When faced with infertility, Amanda and Jeff Walker had a baby through in vitro fertilization but were left with extra embryos — and questions. Tori and Sam Earle “adopted” an embryo frozen 20 years earlier by another couple. Matthew Eppinette and his wife chose to forgo IVF out of ethical concerns and have no children of their own.

All are guided by a strong Christian faith and believe life begins at or around conception. And all have wrestled with the same weighty questions: How do you build a family in a way that conforms with your beliefs? Is IVF an ethical option, especially if it creates more embryos than a couple can use?

“We live in a world that tries to be black and white on the subject,” Tori Earle said. “It’s not a black-and-white issue.”

The dilemma reflects the age-old friction between faith and science at the heart of the recent IVF controversy in Alabama, where the state Supreme Court ruled that frozen embryos have the legal status of children.

The ruling — which decided a lawsuit about embryos that were accidentally destroyed — caused large clinics to pause IVF services, sparking a backlash. State leaders devised a temporary solution that shielded clinics from liability but didn’t address the legal status of embryos created in IVF labs. Concerns about IVF’s future prompted U.S. senators from both parties to propose bills aiming to protect IVF nationwide.

Laurie Zoloth, a professor of religion and ethics at the University of Chicago, said arguments about this modern medical procedure touch on two ideas fundamental to the founding of American democracy: freedom of religion and who counts as a full person.

“People have different ideas of what counts as a human being. Where to draw the line?” said Zoloth, who is Jewish. “And it’s not a political question. It’s really a religious question.”

For many evangelicals and other Christians, IVF can be problematic, and some call for more regulation and education. The process is “inherently unnatural,” and there are significant concerns relating to “the dignity of human embryos,” said Jason Thacker, a Christian ethicist who directs a research institute at the Southern Baptist Convention.

“I’m both pro-family and pro-life,” he said. “But just because we can do something, it doesn’t mean we should.”

Kelly and Alex Pelsor of Indianapolis turned to a fertility specialist after trying to have children naturally for two years. Doctors said her best chance for a baby was through IVF, which accounts for around 2% of births in the U.S.

“I was honestly very scared,” said Pelsor, who believes life begins as soon as growth starts after sperm and egg meet. “I didn’t know which way to go.”

Pelsor and her husband talked and prayed. She began attending a Christian infertility support group called Moms in the Making. She said she started to feel “this inexplicable peace about moving forward with IVF.”

Pelsor, 37, underwent a retrieval procedure in March 2021 and got five eggs. Three were able to be fertilized, and two embryos grew to the blastocyst stage and were able to be frozen. One was transferred to her womb in July 2021, and her daughter was born in March 2022.

“I truly believe she’s a miracle from God,” said Pelsor, who works for a nonprofit that includes a nondenominational church. “She would not be here without IVF.”

Pelsor miscarried the other embryo after it was transferred last year. So she never had to personally face the moral quandary of what to do with extras.

Amanda Walker of Albuquerque, New Mexico, did.

She and her husband turned to IVF after trying unsuccessfully to get pregnant naturally for five years and then having a miscarriage.

She wound up with 10 embryos. She miscarried five. Three became her children: an 8-year-old daughter and twins that will turn 3 in July.

That left her with two more, which she agonized and prayed about.

She said she often wonders how many other women find themselves in the same position she did after the egg retrieval, “where they’re just naive about the process in the beginning,” fertilizing too many eggs and then not knowing what to do.

“We didn’t want to destroy them,” said Walker, 42. “We believe that they are children.”

When Matthew Eppinette, a bioethicist, speaks about IVF, he hears many similar stories.

Couples tell him, “’Well, we got way into the process, and we had these frozen embryos, and we just never realized that we were going to have to make decisions about this,’” said Eppinette, executive director of the Center for Bioethics and Human Dignity at Trinity International University, an evangelical school based in Illinois.

“There’s a large educational component to this, both I think within the church, and maybe even within the medical community, to make sure that people are aware of what all is encompassed in IVF.”

Dr. John Storment, a reproductive endocrinologist in Lafayette, Louisiana, said he talks with patients about such issues, and some with similar beliefs about when life begins take steps to minimize or eliminate the risk of extra embryos. For example, doctors can limit the number of eggs they’re likely to get by giving less ovary-stimulating medication. Or they can fertilize two or three eggs — hoping that one embryo grows — and freeze any other eggs. If a few eggs need to be thawed and fertilized later, he estimated that would cost around $5,000 on top of the usual $15,000 to $25,000 for a round of IVF.

Another option is to transfer one or two embryos to the womb immediately without freezing any embryos or eggs. But if that doesn’t work, a patient could face another costly egg retrieval.

Thacker said that sort of “fresh” transfer is more ethically permissible than freezing embryos for an uncertain fate, “but I still don’t think it’s advisable.”

Religious scholars say the IVF issue is largely under-explored among evangelical Protestants, who lack the clear position against the procedure taken by the Catholic Church (even if individual Catholics vary in whether they adhere to the church’s teachings on reproductive ethics).

Still, Eppinette said most evangelical leaders would advise couples to create only as many embryos as they’re going to use and not leave any cryogenically frozen indefinitely. In his own life, Eppinette goes further, saying “my personal conviction is against IVF.”

That’s why he and his wife weren’t willing to try it when they faced infertility in the 1990s and her one pregnancy ended in miscarriage.

Some couples and religious leaders find an answer in embryo adoption, a process that treats embryos like children in need of a home. Snowflakes, a division of Nightlight Christian Adoptions, has offered this service to more than 9,000 families since its inception in 1997, with more than 1,170 babies born. Executive Director Elizabeth Button said they got an influx of inquiries after the Alabama ruling.

“We were established for the sole purpose of providing a way for people who have remaining embryos after doing IVF to then be able to gift those to an adoptive family,” she said. “Embryos are children waiting to be born.”

For the Walkers, Snowflakes offered a perfect chance to support life and help others. They chose an open adoption that allowed them to pick and get to know the family that would be adopting their embryos.

The adopting mom miscarried one embryo but gave birth to a daughter with the other. The two families now touch base weekly. They even plan to vacation together.

Couples on the other side of the adoption arrangement say it’s been a good solution for them, too.

The Earles of Lakeland, Florida, learned about Snowflakes through an adoption agent they were referred to by a fellow church member. They had struggled with infertility for years and were considering traditional adoption. IVF wasn’t an option because of concerns about leftover embryos.

“We’re believers,” said Tori, 30, who belongs to a Baptist church where her dad once was pastor. “So we just prayed about it, and we asked the Lord to just kind of guide us.”

The idea of embryo adoption resonated. They see embryos as lives in need of a place to grow, and Tori wanted to be pregnant. They adopted 13 that had been frozen for 20 years by another couple. One became their daughter Novalie, born last April. They have 11 more embryos — one didn’t survive — and hope to have another three or four children, knowing that not every embryo grows into a baby.

“God can use everything to His glory,” said Sam Earle, 30. “There’s certainly an aspect that you consider with IVF: the ethics of freezing more embryos than you need. … But for families who struggle with infertility, it’s a beautiful opportunity.”

Tori views pregnancy with a donated embryo as nurturing “what was already established,” she said.

Amanda and Ryan Visser of Sterling, Colorado, feel the same way. When they faced infertility after having a child naturally 14 years ago, they were uncomfortable about IVF. “At some point,” Ryan said, “you feel like you’re playing God too much.”

They fostered and adopted two children, and later heard about Snowflakes on the evangelical podcast “Ask Pastor John.” They adopted three embryos, and two became their twin boys, born in October. They plan to use the one they have left or donate it to someone else.

“God creates families in so many ways,” said Amanda, 42.

Caroline Harries isn’t sure how she and her husband Colby will ultimately build the family they want. They’ve never done fertility treatments and aren’t pursuing any options right now as Colby undergoes chemotherapy for testicular cancer. But they’re open to various ways of becoming parents.

Harries frequently talks with other couples facing infertility as the founder of Moms in the Making, which has 90 groups worldwide. She said she’d never personally tell members pursuing IVF what to do with extra embryos, but “as an organization, we would recommend, hands down, not to discard them or to donate them to science.”

She said the recent IVF controversy in Alabama raised important issues. “It adds this level of responsibility for both the clinicians and the patients to think through: OK, what are we going to do with these embryos?” she said. “It maybe even adds this level of awareness to the gravity of the situation that these couples find themselves in.”

Other Christians who faced infertility agreed, and several said they support the Alabama court deeming embryos “extrauterine children.” When Amanda Walker heard about it, she said, “my heart was jumping because that’s my belief.” Amanda Visser said she hopes it “paves the way for more states to consider the dignity of human embryos.”

Still, no couples said IVF should be stopped, although some wondered whether more regulation or education is needed.

But Matthew Lee Anderson, an assistant professor of ethics and theology at Baylor University who wrote an argument against IVF, said tighter controls seem unlikely after the Alabama decision.

“There’s going to be no path toward providing accountability for fertility clinics because any effort to talk about the need for regulation or oversight is going to be viewed as an attempt to shut in-vitro fertilization down,” Anderson said.

He said the anti-abortion movement hasn’t done enough to deal with the political implications of the idea that human rights are conferred at conception.

Zoloth, the Chicago scholar, said the loss of IVF would be huge and “really unfair” if it “was only because of a religious argument held only by one section of the population.”

Even among Christians who see embryos as treasured lives, religious experts say there’s a wide spectrum of complicated views on IVF. Kelly Pelsor, for one, doesn’t want to see it threatened anywhere.

“When clinics started pausing their services and it looked uncertain for a moment, it broke my heart,” Pelsor said. “I am continuing to pray for a way forward that IVF access would remain open to families — and anything is possible.”

___

Ungar reported from Louisville, Kentucky; Stanley from Washington, DC. Religion writer Peter Smith contributed from Pittsburgh.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. AP religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.