(This article was given first prize in an All-Pakistan Competition on this Topic held by PIMA-Pakistan Islamic Medical Association)
Man, from time immemorial, has been seeking a cure for infertility. This is obvious due to the fact that the desire to have one’s offspring is a very strong human instinct.
“Wealth and progeny are the allurements of this world” (Holy Quran: 14: 46).
Although estimates of the prevalence of infertility are not very accurate and vary from region to region, approximately 8-10% of couples experience some form of infertility problem. When extrapolated to the global population, this means that 50-80 million people may be suffering from infertility. It is believed that 29-44 million of these are Muslims due to the high prevalence of infertility among Muslims in developing countries.
Until recently the treatment options for infertility were medications or surgery to correct anatomical defects and were mostly non-controversial from an ethical or religious point of view. However, the recent advent of assisted reproductive techniques including invitro-fertilization (IVF) changed the situation dramatically. It basically transferred the process of procreation from a private relation between the husband and wife into an artificial process in a laboratory.
Couples for the first time became able to have children without having sexual intercourse. The new type of treatment for infertility has created a great ethical debate all over the world among different societies and the followers of different religions. These changes in the procreative process challenged the basic religious and ethical concepts.
Sources of Islamic Law
The primary sources of Islamic Law are:
1. The Holy Quran
2. The Ahadith (Sayings and Sunnah of the Holy Prophet)
3. Ijtehad or legal Reasoning
a) Qiyas (Analogical Reasoning)
b) Istihsan (Juristic Preference)
c) Maslahah Murasalah (Unrestricted Public Interest)
d) Sadd al Dharai (Blocking of the Means)
e) Aadaat and Urf (Customary Practice)
f) Istishaab (Presumption of Continuity)
First I will briefly describe IVF and then I will discuss the favorable and unfavorable viewpoints and give my conclusion at the end.
This is one of the “Assisted Reproductive Techniques” (ARTs), also called Medical Assisted Conception. (MAC).
IVF is a process in which a woman through hormonal manipulation is made to have several simultaneously developing ova. Hormonal ovarian stimulation can be used to treat anovulation or may increase the likelihood of conception in idiopathic infertility by increasing the number of mature oocytes. Ovarian stimulation may also accompany intrauterine insemination.
These are needle aspirated at the proper time under ultrasonic guidance. In the lab, sperm is made to fertilize the ova. When they reach the 4-8-cell stage they are transferred into the uterus. The uterus has already been prepared by hormones to be ready for implantation of the transferred eggs. Resulting embryos may be transferred to the woman’s uterus or cryopreserved for future use. The current success rate i.e. resulting in a live birth is 20-30%.
IVF has many modifications i.e. GIFT (Gamete intra-fallopian transfer), ICSI (Intracytoplasmic Sperm Injection) etc.
“For Every Disease There is a Cure”
Basic Islamic principle permits persons facing hardships to use all lawful means to solve their problems, while at the same time preserving their trust in Allah that He will help them achieve their goal.
This is especially true in matters of disease and health. A saying of the Holy Prophet is:
“ For every disease Allah has created a cure except death, So Oh Children of Adam, seek cure for your ailments.”
Thus it is clear that infertile couples are instructed and encouraged to seek a cure of their infertility. The command to seek cures for disease also applies to physicians and other healthcare providers. Thus the discovery of new methods of treatment for infertility as well as other diseases is in principle a perfectly legitimate pursuit.
So we may say that infertility is a disease and IVF is a cure for this disease.
The Principle of Istihsan
This principle allows the jurists some leeway in interpreting the law to allow for something that is useful. In such cases it will be permissible to allow the spirit of the law to prevail over the letter of the law.
In this case the spirit of the law says that there is nothing ethically wrong in a husband and wife having children by IVF as long as they are legally married.
The Principle of Maslahah Mursalah or Public Interest
The Islamic Legal system takes the interests of man into consideration. This accounts for the following juridical rules:
Necessity makes the unlawful permissible.
When two interests conflict let the one that will bring greater benefit take precedence.
If forced to choose, choose the lesser of the two evils. The above rules are founded on the principle of establishing what is in the general interest and preventing what is against it.
So if the general gain outweighs the negative aspect of an action, it is allowed, but if the negative consequences of such an action outweigh the good then it is prohibited.
So in this case the benefits of having a child by IVF are much greater than the harm that the procedure produces. Public interest has to be defined by adhering to the five basic objectives of Islamic Law, which are preservation of faith, life, intellect, property and posterity. As long as the posterity is being preserved there is no harm in this procedure.
Islam Encourages Procreation
Islam encourages couples to have more and more children. A saying of the Holy Prophet is:
“ Get married, beget and multiply because I will be proud of you among the nations.”
So Islam encourages procreation within matrimonial bondage. Therefore, why deprive the Muslims this right to procreate by IVF?
Prevents From Doing Shirk (Associating Partners with Allah)IVF is a treatment that is available and which prevents people from getting desperate and going to Pirs and graves of Saints and asking and praying to them to grant them children. This is a big sin and unforgivable in the sight of Allah.
As the rule states above: If forced to choose, choose the lesser of the two evils.
Stress & Infertility
Stress can have a dramatic impact on one’s reproductive life. Most physicians and mental health professionals who work in this field have encountered men who have experienced temporary impotence when diagnosed with azoospermia (the inability to produce sperm), or women who have temporarily lost all interest in sexual intimacy after a diagnosis of female factor infertility.
Research has shown that women going through infertility rated themselves as having higher levels of depression than women going through cancer treatment.
Stress in women disrupts the hormonal communication between the brain, the pituitary, and the ovary, interfering with both the maturation of an egg and the ovulation process.
When we are under stress, we experience several neurochemical changes. This can alter the ordered release of hormones that regulate the maturation and release of an egg. In addition to this, the concentrations of several important chemical messengers involved in reproduction, change when our emotional states change. There is a direct link between the brain and the reproductive tract. Nerve fibers connect the brain directly to both the fallopian tubes and the uterus. The autonomic nervous system influences the ovary’s ability to produce healthy eggs and hormones. For example, when a woman is under stress, spasms occur in both the fallopian tubes and the uterus, which can interfere with movement and implantation of a fertilized egg.
Thus the stress can affect infertility both by the altered regulation of pituitary hormones and from the abnormal nervous-system influences on the ovaries and fallopian tubes.
In case of man, both physical and emotional stress are known to affect the fertility. Sperm counts, motility, and structure are altered under stress. Problems such as impotence and difficulties with ejaculation are often caused by the emotional distress in men.
Stress can Lead to Infertility – This, in turn can lead to increased stress leading to a vicious circle
Stress is like a runaway train that gathers momentum with time. As explained, stress can make us less fertile by its effect on our hormones and reproductive organs. The resultant failure to conceive creates further stress, which results in further loss of fertility and so on. This results in a vicious cycle. The circle goes both ways: stress affects infertility and infertility affects stress.
All this may lead to a miserable life and even divorce or suicide. IVF is a way out.
Scholars favoring IVF say that the children born from IVF are still born by the will of Allah. If He wills, then the couple may still remain barren after performing IVF.
A Hadith also indicates in response to a question on coitus interruptus that any child that has been willed by Allah will be born into this world no matter what we do to prevent it.
Ethically there is nothing wrong with IVF as the two main principles of Ethics state: Do no harm and benefit the person.
Prevention of Genetic Disease
Scientists can do research and experimentation to diagnose genetic disorders especially in a person with a strong family history of fetal disorders like recurrent abortions, fetal malformations etc.
Similarly scientists may also administer specific genetic material to the fertilized ovum with the aim at substitution of abnormal genes by normal genes to prevent the development of genetic disorders.
Some scholars are of the view that conception is only allowed in the natural way. They point to the verse of the Holy Quran that indicates that the sole purpose of going to one’s wife is for procreation.
Allah has ordained that some couples would be infertile as stated in a verse of the Holy Quran:
“ He creates that He wills. He bestows male or female children to whom he wills. He bestows both male and female children and He leaves barren whom He wills.”
So, if Allah has ordained as such, then one should be patient and accept His decree.
Pray to Allah
The method used by the prophet along with all legal methods was to ask Allah repeatedly and sincerely with humility and faith. Eventually Allah answered their prayers.
So some scholars are of the view that instead of undergoing IVF one should continuously should keep on praying to Allah. He can do anything for a person by His will.
Children are not a Necessity
Some scholars are of the view that children are not a necessity. One can stay alive without children. Unlike water and food that are necessary for living and that one may even take unlawful food if lawful food is not available, this does not apply to children.
Avoid the Doubtful
In a Hadith, the Holy Prophet has said:
“Both legal and illegal things are obvious, and in between them are doubtful matters. So whatever forsakes those doubtful things lest he mat commit a sin will definitely avoid what is clearly illegal; and whoever indulges in these doubtful things boldly, is likely to commit what is clearly illegal.”
The Principle of Sadd Al Dharai (Blocking of the Means)
This principle states that:
“When a lawful means is expected to lead to an unlawful result or that a lawful means, which normally leads to a lawful result is used to procure an unlawful end, then the means itself becomes unlawful.”
Scholars argue that IVF can lead to all the following unlawful results:
a) Illegitimate Children
In Islam the right of legitimacy is a basic right and every person has the right to be the legitimate child of his or her parents. So it is important for every child to know the identity of his father and mother. Violation of this closely-knit arrangement can run amok with the society.
This is what is happening in many Western countries. Donor eggs, sperms and even donor embryos are being used. These will result in the biological father and mother to be different from the married couple. In Islam this is in essence similar to adultery in confusing the lineage.
In this case a married couple requests another woman to carry the pregnancy to term and then give the baby back.
In other cases donor embryos, eggs or sperms may be used and then a third woman carries the pregnancy to term.
This will lead to at least three types of parents; the rearing couple, the biological parents who donated the embryo, and the surrogate mother and her husband if she is married.
There are several objections to surrogacy from an ethical standpoint mainly that it results in the commodification of motherhood. It reduces motherhood from a value to a price.
There is one thing that is agreed upon that is that the birth mother who delivered is the real mother as a verse indicates in the Holy Quran.
“ None can be their mothers except those who gave them birth.
The presence of donor sperms, eggs and embryos from sperm banks and other such banks has commercialized the process of procreation. Children become a commodity and the process of procreation becomes a business enterprise.
d) Gender Selection
Some IVF clinics experiment on fertilized Ova in the lab with the purpose of choosing a certain fetal sex i.e. a boy or a girl.
This is prohibited in Islam. It is just like the practice of “The Days of Ignorance” 14 centuries back in which people buried their daughters alive and kept their sons alive.
Pregnancy After Death or Divorce
Many couples have used this procedure to have children after divorce or death of the other spouse. Again this is not allowed in Islam because at the time of procreation there was no legal marriage contract or bond.
Unnecessary Body Exposure
Many scholars argue that many procedures of IVF involve exposure of the private parts, which is not allowed in Islam; even a female may not expose herself before a female.
However these scholars are also of the view that IVF as a whole is unnecessary.
Unnatural Method of Obtaining Sperm for IVF
Many scholars also argue that the method of obtaining sperm for IVF is unnatural and thus should not be allowed.
Risk to the Life & Health of the Mother
There are chances of risk to the mother and fetus especially in the case of multiple pregnancies with increased chances of miscarriage.
Third Party Involvement
Some argue that the process involves a third or more parties (embryologist, obstetrician) and there maybe no guarantee that the child conceived is of the husband and wife. And that infertility may influence results of the procedures (e.g. by mixing eggs or sperms) to enhance chances of the couple conceiving and thus enhancing their repute among the community. Another argument in this regard is that Islam lays great importance on correct parentage of a child. The answer to this is that should there be more than one claimant or doubt to a child’s paternity, as was customary during the time of the Prophet, and there was no conclusive evidence in favour of any of the claimants, the matter was resolved by consulting expert physiognomists, who determined who was the father of the child. They employed their skills by determining RESEMBLANCE OF FEATURES of the child’s physical body to those of the claimants.
Secondly in the modern era, parenthood of the child can be verified through DNA testing as well as other techniques. This technology is a method of Istihsan based on Maslahah.
Thirdly, ultimately the woman who eventually bears the child is primarily the child’s mother. This fundamental principle derives from the Holy Qur’an, which states that “none are your mothers except those who gave you birth ” (58:2).
Conclusion of the Discussion
Islam is a flexible religion, adaptable to the necessities of life, and what is unethical in one situation may become ethical in another situation or at another time. Islam is a religion that has given great importance to what are known today as the ethical principles of autonomy, beneficence, non-maleficence, and justice.
No doubt when a person makes his or her reproductive choice, he or she would like to see that the different ethical principles are observed. However, because the reproductive choice directly affects human life and procreation and involves a potential child, a partner, and the society at large, it is not uncommon that different interests conflict with each other. Also, there is no universal agreement on the meaning of the beginning of human life. Though diversity between physical and religious definitions may not be vast, yet the cultural definition differs markedly in different societies with different cultural backgrounds. In Muslim countries when one makes one’s reproductive choice, one has to observe the ethical guidelines of society, which should not contradict the basic instructions of Islamic shariah, which is adaptable and accommodative to new technological development.
Though reproductive choice is basically a personal decision, it is not totally so. This is because reproduction is a process, which involves not only the person who makes the choice, but it also involves the other partner, the family, society and the world at large. It is therefore not surprising that reproductive choice is affected by the diverse contexts, sexual morals, cultures and religions, as well as the official stance of different societies.
The Shariah is not rigid. It is flexible enough to adapt to emerging situations in different times and places. It can accommodate different honest opinions so long as they do not conflict with the spirit of its primary sources and are directed to the benefit of humanity.
IVF was not mentioned in the primary sources of Shariah. However, these same sources have affirmed the importance of marriage, family formation and procreation.
Family and blood relations in Islam have very important legal implications. The Quran emphasizes the centrality of the family unit. Blood relations have a special status in legal matters.
Islam enjoins the purity of genes and heredity and so to avoid mixing genes is a basic principle. It deems that each child should relate to a known father and mother. Adoption is not allowed, as it implies deceit, hiding from children their true genetic lineage and heredity.
In Islam infertility and its treatment is allowed and encouraged. It is essential if it involves the preservation of procreation and treatment of infertility in one partner of the married couple. This applies to IVF that is one line of treatment of infertility. The modern techniques of MAC, including micromanipulation of the oocyte to facilitate fertilization, are no exceptions. The prevention and treatment of infertility are of particular significance in the Muslim world. The social status of the Muslim woman, her dignity, her self-esteem and her place in the family and society as a whole are closely related to her procreation. Childbirth and child rearing are regarded as family commitments and not just as biological and social functions.
Sometimes IVF is the only available method for the treatment of infertility. The choice of treatment available to the couple and for their physician is governed by the availability of the method, success rate, implications and complications involved, cost, and social, legal and ethical aspects of artificial reproduction.
Any debate on the social, legal and ethical issues surrounding IVF must consider these new techniques within the general context of reproductive health care. In providing this new technology one must respect the dignity of human beings, security of human genetic material, inviolability of the person, inalienability of the person and the necessary quality of services. These principles demand a measure of protection for the human embryo that is consistent with national, cultural, religious and social traditions. Ethical discourse is necessary for societies to develop and form their responses to any scientific or medical innovation.
The four ethical principles are the traditional principles of justice, autonomy (respect for persons), beneficence (duty to do good) and nonmaleficence (avoidance of harm).
Also, there are three moral principles that provide an ethical basis for artificial reproduction. The principle of liberty, which guarantees a right to freedom of action; the principle of utility, which defines moral rightness by the greatest good for the greatest number; and the principle of justice, which requires that everyone have equal access to necessary goods and services. However, one must remember that ethics and morality are only valid when individuals can act freely.
Therefore concluding Physicians should limit access to IVF and other assisted reproductive techniques to where clinical circumstances do not present significant risks to potential offspring. This should be on the grounds of conscience and medicine and not on any social discrimination. Since marriage is a contract between the wife and husband during the span of their marriage, no third party should intrude into the marital functions of sex and procreation.
A third party is not acceptable whether he or she provides a sperm, an egg, an embryo or a uterus. If the marriage contract has come to an end because of divorce or death of the husband, artificial reproduction cannot be performed on the female partner even using sperm cells from the former husband.