INFERTILITY

Medical and Spiritual Causes and Cures

Paul Tautges

October 1996

Introduction

Infertility is a problem that an increasing number of couples are facing each year of which Christian couples are not exempt.  Understanding the medical and spiritual causes and cures of infertility can sometimes help dispense hope.  The purpose of this paper is to identify these causes and cures and to offer practical suggestions as to how the body of Christ can be a source of strength and encouragement to couples that are struggling with this painful reality.

A couple is normally considered infertile if no pregnancy occurs after one year of unprotected intercourse.  An estimated 15% of couples have infertility problems.[i]  This includes those without children and those experiencing secondary infertility.  "Secondary infertility is the inability to conceive and birth another child after one or more successful pregnancies.... This accounts for more than half of all fertility complaints."[ii]  It is usually recommended that after 18 months of unprotected intercourse, a couple should seek medical advice-both husband and wife-unless there is reason to suspect one over the other[iii] 

Medical Causes and Cures

The medical causes of infertility and their corresponding treatments are numerous and affect both men and women.  The AMA Encyclopedia of Medicine states, “In rough terms, about 30 percent of infertility cases are due to factors that affect the man; another 30 percent are due to factors that affect the woman.  In the remaining 40 percent of cases, infertility is due to factors that affect both partners.”[iv]  The encyclopedia also says that age is a factor, "Infertility increases with age; the older a couple is when trying to conceive, the more difficult it may be."[v]

Female Infertility

Female infertility is primarily due to hormonal imbalances and pelvic abnormalities (blockage or scarring of the fallopian tubes and endometriosis), which can sometimes be corrected by microsurgery.  "Anovulation (failure to ovulate) is the most common cause of female infertility.  Failure to ovulate often occurs for no obvious reason.  It can be caused by a hormonal imbalance, stress, or a disorder of the ovary, such as a tumor or cyst.”[vi]  Hormonal imbalances that are organic in nature can often be corrected by the use of drugs that stimulate or slow down hormone production. 

Oral contraceptives also have an effect upon a woman's delicate system of hormones.  Since it is designed to alter the woman's hormonal system, after "the pill" is stopped, it may take from 3-12 months before the body resumes normal ovulatory cycles.[vii]  However, when oral contraceptives fail to prevent conception, they then act as abortifacients.[viii]  The long-term effects of oral contraceptives on fertility are not yet known.

A second major cause of female infertility are complications that hinder the proper functioning of the fallopian tubes, the organs that carry the egg from the ovary to the uterus.  Roughly 30% of infertile women have tubal problems.[ix]  Blockage of the fallopian tubes prevents the sperm from ever reaching the egg, thus making fertilization impossible.  A multicenter medical study revealed,

Tubal occlusion is the principal cause of 25% to 30% of female infertility.... The recommended primary procedure is microsurgical tubal anastomosis, giving an approximately 44% first-year probability of conception in the best of hands.  Microsurgery, however, is costly.... Moreover, in vitro fertilization is still a costly and time-consuming procedure, yielding at best only an approximately 16% clinical pregnancy rate per attempt.[x]

Another such procedure is Transcervical Balloon Tuboplasty (TBT).  TBT operates on the same principle as angioplasty.  It involves the insertion of a thin plastic tube with a deflated balloon into the fallopian tube through the cervix.  The tube is then inflated causing the fallopian tube to reopen.  Microsurgery also presents other problems without the guarantee of success.  As author of The Infertility Book, Carla Harkness writes,

The pregnancy rate in women having tubal surgery to correct problems caused by infection is fairly low (10-50% at best), and the odds that an ectopic pregnancy will occur are 5 to 10 times greater for these women than for those in the general population.[xi]

An ectopic pregnancy occurs when the fertilized egg deposits and develops outside of the uterus, most often in the fallopian tube.  This presents great danger to the mother and is always fatal for the baby.  The Centers for Disease Control reported that, "more than 88,000 women in the United States developed ectopic pregnancies in 1987."[xii] 

Pelvic Inflammatory Disease (PID) or Salpingitis also leads to fertility problems.  PID is an infection or disease of the pelvic organs, which usually results in the fallopian tubes suffering fertility impairment.  It is normally caused by sexually transmitted diseases or previous use of the Intrauterine Device (IUD).  Concerning the IUD, Carla Harkness writes,

Many physicians now regard them as potentially dangerous devices that have contributed to fertility problems in many women.  It has also been suggested that the threads attached to IUD’s, which pass through the cervix and into the vagina, often serve as "ladders" to the uterus for infectious bacteria and viruses.... It is now believed that all IUD devices can cause reproductive problems.[xiii]

A letter sent from five doctors to the editor of the New England Journal of Medicine stated, "Women who had ever used an IUD were found to be at an increased risk of tubal infertility."[xiv]

Sexually transmitted diseases (STD's) also contribute to infertility in women.  Most prominent of them all is Chlamydia (Chlamydia trachomatis).  In an article entitled, "Clueing in on Chlamydia," Wendy Gibbons writes,

It infects more people in the United States than any other sexually transmitted disease...It leads to infertility in more than 20,000 women in the United States each year, but many of them won't discover they have had the disease until they try to get pregnant.[xv]

The article continues, "...about 75 percent of women who cannot get pregnant because of a fallopian tube blockage also test positive for Chlamydia antibodies, indicating past or present infection..."[xvi] Medical experts have also begun to blame this disease for a dramatic rise in ectopic, or tubal, pregnancies.  Gibbons describes the insidious nature of this disease:

In women...the infection strikes silently, beginning in the cervix.  Antibiotic treatment at this initial stage can quench the disease and prevent fertility problems--but the absence of symptoms works against such early detection.  If untreated, the infection can go on to invade the uterus and fallopian tubes, causing a condition called pelvic inflammatory disease (PID).[xvii]Another major cause of infertility in women is endometriosis, which is responsible for at least 20% of female infertility.[xviii]  Endometriosis is, "a painful condition in which the uterine tissue migrates into other parts of the abdomen...[it] seems to be striking ever younger women."[xix]

This too, is surgically correctable.

Infertility also occurs if the woman's cervical mucus provides a hostile environment to her partner's sperm by producing antibodies that kill or immobilize them.[xx]  This is called Immunological Infertility.

A woman's overall lifestyle can also affect her fertility.  Obesity "may be associated with polycystic ovary syndrome and abnormal hormone production which can cause infrequent ovulation."[xxi]  Doctors overwhelmingly agree that a healthy diet and regular exercise can help to prevent infertility.  Women are encouraged to avoid unhealthy "crash" diets, which are known to hinder the proper functioning of their reproductive systems.

Male Infertility

The causes of infertility in men, of course, center on the ability of the man to produce and disseminate healthy sperm.  Between two and three million men in the United States have some sort of sperm problem.[xxii]  Sperm problems account for more than half of male infertility.  "The major cause of male infertility is failure to produce enough healthy sperm.  Azoospermia (in which there is no sperm) and oligospermia (in which few sperm are produced) both cause infertility."[xxiii]  Other sperm problems include: poor motility, morphology, and viscosity; low sperm counts; inadequate volume; and chemical imbalance.  Hormonal drugs can cure some of these.

The leading cause of sperm problems is a varicocele.  "A varicocele is an enlarged blood vessel in the scrotum.  It impedes the flow of blood there, causing the temperature of the testicles to rise enough to damage sperm."[xxiv]  In 25% of infertile men, varicocele is the cause of a low sperm count.[xxv]

Other causes of male infertility include excess weight; poor diet; inadequate vitamin C, E, and zinc; stress; some high blood pressure medications; inflammatory bowel disease; ulcers and gout; some antibiotics; and exposure to lead or radiation.[xxvi]  The AMA Encyclopedia of Medicine states, "Toxins, such as alcohol, cigarettes, or various drugs can lower the sperm count."[xxvii]

Some men who produce perfectly healthy sperm can also be rendered infertile due to obstruction of the ducts that transport the sperm.  Simple obstruction is easily corrected by surgery.  However, damage to the spermatic ducts caused by sexually transmitted diseases (STD's) is sometimes irreversible and results in the development of malformed sperm.[xxviii]

Immunological Infertility is a problem in men and women.[xxix]  This is more common in men who have had vasectomies.  Since the sperm can no longer be expelled, they are absorbed by the body tissue and reckoned by the immune system as intruders.  The man's immune system then builds up antibodies against his own sperm.  If a man desires to have reversal surgery in order to become fertile again, his chances are diminished if a great deal of time has passed since his sterilization.

It is also possible that male infertility is the result of environmental contaminants.  In a controversial U.S. News & World Report article entitled, "Investigating the next `Silent Spring,'", Betsy Carpenter says,  "New scientific research suggests that the average male sperm count has plunged by almost a half in the past 50 years, and dozens of ubiquitous pollutants may be to blame."  The focus of this new theory is upon,

...hormonlike chemicals that seem to do their dirty work by bollixing up the body's natural system for orchestrating development in infants and the unborn.  Hormones travel through the blood, turning on and off vital biological processes by slipping into cell receptors, much like keys fit into specially constructed locks.  It was long assumed that receptors were highly discriminating and bound only with their lock-and-key mate.  But now scientists are discovering that some receptors will bind with a diverse cast of chemical impostors that wreak mayhem on developing body systems by turning on cellular processes that should be turned off and turning on processes that should be running at full throttle.[xxx]

Another cause of male infertility is "abnormal development of the testes due to an endocrine disorder."[xxxi]  In rare cases, there may also be a chromosomal abnormality.  The medical field agrees, "When no specific cause can be found, improving the general state of health may help."[xxxii]

The Sovereignty of God in Child-Bearing

The sovereignty of God is one of the most comforting doctrines in all of Scripture.  The psalmist declared, our God is in the heavens; He does whatever He pleases (Ps 115:3), and Whatever the Lord pleases, He does (Ps 135:6).  It is impossible for finite human minds to completely understand the ways of God.  As the sovereign One, God is ultimately in control of all of His creation.  Mysteriously, He is able to bring about His glorious plan without ever compromising the integrity of the human will.  When dealing with the subject of human infertility, it is crucial to acknowledge that God's ways are higher than the ways of man.  It is in this great truth that the infertile couple must find their peace.

The Scriptures are very clear in their acknowledgement of God as the source of children.  In Psalm 127:3, children are called, a gift of the Lord.  When Esau and Jacob were reunited, Esau saw the women and children and asked, who are these with you? Jacob answered; they are the children God has graciously given your servant (Gen. 33:5).  Later, Jacob asked his son Joseph a similar question, to which Joseph replied, they are the sons God has given me...(Gen. 48:9).  The prophet Isaiah said, here am I, and the children the LORD has given me (Isaiah 8:18).  David prayed to God, Thou didst form my inward parts; Thou didst weave me in my mother's womb (Ps 139:13).

God's Word also highly esteems children.  Children are like arrows in the hand of a warrior...how blessed is the man whose quiver is full of them (Ps 127:4-5).  Grandchildren are called, the crown of old men (Proverbs 17:6).  Jesus said, Let the little children alone, and do not hinder them from coming to Me, for the kingdom of heaven belongs to such as these (Matt 19:14).  Adam and Eve were commanded to be fruitful and multiply, and fill the earth (Genesis 2:28).  It is evident that children occupy a high place in the mind of God.

Spiritual Causes and Cures

However, God's Word does address the issue of infertility and acknowledges some instrumental causes.  In the Bible, infertility is referred to as barrenness.  Moses wrote, Sarai was barren; she had no child (Genesis 11:30); and Abram referred to himself as childless (Genesis 15:2).  Manoah's wife was barren and had borne no children (Judges 13:2).  Zacharias and Elizabeth had no child, because Elizabeth was barren (Luke 1:7).  In the case of Abraham and Abimelech, barrenness was the result of sin.  Genesis 20:17-18 records And Abraham prayed to God; and God healed Abimelech and his wife and his maids, so that they bore children.  For the Lord had closed fast all the wombs of the household of Abimelech because of Sarah, Abraham's wife.

The medical field has proven that a great deal of infertility is caused by sexually transmitted diseases.  This is simply the Law of the Harvest in action (Gal 6:7).  The connection between morality and health is not new.  Moses spoke the Word of God to the people of Israel,

If you will give earnest heed to the voice of the LORD your God, and do what is right in His sight, and give ear to His commandments, and keep all His statutes, I will put none of the diseases on you which I have put on the Egyptians; for I, the LORD, am your healer (Ex 15:26).

What Moses was teaching is that obedience to God's commandments would lead to His protection.  In short, their morality would determine their health.  The book of Deuteronomy teaches the same principle:

Therefore, you shall keep the commandment and the statutes and the judgments which I am commanding you today, to do them.  Then it shall come about, because you listen to these judgments and keep and do them, that the LORD your God will keep with you His covenant and His lovingkindness which He swore to your forefathers.  And He will love you and bless you and multiply you; He will also bless the fruit of your womb and the fruit of your ground, your grain and your new wine and your oil, the increase of your herd and the young of your flock, in the land which He swore to your forefathers to give you.  You shall be blessed above all peoples; there shall be no male or female barren among you or among your cattle.  And the LORD will remove from you all sickness; and He will not put on you any of the harmful diseases of Egypt which you have know, but He will lay them on all who hate you (Deut 7:11-15).

Though this is part of a covenantal promise to the nation of Israel, it contains a principle that transcends all dispensations.  God's creation contains certain irreversible laws that govern its function.  As man violates God's commands, he invites upon himself the consequences thereof.  In the realm of infertility, America is now experiencing some of the painful consequences of the sexual revolution.  The future undoubtedly holds even greater infertility as young people are taught to live for today in the midst of a society that holds virtually no moral standard. 

Infertility, however, is not always behavioral.  It is clear that God sovereignly opens and closes the womb, and in most cases, it is for purposes known only to Him.  In 1 Samuel 1:5, we read of Hannah, the Lord closed her womb, while Genesis 29:31 says He opened the womb of Leah.  Sarah said, The Lord has kept me from having children (Gen. 16:2).  Later, God told Abraham, I will return to you at this time next year; and behold, Sarah your wife shall have a son (Gen. 18:10).  The Angel of the Lord said to the mother of Samson, Behold now, you are barren and have borne no children, but you shall conceive and give birth to a son (Judges 13:3). A childless marriage is sometimes in God's sovereign plan for a couple.  If this is the case, He will provide the grace that is needed to deal with the emotional pain of infertility.  Proverbs 30:16 mentions the barren womb as one of four things that are never satisfied.  Since God has created women with the innate yearning for motherhood, He will uniquely comfort those whose yearning cannot be realized. 

It is not the purpose of this paper to explore in depth the moral and ethical dilemmas presented to the Christian by the many modern methods of assisted procreation.  In brief, methods such as artificial insemination, Gamete Intrafallopian Transfer, and In Vitro Fertilization, are not a viable option because they require the introduction of a third party into the procreative process, thus destroying the uniqueness of the one-flesh relationship.  The biblical record is replete with examples of the problems that result from surrogate relationships (e.g. Sarah & Hagar, Rachel & Leah).

However, this does not seem to rule out the validity of normal fertility testing in order to determine if the cause of infertility is simply the improper functioning of the reproductive system.  The moral dilemma of obtaining male sperm for testing is easily solved by surgical removal.  Correcting defects in one's own reproductive system hardly seems to be much different than eye surgery or any other corrective surgical procedure.

Ministering to Infertile Couples

The presence of infertility provides the body of Christ with a unique opportunity to be involved in real-life-ministry to those experiencing its pain.  This ministry is twofold: support and encouragement, and preventive instruction.  It is crucial that the local church not approach the subject of infertility with a judgmental spirit or any hint of condemnation.  Infertile couples should not be made to feel that they are second-class Christians.  Instead, they need support and encouragement.  It may be necessary to develop some type of support system among those with similar experiences.  Prayer support is essential as well as finding ways for these couples to be fulfilled in ministry.  Support and encouragement should also come in the form of sensitive counsel.  The infertile couple needs to be encouraged to completely surrender to God their desire to bear children.  They should be encouraged to follow the instructions of James, call for the elders of the church, and let them pray over [them], anointing [them] with oil in the name of the Lord; and the prayer offered in faith will restore the one who is sick, and the Lord will raise him up, and if he has committed sins, they will be forgiven him (James 5:14).  It may very well be God's will for a couple to bear children, and through this demonstration of faith, His will is accomplished.  The couple should also be encouraged to publicly enlist the prayers of the congregation.  This could be done at a regularly scheduled prayer meeting.  It is through this that the body as a whole can begin to sense the pain and the reality of the need and thus bear one another's burdens.

Bible expositors should also be committed to teaching the whole counsel of God as preventive maintenance for God's people.  People of all ages, but especially youth, must be instructed in God's sexual standards and warned of the painful consequences of "sowing wild oats."  There is no doubt that sexual purity will protect the next generation from at least a good portion of the diseases that now wreak havoc on the reproductive system.

Conclusion

The medical and spiritual causes and cures of infertility are numerous and often complicated, but the body of Christ has a unique opportunity to minister to the real needs of people.  The biblical doctrine of the sovereignty of God should be a great source of peace to those who are striving to live under the Lordship of Christ.  Mark Blocher's comments are a fitting conclusion,

Childlessness is certainly difficult, but it is not a life-threatening condition.  The childless couple deserves our sympathy and understanding, just as we would empathize with anyone whose deepest ambitions and hopes are unfulfilled.  Where infertility can be medically corrected a couple may want to pursue treatment.   Still there are no guarantees in life.  People throughout history have been forced to live with unfulfilled expectations.  In the end, regardless of our circumstances, the Christian must determine whether he or she will accept God's grace as sufficient.  Although the desire to have children is normal and admirable we must give serious thought to medical techniques that attempt to give man complete control over the entrance gates of life.[xxxiii]

*Note: All Scripture quotations, except those noted otherwise, are from the New American Standard Bible.