband to withdraw his penis from his wife’s vagina and genital region before he reaches climax. Efficacy of this method varies as sperm can be released in pre-ejaculate fluid, and interrupting intercourse as climax approaches requires considerable self-control.	20	4
Barrier: A physical barrier is used during intercourse to keep sperm from entering the uterus. Condoms are most common but there are other options as well.	13	2
Spermicide: Chemicals that kill sperm are inserted into the vagina prior to intercourse. Spermicides come in many forms (gels, foams, creams, and suppositories).	21	16
Hormonal: Hormone-based contraceptives primarily prevent pregnancy by preventing ovulation. Safe, effective, and well tolerated by most women these medicines do not impair future fertility and slightly decrease the risk of some female cancers. Several options exist from daily pills, weekly patches, monthly vaginal rings, quarterly injections, and 3-5 year arm implants and hormone-containing intrauterine devices (IUD’s). Consultation with a medical professional and a prescription are usually required.	0.1-7 (higher efficacy for long-acting methods)	0.1-0.5
Copper IUD (intrauterine device): Does not contain hormones and does not prevent ovulation. Once placed in the uterus by a medical provider, it creates an inflammatory reaction that repels sperm and makes it harder for them to survive in the female reproductive tract to fertilize an egg. It may also work by preventing implantation of a fertilized egg though the precise degree of this potential effect is unknown.	0.8	0.6
Permanent sterilization: Surgical procedures cut and tie off the tubes responsible for transmitting sperm (vasectomy for men) or eggs (tubal ligation for women) from their site of production (testicles and ovaries) into the main reproductive tract. These are permanent procedures.	0.1-0.5	0.1-0.5

 

Additional considerations regarding hormone-based contraceptives

Useful for treatment of other medical conditions: Diseases related to the uterus and menstruation like endometriosis, polycystic ovaries, and uterine fibroids all can cause significant suffering and medical complications for women. Currently these conditions are primarily treated with hormone-based contraceptives. Some women who wouldn’t otherwise have chosen these medicines for fertility management may find hormone-based contraceptives are their only reasonable option for treating these medical problems.

Secondary actions: Hormone-based contraceptives primarily prevent pregnancy by preventing ovulation. They may also prevent pregnancy through several secondary effects.  For instance, hormones will thicken cervical mucus reducing the ability of sperm to enter the uterus. They may also reduce the movement of an egg through the fallopian tube decreasing the likelihood of fertilization. Furthermore, they thin uterine lining – which is useful for managing menstrual problems but may limit the ability of a fertilized egg to successfully implant.

Currently we do not know the degree to which these secondary effects may contribute to preventing pregnancy since hormone-based contraceptives are so effective at preventing ovulation and we do not have a way of measuring how often an egg is fertilized but does not implant. Where the intent is to conscientiously prevent conception rather than disrupt implantation or end a pregnancy, different convictions regarding these methods should be respected in Christian fellowship.

Other considerations

A note on ectopic pregnancies: An embryo will die if it implants in the fallopian tube rather than the uterus. These ectopic pregnancies also threaten the life of the mother and require emergency medical treatment. Surgical removal of all tissues that develop as part of the pregnancy (often referred to as the products of conception which includes the embryo and placenta) is one common treatment. Another treatment uses the medication mifepristone to help the body naturally pass or expel products of conception without surgery. When medically feasible, this can be much safer for the woman and allows a faster recovery, and better-preserved fertility (surgery requires removal of the fallopian tube with the ectopic pregnancy). Treatment of an ectopic pregnancy is not an abortion.

Infertility is complex, counseling is recommended to process the emotional, spiritual, and ethical implications of fertility treatments: The ability of medical technology to help couples with infertility has blessed many people while introducing some serious ethical and moral concerns that often compound the existing emotional stresses of infertility.

• Use of medicines to induce release of eggs from the ovaries may result in a woman becoming pregnant with multiple babies simultaneously. When this occurs, medical providers are obligated to offer “selective reduction”. This procedure kills some of the developing embryos in the uterus in order to make the pregnancy safer for the woman and the unselected embryos.
• In vitro fertilization (IVF) creates embryos (new human lives) by combining sperm and eggs outside of the uterus and then reinserting them in small batches for implantation. Since implantation is not universally successful with this method, since harvesting eggs puts considerable strain on a woman’s body, and since this method is expensive, standard approaches to IVF often produce excess embryos that remain unused by a couple and can be held indefinitely in a suspended state of development in frozen storage. Couples considering this method are faced with difficult decisions regarding how to honor the sanctity of human life.
• Use of donated sperm or eggs, embryo adoption from another couple’s IVF treatments (the embryos they don’t end up using), and use of a surrogate to carry a pregnancy can introduce complex and weighty questions for all involved. Genetic connections and carrying another life in one’s body often create mysterious, strong, and lasting emotional bonds that can be confusing or distressing for the child, donor, or surrogate to process.

Individuals struggling with infertility and considering these options are strongly encouraged to seek godly counseling, submit to hard self-examination, and explore the difficult questions deeply and thoughtfully before pursuing these methods. Consideration of the weighty consequences for all concerned, the implications for human life, and placing other’s needs above their own desires is essential.

Appendix: The female menstrual cycle

The average menstrual cycle lasts 28 days with day one being the first day of menstruation. This cycle can be divided into four phases.

• Menstruation – The uterine lining sheds and flows out of the vagina as a bloody discharge
• Follicular Phase – The follicular phase starts on the first day of bleeding. Differences in the length of the follicular phase account for the different lengths of the menstrual cycle. During this phase, the pituitary gland in the brain releases FSH (follicle stimulating hormone). FSH stimulates the ovary to produce estrogen which develops (or ripens) an egg within a follicle in the ovary. Estrogen also thickens the uterine lining in preparation for a possible pregnancy.
• Ovulation – Ovulation is triggered when a spike in estrogen stimulates the pituitary gland to secrete LH (luteinizing hormone). LH triggers the release of the mature egg from the follicle in the ovary. This occurs about 14 days from the first day of menstrual bleeding but can vary from 7 to 21 days or more for some women. Once released from the ovary, the egg moves along a fallopian tube towards the uterus. Pregnancy is most likely to result when sexual intercourse occurs a few days prior to or on the day of ovulation.
• Luteal Phase – After ovulation, the follicle that released the egg transforms into what is called the corpus luteum. The corpus luteum produces high levels of both progesterone and estrogen. These hormones have several effects. They raise the body’s core temperature causing a small increase in body temperature that can be tracked to identify when ovulation has occurred (and therefore when a woman is most likely to be fertile). They further thicken and stabilize the lining of the uterus to prepare for a possible pregnancy. They also thin the mucus in the cervix making it more slippery and stringy. This allows sperm to more easily enter the uterus to fertilize an egg. Women may notice they have more vaginal secretions or discharge around and right after ovulation.

A new cycle begins either with pregnancy, or menstrual flow. If fertilization occurs and the fertilized egg implants into the uterine lining, new hormones begin to be generated, and a pregnancy develops. If implantation does not occur, the corpus luteum involutes (stops functioning and shrivels up) 14 days after ovulation. Estrogen and progesterone levels then drop quickly causing the uterine lining to shed. This drop in hormones also contributes to other emotional and physical changes that women may experience just before or as their period begins.

To view complete PDF, click here.

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Resources for Further Reading

Fearfully and Wonderfully Made
Author: Dr. Megan Best
Christian obstetrician writes about beginning-of-life issues including the biology, science, and bioethics of the field. Examines contraception, abortion, prenatal screening, infertility, assisted reproductive technologies and related ethical quandaries from a Christian perspective.

Beginning of Life Medical Decisions
Project by Center for Bioethics and Human Dignity to guide people in medical decision making at the beginning of life.

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References

1. James 4:11-12, Romans 14:4-12, Matthew 7:1-3
2. Ephesians 5:31-32
3. Consider the joyful tone of the Song of songs and its celebration of the wonder of the other spouse. There is nothing self-serving. No other aim or goal except the shared joy of each other.
4. Ephesians 5:21, 1 Corinthians 7: 3-5, Philippians 2:3b-4
5. Hebrews 12:2-3, Isaiah 62:5
6. Genesis 1:28, Genesis 9:1, Psalm 127:3-5, Deuteronomy 6:1-3
7. 1 Corinthians 7:7-8, 1 Corinthians 7:32-34, Matthew 19:12, Luke 2:36-38, Isaiah 54:1
8. Ephesians 5:25-33, Philippians 2:1-8, James 3:17
9. Genesis 1:26-28, Philippians 4:2-3, Romans 16:1-2, Romans 16:6-7, Luke 8:1-3, Mark 15:40-41, Joel 2:29, Colossians 4:15, Esther 4:14, Judges 4:4-5, Exodus 15:20, Acts 9:36-42, Acts 16:14-15, Acts 18:24-26, Acts 21:8-9, 1 Corinthians 1
10. Psalm 103:13-14; Psalm 113:7-8; 2 Corinthians 12:9-10
11. Data taken from UpToDate: “Percentage of women experiencing unintended pregnancy during the first year of contraceptive use (typical and perfect use) and the percentage continuing use at the end of the first year: United States” accessed 4/9/2024.

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