SART Fertility Experts - IVF & Religion with Dr. Kelly Lynch and Dr. Bill Petok

Explore with host and reproductive endocrinologist Kelly Lynch, MD, how major religions view IVF, fertility, and surrogacy, with insights from psychologist Bill Petok, PhD, on balancing faith and family building.

Hello everyone, my name is Dr. Kelly Lynch and I am meeting today with Dr. Bill Petok. He is a psychologist in private practice and Clinical Associate Professor of Obstetrics and Gynecology at the Thomas Jefferson School of Medicine. Today we're going to talk about IVF and religion.

Dr. Petok, thank you so much for taking the time to speak with me today. It's my pleasure. I am glad I'm able to do it.

As you know from your research and your time taking care of patients of diverse religious backgrounds, there are multiple views about religion and IVF. Can you share a little bit of your knowledge about this with us? I would be glad to. First let me talk just a little bit about the three, what I would call Western faiths or Abrahamic religions, and that would be Judaism, Christianity, and Islam.

And I say that because they all derive from the same source eventually and one builds on the other. But in the very beginning of the Hebrew Bible, the notion of reproduction becomes really important. In Genesis it says, and God blessed them and God said unto them, be fruitful and multiply and replenish the earth, making it very clear that people are supposed to have babies.

And there are multiple stories that go towards that and multiple times in Genesis where that occurs, but fertility raises its head very early on in that the first patriarch, Abraham, has difficulty conceiving and his wife is unable to conceive and she eventually says that he should use her maid servant, Hagar, and have a child. And so we have the first gestational carrier, if you will, surrogate, and Hagar has Ishmael, and then at some point Sarah gets a little upset about it and she's jealous, which wouldn't be surprising, and Hagar and Ishmael are banished from the community and Ishmael goes on to start a great faith, which would be Islam. And then Sarah conceives at age 95, and while we could have an interesting conversation about the reality of that, one wonders about whether or not this was just female factor infertility or if Abraham had some male factor stuff going on with him.

We could have a long conversation about that, but we'll skip that. And there are multiple stories throughout the Hebrew Bible that deal with fertility as an issue. And then you have the advent of Christianity, and of course the story changes somewhat with Christianity because Jesus had no children that we are aware of.

And in fact, if you look at holiness in Christianity, the priest, the holiest of people, is basically commanded not to have children. And so that creates this tension. Are you less holy if you do have children, or are you more holy? What is going on there? And for me, that's been a fascinating thing.

Islam is a little bit different, of course, because Islam now builds on Christianity. And there are divisions within Islam. We'll talk a little bit about that.

But I want to make sure that I mention the other two big religious traditions and the other karmic religion, which would be Buddhism. And so Buddhism addresses the notion of infertility very indirectly, because it says that suffering is at the core of human existence, and you and I can't think of any more suffering than wanting to have a child and being unable to. And these are addressed in different ways in how the faith says that reproduction should go forward.

But let me stop at that and see what other kinds of things we could talk about that would be illuminating for our audience. Yeah, that's a very good point, just the differences between the major religions and how they view family building and infertility. And as you mentioned, Buddhism, or sorry, the Hindu view, there was a comment, I saw that infertility may be almost punishment, I came across, or... Yeah, yeah.

You know, it's, if you think about karma, both in Buddhism and Hinduism, karma becomes important. And one of the tenets in both of those faiths is that infertility is caused by karma. So one wonders, is that the problems, the wrongdoing of someone in a past life, which is now visiting the person in the present life, or will the person in present life's fertility have a impact on them when they come back in reincarnation? And it's interesting, because procreation is a religious duty in Buddhism, Hinduism, and Judaism.

It's so interesting that so many patients blame themselves for the situation they find themselves in. So it's interesting that you make this comment when we often know that this has nothing to do with their faults. Yes, it's bad.

Bad luck would be the way I would think of it. It is some chromosome mutates in a way that no one caused, just by randomness. So how do you counsel couples who come to you with a conflict between their religious beliefs and their desire to have a family? It's a really good question.

And I think, first of all, I need to know just how strong their faith is and what they consider to be the proper religious way to go about doing things. So, for example, the Catholic Church has a very, well, it's changing at the moment, and I think it will, as the Pope has become, the past two Popes, we'll see how this Pope is, but it seems like he's more liberal, have taken a more generous approach, although in certain countries where the faith is very strong and very traditional, the use of third parties is seen as, you know, unallowable. And the reason is that the marriage between two people is seen as holy.

And if you introduce a third party, you've really corrupted the holiness of that relationship. Now, what I will say to folks who are struggling with this is that absolutely you should talk with your priest or your minister or your rabbi or your imam, someone who understands the faith in ways that I can't possibly do and can speak with you about that. And, you know, I've often said to folks, you know, the first commandment in the Bible is to be fruitful and multiply, but it doesn't specify how.

And that's true, but of course, you know, reproductive technology didn't exist in those days. It was God's intervention with Sarah, right? But I think, you know, you want to counsel people to make sure that they don't do something which would cause them to feel guilt or shame for violating a religious principle, which is important to them. Right.

And I think you you mentioned that is that it's really important to not introduce conflict for them and to completely understand where they're coming from. And that goes and that for many of us goes against what we might personally believe. But we're not patient.

We are we are not the ones trying to create a family and we are not the ones who are adherence to a specific faith. And I think that's incredibly important to be respectful of people's belief systems. Right.

So Catholicism presents some real challenges with regard to IVF because of the specific concerns about decoupling conception from the conjugal act. That's the big the big problem. And more importantly, the holiness of the conjugal act.

Exactly. Yeah. There's also concern about discarding unused embryos.

And there are many concerns in Catholicism. You know, it's challenging to counsel couples, though, because we know that most embryos don't successfully implant. And so there it can be difficult to reconcile this when we're counseling our our Catholic couples.

Yeah. I mean, even even people who are who follow the Muslim faith, who follow Islam. So, for example, in Islam, embryo donation is acceptable to infertile spouses.

Right. And gamete donation or surrogacy is forbidden. Correct.

Because it is unacceptable to the faith. And you're right. What do you what do you do with unused embryos? And that says an awful lot about what is the belief about when the soul is created? Right.

So if you're Protestant, the soul comes from the parents in the process of procreation. But for some personhood develops more gradually. So for some religious adherence, some destruction of embryos may be acceptable for research or infertility in infertility treatment.

And in the Hindu faith, some Hindu teachings say that incarnation takes place as late as seven months of gestation. So what does that say about premature termination of a pregnancy or spontaneous termination of a pregnancy or what? You know, most embryos that are utilized in research are not more than five days old. So if if incarnation doesn't take place till seven months, I guess it's OK.

And of course, I always refer people to someone they respect in their faith who has the training because as a provider in the reproductive health care field, we can't be expected to know everything. So anyway, that's that's it's a great question and it's a complex question. And there are no easy answers.

And I think we need to be very careful in even hinting that there may be an easy answer. Can you talk a little bit about when religion and infertility collide or when a person's faith might make it harder for them to conceive? Are there any circumstances you think that can lead to fertility issues? Yeah, absolutely. Well, let me talk about about Judaism, which is one I know the best because I'm a practicing Jew.

So if you are the most observant of Jews, spilling seed masturbation is not allowable. However, if you've got a male factor and you're trying to diagnose it, how are you going to obtain the sample to validate whether or not it is a male factor? Well, there are two ways. One is to masturbate.

And the other is there's something called electro ejaculation, which most men who are not under anesthesia wouldn't want to have happen to them. So there are workarounds that are developed by people who are more steeped in the faith than me. So for example, there are collection condoms devised, which make it possible for sperm to escape, but don't make it probable.

So that's one of the workarounds that happens there. In the use of donors, if you use a non-Jewish sperm donor, the child conceived from that sperm donor, you don't have to worry about incest then because the sperm donor was not Jewish, so he couldn't have been related to the woman whose sperm is transferred to him. And the child can be converted and become Jewish with no conflict seen through Jewish law.

Very interesting. So it's fascinating. But clearly the adherence to the faith, the clergy have thought deeply about this because to be fruitful and multiply is important and they want to help, in many cases, want to help families have children.

Because if you don't have children, the faith doesn't go on. So there's something practical about that. That's a great point.

So sperm collection is a great example and the workaround. And I think also in Catholicism, that workaround has come to be thought of as acceptable as well. And I know with Catholicism, some Catholics are comfortable with insemination, but some are not.

Most, though, are not very comfortable with in vitro fertilization, or at least most faithful people are not. But we do know that there are Catholics who choose to do in vitro fertilization to have a family. And I think ultimately people have to decide what they're comfortable with and what they are willing to do.

You raise a really good point that I hadn't thought to mention. And that is, if destruction of an embryo is problematic, as it would be if you were a devout Catholic or even an evangelical Protestant, what do you do about that if you have excess embryos? And there are really two choices, it appears to me. One is to donate those embryos to another family and hope that those embryos grow to be children.

And the other is to do something which there's some question about, and it's called compassionate transfer. And that is to thaw the embryo and transfer it not to the uterus, but to the vaginal barrel and hope that it might migrate to the uterus, with the clear understanding that it probably won't. But it is just like those collection condoms, a workaround that helps people feel more comfortable with the eventual outcome, which would be the embryo not turning into a fetus.

Well, you raise a great point with embryo donation. It is a viable option for many couples. And actually, there will be another podcast coming soon about embryo donation.

So you can check that out. More detail there, you'll be able to know way more than a little teaser I've just given you. Yes.

Some of the other questions I had for you. So go back to Judaism for a second. Sure.

So IVF is specifically okay for Jewish couples? Yes, IVF is okay. IVF, and we're talking about without a donor, right? Okay. And so, you know, there are certain IVF programs, or certain organizations, which work to manage the purity of the embryo, if you will.

So there's, you refer to them as a kosher IVF program, where there's provenance of the sperm and the egg are monitored by someone who's independent, and the embryo is monitored by someone who's independent until it is transferred to make sure that it wasn't switched with somebody else's, that it's halakhically, halakha is the Jewish law, is appropriate. And it's a way of ensuring purity, if you will. So it's a measure to help people feel more comfortable with the religious structure and purity of their reproductive choices.

Need to know that. That's a really interesting twist on IVF that you can have. Kelly, there's something analogous in the life.

So when a Jewish person dies, and their body is in the funeral home, traditionally, someone sits with the body until it is buried to make sure that it isn't tampered with, and that it is the same body. It's the mirror image, you know, what has been structured for the beginning of life, which is what happens at the end of life, which I find fascinating. That is fascinating.

So are there any other religions that specifically allow IVF? Yeah. You know, it's interesting. Islam is okay with IVF.

And in fact, as you're aware, fatwas are religious legal rulings. And the first fatwa about the subject of ART, assisted reproductive technology, was in Egypt in 1980. And Egypt follows the Sunni branch of Islam.

And so what was determined then was that IVF was okay to relieve the couple of the pain and the threat to their marriage posed by infertility. The couple's own gametes had to be used, their own sperm and egg, because lineage is really critical to identity in Islam. And adoption isn't really allowed, although it's often practiced.

The adopted child is not legally or morally part of the family, but is afforded the protection of hospitality. But not of kinship. And then about 20 years later, 1999, there was a fatwa in Iran, which follows the Shia branch of the faith, which says donated gametes are acceptable with conditions.

Okay. And so the child only inherits from the donor, rather than from the family into which the donor conceived child was born, because that maintains Shiite family integrity. And so, as you can see, both in Judaism and Islam, integrity of lineage becomes really important.

And each faith has its own way of dealing with that. The challenge, I think, for people is, suppose you're a Shia living in a Sunni country. What do you do? Do you go somewhere else? And for those of us who are practitioners here in the United States, it would be important to know if someone is Islamic, which branch of the faith do they follow? It's really helpful to point out.

And I think for our listeners to know these differences between faiths is really important so that we can be sensitive to the needs of our patients. Yeah, it really is. There were also some, you mentioned specifically about surrogacy.

And we know that, or which we now call gestational carrier, but there are some faiths that specifically allow surrogacy and others that don't. Can you talk about that a little bit? Sure. I've talked about them in Judaism, for example.

The preference is that the surrogate, the gestational carrier, be a non-Jewish single woman. And why is that? Well, then you don't have to worry at all about family integrity. She's not Jewish, so she cannot have been in some way.

There can't be an incestual relationship. It's just impossible. And single so that there's no concern that the child is the product of her relations with her own husband.

Again, making sure that this is not possible. Now, that's a workaround, obviously. The mother's Jewish heritage is what determines the child's Jewish status.

So in surrogacy, we don't consider the gestational carrier to be the biological mother because she's not. Now, 40 years ago, when there was what we call traditional surrogacy, where it was the father's sperm and the gestational carrier's egg, different story entirely. But that's something which happens very infrequently today.

And, you know, to go back to that, if the surrogate was married. Carrying another man's child could be seen as violating the prohibition of forbidden sexual unions. Right.

Even though it's not, as you're well aware, people do get confused about how did the baby get there with a surrogate. Right. So it's it's complex.

And again, this is one of those things where you would refer your patient to their religious expert, their rabbi, in this case. And I will say this. For many rabbis who are involved in these questions, they have a rabbi they go to.

So, you know, it goes up the chain to make sure that the best opinion possible is provided. That's that's really good advice, both for our patients and for people taking care of patients of diverse religious backgrounds. One of the what do you think are the key takeaway points for our patients who are trying to reconcile their religious beliefs with their fertility goals? Well, I think I think the first thing is you want to make sure you consult with your clergy about this and make sure you understand the faith through the eyes of the person who is presumably more expert than you are, because you may be unaware of changes in religious law.

Some faiths do allow for revision over time. Judaism is pretty good at that. The whole Protestant faith is a revision of the original Christian faith of Catholicism.

So there are many and there are variations within that. So it would be important to consult with someone who is more knowledgeable than you about the faith. And then I think the other part of it is you have to sort of justify for yourself.

Is having a child and creating a family more important to me than some other thing? And our patients are making these decisions all the time. The financial decisions, the decisions about what age to do things, the decisions about who to be partnered with. These are all important decisions.

And, you know, for some people, faith is not as important as it is to other people. If it's incredibly important to you, you don't want to do anything that violates it. But if you're, you know, and many people were raised in a faith, but they don't follow it very strongly.

I think for them, the decisions are easier because they've made a decision not to be actively participating. It's part of their tradition. But, you know, it's not what drives their everyday life.

So I think it's important to understand where you are in that line. And for the provider to understand where the patient is in that line. Those are great suggestions.

Thank you so much, Dr. Petok, for taking the time to talk with me today. Well, thank you, Dr. Lynch, for inviting me. This has been a pleasure.

Well, thank you for listening to today's episode of SART Fertility Experts, the podcast for people trying to build a family. This has been a wonderful conversation with my guest, Dr. Bill Petok. Thank you and have a good rest of your day.

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates. These are provided as a source of general information and are not a substitute for consultation with a physician.