Episode Transcript
[00:00:08] Speaker A: You're listening to faith in healthcare, the cmda matters podcast. Here's your host, Dr. Mike chubb.
[00:00:19] Speaker B: Welcome friends, to Faith in Healthcare. In this episode, we're continuing a conversation that touches one real people as well as real marriages and real heartbreak as we discuss infertility and in vitro fertilization.
Joining me as a first time CO host is Dr. John Pierce. He's CMDA's Vice President of Missions and Medical education.
And we're grateful to be joined by Dr. Ward McClellan who's a reproductive endocrinologist and OB GYN and a definite follower of Jesus Christ. He's gonna help us think clearly today about E and the Christian conscience that's in this space.
So let's dive in.
Well, today on Faith and Healthcare, I am so excited to welcome to the program for the first time ever as a co host, our Vice president of missions and medical education, that is Dr. John Pierce. John is faculty at Liberty University, the College of Medicine there there has finished eight years on our board of trustees, helps head up our Remedy Medical Missions conference there at Liberty and has been a wonderful adjunct helper in so many ways. Not only is he board certified in ob gyn, but he's board certified in internal medicine. He sat as chair of our CE committee for many years, helped us go through reaccreditation. So Dr. John Pierce, welcome to Faith and Healthcare for the first time.
[00:01:56] Speaker C: Thanks a lot, Dr. Chupp. I really appreciate it. It's a privilege, it's an honor. I have been not only involved in CMDA, but a huge fan of CMDA since I really began early in my academic career. So I am thrilled to be part of Missions because it's changed my life and medical education and just passionate about being able to pass it on to the next generation.
[00:02:17] Speaker B: Well, Dr. Pierce, you're here for a very important reason in that you know our guest personally and he's also someone who shares your specialty, at least your second board certific obgyn. So why don't you introduce our guest today to our listeners?
[00:02:31] Speaker C: Well, Dr. Ward McClellan is, I think the first thing to introduce him is he's a follower of Jesus when you talk to him. Especially as an ob gyn. With my internal medicine background, I love to be able to talk to people that are believers and have a perspective that really pays incredible dividends as you practice medicine and as you communicate with others. So Dr. McClellan's married to his wife Haley and they have five kids.
And so I'd like to welcome Dr. McClellan and really, I think the first thing that would kind of introduce him to our viewers is let him. Let everyone realize he's been through so much as a patient or as a father, as much as just a physician being here. So, first of all, welcome, Dr. McClellan, and do you have anything else that you'd like to add just as beginning on the podcast?
[00:03:22] Speaker D: Well, thank you. It's really an honor. I was humbled when you asked me to come. I've been listening to the podcast for five years, almost every week. So it was really shocking to me that you wanted me to be on the podcast. I'm hopeful that this will be helpful for the membership and any patients that might listen.
[00:03:38] Speaker C: Well, I think we'll get into some really good topics, which will really help our listeners. But before we do that, would you mind just explaining a little bit about what's happened with you as a father, as a husband, with your youngest son, Beckett?
[00:03:51] Speaker D: Yeah. Thank you so much for that opportunity. I really want to say I just have to give so much glory and thanks to God because my son Beckett was born in June of last year.
And it was about this time last year that we found out that he had a major congenital heart defect. He had transposition of the great arteries.
He's our fifth child. We've had four children that didn't have any health issues before birth. And so it was really overwhelming to get that diagnosis and then to try to figure out it resulted. We had to change where we were going to deliver.
We had to seek, obviously, subspecialty pediatric cardiothoracic care. But I just saw so much faithfulness from God through that. I started keeping a journal through that whole process that it just. It's such a reminder of God's goodness and God's faithfulness. And obviously, God used a surgeon that we're very thankful for, his skill and the pediatric cardiology team and an entire pediatric cardiac intensive care unit that really was helpful in providing healing for my son. But we know that God is the one that was behind all of that, and he's doing great now. His most recent echo, everything looked great, and he's just such a. Like a really joyful, happy child. And he. He's named after St. Thomas Becket and then C.S. lewis. His middle name is Lewis. So It's Beckett, Lewis McClellan. We named him after, you know, two men that I really respect for their. Their prominence and the stance that they've taken in advancing God's kingdom. So that's my prayer and hope for him is that God him in a similar way.
[00:05:28] Speaker B: Thank you, Dr. McClelland. And I'm going to switch to first names for all of us for the rest of this interview. But so, Ward, thanks for sharing that personal story. What a trophy of grace your son is. Now, I want to set just sort of the stage for our listeners that last week we heard from bioethicist internal medicine faculty at University of Michigan, Dr. Kristen Collier. And Ward, you're familiar, you are aware of what we discussed last week. And I had the opportunity in sitting on the board to listen in to a godly group of men and women discussing in vitro fertilization, to come up with our recent position statement on this very issue. And it was tough. It was really hard because we had folks on the board, practitioners who just dealt with infertility in their patients frequently, and then bioethicists like Dr. Collier, you know, certainly our Catholic brothers and sisters out there, very, very strong feelings about this. So I felt that it would only be fair for us through Dr. Pierce to invite a practicing reproductive endocrinology obgyn to the program. So thanks for joining us. My first question.
Wow. Something kind of simple that will require like, no time for you to answer. When does life begin? And how should Christians treat human life? And why in this whole arena on this issue, does it even matter?
[00:06:49] Speaker D: Yeah, I think that's really a great question. And I think it's the fundamental question when you're reproductive technology, when does life begin? Because if a human embryo is a human life, then that has repercussions in how we treat that embryo. If it's not, then I would argue that you could do essentially whatever you want with a human embryo.
The answer to this is complicated. 20 or 30 years ago, there would have been uniform agreement in the field among biologists and reproductive endocrinologists that life began somewhere between fertilization of the egg and formation of the zygote.
There would essentially uniform agreement that by the time the zygote was formed that you had a new human life. Over the last several decades, and in particular in my field, clinically, in the last 10 years, there have been a series of editorials and a shift in the field towards a very different understanding of when human life begins. I think that the argument that is currently posited is that it's difficult to say when human life begins, because saying that life is present or not is a categorical observation. And you can't make a categorical observation on something that occurs on a continuum.
When, when you look at what is a Zygote. The argument is that the zygote is really pretty similar to the egg and that you have to have individuality before you have a unique human life. And because you can have twinning in the case of conjoined twins, and that can occur until the 14th or 15th day after fertilization, that you do not have at the point of fertilization and a zygote, or for sure, even at the point of. Of a blastocyst, you do not have a unique human life. But I think that this is really the foundational question that has to be answered. Because if you will, the goalpost has sort of been moved in the debate because it used to be, again, uniformly recognized by biologists and even reproductive endocrinologists that life did begin with fertilization or that process began and again, once you had a zygote formed, that you had a unique human life. But I think it's really important that we step back and you look at what actually is a zygote and how is it distinct from the egg? Because that difference, I think, is really important when you argue about what the zygote is and what the subsequent embryo is. So obviously an egg is haploid. You have a zygote that's diploid, and it has its own unique, complete human genome. The zygote begins to function in a way that is evidence of it acting towards its own benefit. It is true that you can have twinning that can occur, and that's something that. That is sort of difficult when you. You do talk about personhood. But I think that as Christian physicians and as scientists, it's best for us to really deal with what can we answer with science. And what we can answer with science is biological life. And so I think that when you look at what the zygote is, I think it clearly is a human life. Eggs are the secondary oocyte is going to be arrested in Metaphase 2. It is not going to be able to replicate. It is not a totipotent stem cell. And this is obviously very different from what the zygote is. And the zygote has this capability because it has gained it through the joining of the sperm and the egg and the progression to formation of that zygote. So then you have a totipotent CE is able to continue to divide under either in vivo or in vitro.
If given the opportunity, that cell will progress and will form a cleavage stage embryo. It will then form a blastocyst if implantation is successful, it will go on to develop a fetus, and then it will go on to develop, hopefully, a live born human. When you look at human life as a whole, it's true that human life does occur on a continuum. I think that it's really difficult, though, when you deny that the zygote, which has the entire genetic composition of life, it's unique. And again, if left on its own, it will progress to a point where it can lead to a living child.
If you deny that that is a human, the question is then where do you say that human life begins?
Is it with implantation? Is it with cardiac activity? Is it with formation of an intact neural tube? Is it with the ability to sense outside stimuli? What about being attached to a mother, you know, being dependent upon the placenta for function? And you can play that all the way out, you know, as an infant. My son Beckett, he doesn't have the same cognitive capacity that my 9 year old does. So is he a human? Is my older son a human? Because he doesn't have the same capabilities that I do. So I.
[00:11:45] Speaker B: That.
[00:11:45] Speaker D: That's really important point for the issue of twinning. If you're interested in trying to like, understand, like some of the philosophical arguments behind this, I think a good resource is the book Embryo that's written by Robert P. George and Christopher Tollefson. I think that they're really able to articulate well what the science can say and then what the philosophy says. So I think that the question of when human life begins is really essential because what science can tell us, I think, is really clearly a zygote is a human life at its earliest stage.
That's true. And it's dependent upon many things happening to get to a point where it looks in appearance like we do as human adults. But that doesn't change the fact that it is a human life. And from a Christian perspective, as Christian physicians, I think it's really important that we ensure that we are mindful that we're treating all human life as it's created in the image of God.
[00:12:42] Speaker B: Yeah. Thank you.
[00:12:43] Speaker C: One quick question, Ward. I think a lot of the times when you look at the scientific things, a lot of this justification is trying to divide the religious side, as the academics will say, versus the rest of the scientific side. So all of these discussions have really been, in my mind, as a practicing obgyn, a way not to address the issue that life does begin at conception with the zygote, and therefore it's on a continuum. And that Continuum begins very early on.
Would you agree with that? Do you have any other comments along?
[00:13:14] Speaker D: No. I mean, I would agree with you. I think that by the time you have a zygote formed, you have a human life that's present. It's at the earliest stage of human life. But the argument against what I'm saying, which is what most people in my field would. Would say, is that again, they would say that because you're making a categorical determination that life is present with a zygote, whereas it was not present before. And because all of these processes are occurring, you know, from the point of fertilization to blastocyst formation, you obviously, you have so many steps that have to occur in a way. And so the argument that they posit is that because this is occurring at this point, you say it's alive, but it wasn't before this. At some point you have to have human life that's present. And you can use that same argument, flip it around and say, well, if you deny that the zygote is a human life, then when does human life begin? Because again, you have an entire cell that has a unique genome that is designed in a way that if you believe in a creator that's designed in a way, if you don't believe in a creator that is functioning in a way that is going to develop into a set thing, a zygote that is correctly fertilized with a complete, unique, correct human genome is not going to turn into a chimpanzee. It's not going to turn into a parakeet. And it's a human life. It's very, very early human life, but it's a human life. Yeah, I think that that's really important when you consider these topics.
[00:14:46] Speaker C: Thanks. Quick question. As we transition to kind of talk about clinical care and, you know, I think it's really important that a lot of people think and understand about natural fertility and what happens as God being sovereign. We're dealing with a lot of difficult issues that patients deal with that are very emotional and relational. But can you just talk to us a little bit about natural fertility and what we would expect as clinicians and for patients?
[00:15:13] Speaker D: Yeah, I think that's really important point. I think it's an area in medicine and society where we have not done a very good job of informing patients about what natural fertility looks like. It's not uncommon to get patients in their mid-40s that come in thinking that there's not going to be any issues having a baby. And it's really unfortunate because that's just not the case when you look from a natural fertility talking about just women that are trying to get pregnant in a normal cycle. Even among societies where there's a high pressure to reproduce up until the point of menopause, there's an Anabaptist group, the heterites, that they looked at what was the average age that these women had their last pregnancy in. Again, their religious beliefs compel them to try to reproduce something to the point of natural menopause. But the average age of the last pregnancy in these women was 41, actually right before they turned 41. And so when you look at the likelihood of conception in a couple that are trying to conceive, they're going to have the highest likelihood of conception within the first three months of trying. And then 80% of couples that are trying to become pregnant, that are engaging in regular intercourse are going to become pregnant within the first six months. The fertile window is going to be a six day window. It's the interval that ends with the day of ovulation. So if you know when ovulation is, then you count backwards and it's those six days that lead up to that point during the fertile window, Daily intercourse might be more likely to result in a pregnancy when compared to having intercourse every other day. And then there does not appear to be any reason that couples should be told to refrain from more frequent intercourse. So if you're having intercourse several times a day, that does not appear to reduce the likelihood of conception.
And then this is something that we're seeing within our country, but not just our country like within the world. So women are going to have their highest chances of becoming pregnant in their late teens and their early 20s. Naturally, when you look at who the age of reproduction in our society, in the United States, this age keeps shifting higher and higher now into the late to late twenties. But the, the point at which a woman is going to have her highest likelihood of, and our highest for natural fertility is going to be late teens and early 20s.
Fertility begins to actually decline as early as age 32. And that decline starts to become more rapid and clinically significant and meaningful starting around age 35.
A lot of this is due to the increase in the aneuploidy or the abnormal chromosomal compensation of the eggs that are ovulated or released from the woman in each cycle.
[00:17:50] Speaker C: Great. So we're talking about fecundity or the chance to get pregnant with every cycle. And clearly with the pressures cultural to delay pregnancy, to delay beginning Families, it is harder. So can you tell us how we would really define infertility? And then we'll talk really about what the Christian couple should do as far as addressing infertility.
[00:18:12] Speaker B: Yeah.
[00:18:13] Speaker D: So classically, infertility has been defined as with regular intercourse, the inability for a couple to conceive, have a pregnancy within a certain period based on the age. So for women that were under 35, 12 months of unprotected intercourse, and then for women that are 35 or older, for six months, then it's been recommended that women that are trying to conceive, that are 40 or older, that they seek assistance essentially right away when they decide to try, just because of the reduced natural fertility at that age. In 2023, the American Society for Reproductive Medicine, they expanded the definition of infertility. They changed it from the biological definition that was historically taught that was based upon coital exposure. Obviously, to have a baby, you have to have an egg that's released. You have to have a sperm that joins with the egg. You have to have transit in vivo, in transit through the fallopian tube and implantation in the uterus. They changed the definition ASRM did to include the LGBTQ community, intended single parents and then those that were requiring donor gametes. And ASRM said that their practice committee intentionally moved beyond this limitation, meaning the historic definition of INF that was based on coital exposure, by updating its definition, recognizing infertility not only as a disease of the reproductive system, but as a condition shaped by circumstance and access to reproductive resources.
So that's how infertility is now defined.
[00:19:43] Speaker C: That's very helpful. One other real clarification or addition, I would add. I think all the viewers should know that CMDA has a great ethics statement on in vitro fertilization that is very good and available on the website through the position statements. So that's helpful. Mike, do you want to take over
[00:20:00] Speaker B: as far as the question infertility, it's so common. I mean, my predecessor, good friend of both John and I, Gene Rudd, said that when he's talked to pastors often, they don't think that an ob GYN would have much practical to share to a congregation. And then he'd say, just let me ask one question, and it's about this infertility issue. And then the pastors are like, oh, my word, this is so common. And yet maybe a lot of parishioners don't have the courage to ask their pastor to pray for them.
So I want to ask this question. What can a couple with infertility expect in terms of a general evaluation and the treatment options. And then I'm going to follow up, we'll get to the heart of the matter regarding ivf.
[00:20:45] Speaker D: Yeah, absolutely.
I think that's important to answer to your earlier point. I really do think that it's important for Christianity, couples that are facing infertility to talk to their pastor. You know, in, in James, there's an outline of what someone suffering from sickness or illness is to do. And it's, you know, that you meet with the elders and you have them pray for you. I think that as a Christian and as a Christian physician, it's really important that we remember that we have knowledge, we have skill, we receive training to be able to treat diseases.
But ultimately God is the creator of the universe and he is the great physician and he is the one who brings healing. So a couple that has infertility, I would encourage them, before they even start with their physician, that they start with the elders of their church and that they receive prayer from the point of the consultation. Assuming that you're seeing a reproductive endocrinologist. I think that it's important that a Christian couple be honest about their beliefs and make sure that that's going to be a good fit for them and that their beliefs are going to be respected throughout the process. A sort of general infertility evaluation is really, you know, basic. It starts with what most areas of medicine do. So you start with a comprehensive history and then targeted physical examination.
You want to, because you're preparing to hopefully have pregnancy, you want to ensure that your general pre pregnancy counseling and evaluation is completed if it hasn't been by the referring ob, GYN or primary care doctor. And then you want to think about what are the different causes of infertility. So things that you're interested or that you're going to be asked as a patient, trying to figure out if ovulation's occurring is an important thing for a couple. So in women that have regular 21 to 35 day cycles, that do not have evidence of hirsutism, which could be evidence that they actually have an ovulatory cycles, the assumption is that those women are going to be ovulatory. You're then going to have a structural evaluation of some type, either with an HSG or with a saline sonogram where agitated saline is used to assess for tubal patency.
And then there's targeted laboratory evaluations as well to evaluate for other potential endocrinologic abnormalities like thyroid disorders, insulin resistance for instance, and Then it's also important because it. It does take an egg and a sperm to have a baby, to get a good history from the male. And then the semen analysis is the most important thing from that standpoint. And then further targeted evaluation is really going to be based off of what's found in that initial consultation.
[00:23:20] Speaker B: Thank you, Ward. We've been referring to the CMDA position statement on in vitro fertilization, and I appreciated your honesty with both of us that you think it's fantastic, with maybe one exception as an REI specialist, and that has to do with the freezing of embryos. And as I mentioned, I just saw the passion and differences of opinion between even different board members. So what I like about the position statement so much is it recognizes. You talked about Anabaptists earlier.
Our Roman Catholic colleagues are going to feel pretty strongly about the unitive and procreative aspects of sex and that they're inseparable. And for those who do believe those are inseparable, most of them will say that IVF is not an option, if I'm not mistaken. So for those. The position statement says clearly, for those who are willing to consider and don't feel in their conscience that it is an ethical issue, if done properly.
Help those listeners in that category, those seeking help for their infertility, to understand how could they pursue IVF without compromising their faith.
[00:24:34] Speaker D: Yeah, I think you bring up really good points. I think it's important that you should not encourage someone to go against their conscience. So I'm. I'm not trying to talk people into pursuing a treatment that they think is unethical. My. My hope is just to explain what the options are and then to present the science behind that thinking for. For consideration. So, for, I think for people to answer your question that are open to pursuing ivf, I think that it's really important, again, that you have a conversation with your physician about what that's going to look like and the things that are important to you.
There's a lot of different technology that is used, and there's a lot of different ethical concerns even in the evaluation. For instance, a lot of times to obtain the semen analysis or to obtain sperm, either for intrauterine insemination or for ivf, pornography is offered by clinics for the collection of the. Of the semen. And so, you know, obviously, that's something that I think is not consistent with a Christian worldview, there being pornography. That's a part of the process. So I think that's a specific ethical area that patients should be aware might be a mainstay in their clinic that they shouldn't be surprised if they necessarily see, but that they could avoid. For some people that have concerns about not divorcing the conjugal act from conception, I've had some patients that will use collection condoms and then they'll perforate a whole a specialized condom that the clinic can provide you or can be purchased. They'll perforate like a small pinhole and they'll have intercourse and then they'll allow the semen to be washed and the sperm to be used for intrauterine insemination or IVF sometimes. But that's that's one option that's available to a couple that might be concerned about divorcing the conjugal act.
[00:26:31] Speaker A: Before we continue with this week's episode, here's a special announcement for you.
Mark your calendar for the 2026 CMDA National Convention, April 23 through 26 in Loveland, Colorado, a time to renew your spirit, recharge your faith, and connect with fellow believers in healthcare.
We're thrilled to welcome John Stonestreet, president of the Colson center and co host of breakpoint Radio and now nationally recognized voice on faith, culture, theology and Christian worldview.
Convenient lodging is available at Spring Hill Suites by Marriott, with special CMDA room rates reserved for attendees.
Learn more at CMDA.org events Let's jump right back into this week's episode.
[00:27:26] Speaker D: I think it's really important if you're proceeding with IVF that you have a discussion about and you think about, again, what are you creating? And I would say that, again, science, I think, is really clear, even if it's denied by the broader scientific community through redefinition of terms that a zygote and the cleavage stage embryo, the blastocyst is a human life.
And so it's important that you're thinking about that as you're creating these embryos. And I think for a Christian from a Christian worldview to be honoring the Imaho Day and acknowledging that that is a human life, there needs to be a willingness to transfer every embryo that is created. Like I had told both of y', all, there are certain situations where freezing embryos does, I think, make sense. It can improve the outcome for certain subsets of patients, for instance, patients with endometriosis or adenomyosis. And so I think that freezing embryos for some patients might be clinically appropriate. But again, I think that the way that that's done from a Christian standpoint, the mindset needs to be that there's going to be a willingness to use all those embryos. Then I also think that how those embryos are created is important.
The use of what are called donor gametes. Those are either an egg or sperm or both that are purchased from someone that's called the donor and then used.
Katie Faust has really good, a lot of really good pieces about this. But when you do that, you're separating that child from their biological parent.
Now, I've been told that because the person who is a donor does not identify as a parent, that that's not what you're doing. But that doesn't change for the, doesn't change the biology, the biological relationship there. And I think that that's something that is concerning from a Christian standpoint. So I think that's something Christian couples should avoid. The other thing that a lot of clinics in the United States are using is various forms of genetic testing of embryos. So on the fifth day at the blastocyst stage, the embryos, the part of the trophectoderm which becomes the placenta is biopsied. The embryos are frozen. That's an offer genetic analysis using next generation sequencing. And then you get a report back that can tell you lots of information. There's various types of pgt. So there's PGT A for aneuploidy, there's PGTM looking at specific disorders. There's PGTSR looking for structural rearrangements like translocations.
And then there's new technology which ASRM currently opposes in widespread practice. I think is good that they oppose it, which is pgtp, which is polygenic risk scoring, looking for percentage risk of various disorders like for instance, schizophrenia.
You know, all these technologies, there's, for PGT A, there are some clinical concerns about the actual validity of the results, like the accuracy of the results. There's variations that have been published between various labs where you have very different percentage call rates of normal versus abnormal or aneuploid versus euploid embryo rates based on the platform in the lab that you're using, which is concerning.
There's currently a class action lawsuit that's involving pgta. And I think that the reason behind that is there's concerns about the accuracy of that technology. But even if you assume the technology is completely accurate, the concern that I have with that is the eugenic component of it. You're choosing say with pgtm, you have a child, you have two people that are carriers of cystic fibrosis. You can do that testing. You can I get A report that says these embryos have this disorder, these embryos are unaffected, these embryos are carriers. And what typically happens in that case is that the embryos that have cystic fibrosis would be discarded. So they would be thrown away and then you would only transfer carriers or unaffected embryos.
[00:31:19] Speaker B: Ward, if I could ask a quick question, clarification, because I'm sure Dr. Pierce knows this, but maybe many of our listeners, as I was reading the information, the A and the M and I mean, what's the distinction between these tests?
[00:31:31] Speaker D: Yeah. So the like the way.
[00:31:32] Speaker C: And one other thing just to make sure PGT is pretty. Genetic testing.
[00:31:37] Speaker D: Yeah. Pre implantation genetic testing.
[00:31:39] Speaker C: Yes. So with the. This is early on where you have the zygote and you're actually biopsying prior to transfer.
[00:31:47] Speaker D: Correct.
[00:31:48] Speaker C: Okay, so go ahead. I'm sorry, I just wanted to make sure.
[00:31:50] Speaker D: Yeah. So the. So with, with PGT pre implantation genetic testing, there's lots of different variations of it. The technique is done clinically in the embryology lab. The same you have the trophectoderm part of the placenta or what will become the placenta that is removed and then that' off for genetic testing. The embryos are then frozen. So PGT A, which is pre implantation genetic testing for aneuploidy, it's supposed to tell you if the chromosomal composition is normal or not.
And then you can get variations of that, what's called a mosaic, which is actually, it's really an intermediate copy number variant, but it's labeled mosaic. And it can identify chromosomalities like down syndrome. It can also identify wide aberrations in chromosomes that are thought to be incompatible with implantation.
Interestingly, in one of our subspecialty journals a couple months ago, there was a case report that was published of aneuploid so known abnormal embryos that were transferred using this PGT test, testing the PGTA that resulted in healthy live births.
The clinical question, like the scientists of in me is concerned about how that technology is utilized in that healthy embryos, even if it's a small number, are discarded that could result in a live birth. So are you harming a patient by using that? The data in the society would rec would agree for young women like under 37, some would say under 35. The data is pretty compelling that you are harming patients meaning reducing live birth rates by using that technology.
For older women, there's some studies that say that you might increase a live birth rate because you will end up rank Ordering the normal embryos for transfer first. So you're more likely to either more quickly get a live birth or some women will stop going through the transfer process before they've used all their embryos for various reasons, you know, financial or emotional reasons. And so if they haven't transferred a normal embryo that's chromosomally normal, they might not ever reach that live birth from that cycle. With the PGT A, the M is targeted for specific disorders. So like again, a specific example that I talked with patients about, cystic fibrosis is one you're looking for specific genetic disorders that you know, someone is a carrier for that you can select out for. And then SR is translocations. So looking for, you know, translocations that are present. And then the pgtp, the pre implantation genetic testing P that is looking at polygenic risk scoring, again, where they use lots of different markers to try to determine the likelihood that an embryo will have a specific disorder once that embryo is an adult. So schizophrenia or diabetes, hypertension for instance. And you can get these complicated reports that have percentages for various conditions for the embryo. The last one, PGTP is right now the position of our professional societies that that should be done within a research context and it should not be widely adopted. But, but you can go to a clinic and get PGTP if you're interested.
[00:35:00] Speaker C: So Ward, it's, you know, as an obgyn, you end up talking to people all the time about this. And I really wanted to speak to patients that come in, you know, how do you handle this from a Christian perspective? I, as a practicing Christian obgyn, would always ask the patient, okay, what perspective do you come from?
What beliefs do you really have?
And therefore we determine what must we do to handle this really well.
So as if you are a infertile couple or you are another physician that's counseling an infertile couple, what would you tell them in counseling them to come to an REI in the initial approach and how to then handle it in subsequent visits. That would really make handling the difficulty of infertility with an ethical Christian approach that would therefore leave us with contentment in the heart.
[00:35:54] Speaker D: Are you asking for like typical treatment?
[00:35:57] Speaker C: So no, I'm asking really as a patient that comes in a lot of the times I, I guess what I'm saying, how would you handle it differently if someone comes in and doesn't say anything to you versus they come to you as a Christian and they say, this is what I believe, this is how I'd want to handle It. What do we need to do?
[00:36:14] Speaker D: Yeah, so I, I think that for the talking about the Christian couple, I think understanding what they believe and what their concerns are is important.
And I think that there's a lot of physicians in my field who, they're not coming from a Christian worldview, but I think that there are a lot of practicing reproductive endocrinologists that would be willing to honor and respect someone's sincere religious beliefs and their treatment. And that's why I think it's really important that. That the couples are. They're honest and upfront with their doctor about what their concerns are. And I think the, the big concerns, like we've talked about, you know, various technologies, the, you know, genetic testing of embryos, I think that that's morally problematic.
The creation of what are called supernumerary embryos or extra embryos that are going to be discarded if they're not implanted intentionally. Doing that, I think is. Is inconsistent with what a Christian would be looking to do going through the treatment process. And so I think that being honest with your doctor about those things and your concerns and making sure that you're in a clinic where they're going to do that. For instance, there are some clinics where essentially all their cycles are using genetic testing of embryos.
That might be a challenging place for a couple if they're concerned about that. But there's other clinics that. That would not be an issue for them. And so I think that those, those things are important.
And then finally, I think infertility can be really devastating. You know, regardless of what the underlying diagnosis is, whether it's infertility, unable to get pregnant, you have a patient that has recurrent miscarriages. These can be really devastating for couples that really are hoping to have a child. And, you know, I have, obviously, I have a lot of empathy for them. I mean, that's my almost entire practice is, you know, helping people that have infertility. And it can be really difficult.
I've known people, not as patients, but as friends that have gone through treatment, and they had really strong, sincere religious beliefs that they set aside during the process.
And they did things that they were conflicted about in their conscience.
And we talk about moral injury in health care, and that's a real thing. But that can be true for patients, too. Sure. And I think that it's really unfortunate when that happens for patients because, you know, you end up having that moral injury from.
There's healing that has to go on from that. And so I think that it's important that Christians do really consider that and, and that the pursuit of a child is not put ahead of the glorification of God and being faithful to him.
[00:39:14] Speaker C: Yeah, I think as an ob gyn, just in general ob GYN ward, I've always tried to tell patients, one is take this slow. There are tremendous pressures on the couple to achieve rather than out of that relationship that God has brought together to allow the Lord to work. And most of the time that goes slower than what we typically desire in our culture.
So I've always emphasized one, make sure that you think about everything that goes on before you get too far down the road.
So like you're talking about pre implantation genetics. If I don't want to do that, to be able to communicate, this bothers me and I can try to explain why, to have an open discussion. So like you said in the beginning, incredibly important to go into this prayerfully with good support, including people at your church, pastor, Christian physician, who could also help guide you, as well as great communication with an REI specialist as you begin the process. Is there anything else that you would say as a Christian couple that you should really consider avoiding with IVF or further down the road as far as getting into trying to solve the problem of infertility, but just using technology over the relationship and what God's given us?
[00:40:34] Speaker D: Yeah, I mean, I think like you said, the. My, my intent, regardless of where a patient is coming from, when I see them as a patient, is when you're doing that evaluation, going back to that initial evaluation, the hope and what I tell patients is my hope is that I am going to be able to identify a cause. Because if I have a cause, then I can direct my treatment towards that cause.
Then the next goal, whether we're successful or you end up with unexplained infertility, which a large percentage of patients will, you then try to help them achieve pregnancy in the least invasive means possible.
That's really better for the pregnancy, results in fewer complications that are related to the pregnancy. But if you get to the point of IVF or that's where you're left staying, you know, we've been, we've tried ovulation induction, we've tried intrauterine insemination. We've done multiple cycles. We're not getting pregnant. If you're looking at going to ivf, then, you know, there's various ways IVF can be done that might be more conducive to a Christian, particularly if you're concerned about the creation of supernumerary or Extra embryos that are indefinitely frozen. But I think the key points are that you need to make sure that what you're doing is not, as a Christian, that you're not breaking or acting in a way that is divergent from God's, like, clearly ordained way for life. And so I think that that's why I believe that the utilization of donor gametes should be off the table for Christians. I think that it. There's cons. There's real concerns about the effect of that within the marriage, the Christian marriage, but also the. The child. It doesn't honor the child's rights to their biological parents. You know, there's concerns about the use of commercial surrogacy where you have a paid surrogate. You know, the women that tend to do that tend to be lower socioeconomic or, you know, military spouses. And there's concerns about that, you know, an issue for, like, exploitation of the surrogate or the gestational carrier. I think that the. The genetic testing, like we talked about, is something that. Is something that needs to be avoided as well.
Were you. Were you wanting to talk about going into, like, various types of ivf? Like, what, you know, natural cycle, modified? Is that what you're.
[00:43:01] Speaker C: Yeah, I think that's probably another topic for another day, just because of the complexity. But I think the key that I always try to stress to patients, you know, even in the midst of this struggle, even in the midst of the suffering, God is sovereign. He has not abandoned you. He has not forgotten you, and he is there. And I think that that is often forgotten. And I know from an OB GYN perspective, it's rare that you'd ever hear an OB GYN tell a patient that. But I think speaking truth in love is incredibly important in making that happen. So one other question. There's been, you know, kind of this illusion in the public sphere that, oh, IVF will help declining fertility rates. What can you tell us about that? What would you say?
[00:43:47] Speaker D: Yeah, I would say, respectfully, that's nonsense.
[00:43:51] Speaker C: So we.
[00:43:52] Speaker D: We have so many issues in our society that are contributing to the decline that we have in our birth rate. So if you're interested in looking more at this, Brad Wilcox has a lot of really good material and books that he's put out about, you know, the effect of delaying marriage on society. But that's been really driving a lot of the change that we have. Right. You have the forces of delayed partnering, where people are entering into relationships and marriages later in life. They're delaying childbearing, contraception use, being Widespread.
When you look, I think in 2025 there were over approximately a million abortions.
And when you compare that to about 3.6 million live births, that number, you assume 25% maybe of those abortions might have spontaneously miscarried 20, 25%, but that, that would increase your life birth rate if you didn't have all those terminations of pregnancy as well. And so IVF is very expensive. When you look even at the ideal couple, a young woman who's under 35, you're going to have. If you look at an intention to treat, I intend to take you to ivf and we're going to transfer all the embryos that we can from that cycle. You're going to have a slightly over 50% live birth rate from that IVF cycle with the transfer of all those embryos. And that can be a little bit higher or a little bit lower based on the individual factors of that woman. And then obviously the 23 year old woman is going to have a better prognosis than a 34 year old on average. Although that can change too based on what the underlying cause of the fertility is. But people that are saying IVF is going to be the savior of, of our population pending population collapse, that might be a good talking point and it might be beneficial for certain advancement of certain ideas.
[00:45:45] Speaker C: But it's just politics.
[00:45:47] Speaker D: It's not gonna, it's not gonna, it's not true.
[00:45:50] Speaker C: No.
[00:45:51] Speaker D: It can be a useful adjunct and a useful tool to treat infertility in patients. And I think that it is appropriate to use it for that. But to try to sell it as a way to solve our population collapse is.
It might be well intentioned, but I don't think that it's going to be.
[00:46:08] Speaker B: Yeah. One of our recent guests on faith and Healthcare, Al Mohler, said not just nonsense, but nonsense on stilts.
I like that terminology.
[00:46:18] Speaker D: He said it more eloquently than me.
[00:46:21] Speaker B: Well, we're running out of time. And While this conversation, Dr. Pierce, has turned out as well as I really hoped it would, there is an editorial that I want our listeners to be aware of that John Pierce made me aware of. And it's actually by past guest when we called the program CMDA Matters, John Gordon from Knoxville of Rejoice Fertility, who wrote an article just a couple months ago and it's great to read an article, an editorial written by one REI experienced practitioner. To all the rest of you guys, it's called Consider this moment the moral issues raised by ivf. Let's be honest with one another. And the last half of the article is several points. Let's be honest this, you know, life does begin at fertilization. Let's be honest, embryos are alive and represent the earliest form of human development and that all patients struggle with the disposition decision regarding their supernumerary embryos. So multiple points. I won't go into them all because we've run out of time, but we'll have that in our show. Notes, a link to this particular editorial, because we do know Dr. Gordon. He's one of our members, and I think he asked some really, really good points. He's not sure if anyone's going to listen in your special, but he's asking some really good questions. I wish we had more time, I really do, just to dive into restorative reproductive medicine and some things we talked about before we started recording today. But maybe later. Ward and John, let's come back for part two to talk about some other issues. But we have run out of time. Any final comments, Ward, that you'd like to make? Any hanging chads?
[00:47:56] Speaker D: Yeah, there's one thing that I guess I would.
I'd like to say to Christian physicians in general is I think it's really important that we are intentional about honoring the Lord through our practice. I've been very guilty of siloing my faith and my practice of medicine in the past. And I think that we're at a point in our society where if we're going to really practice, you know, the way of medicine as that far Curlin and Christopher Tolson put forward, if we're going to really practice in a way that honors God, I think that we need to, with love, but with boldness, stand firm on the truth.
[00:48:38] Speaker B: Amen.
[00:48:38] Speaker D: And I think that if you are doing that in today's age, you're going to invite some level of persecution. And so I would ask other Christian physicians, as I examine my own self, are you facing any persecution? And if not, are you standing firm for the truth and love?
[00:48:58] Speaker B: Wow. Dr. Pierce, any final comments?
[00:49:01] Speaker C: You know, Mike, I think I go back to, you know, a common known verse that is that I've used throughout my career. It's Proverbs 3, 5, and 6. And I think it really applies here. You know, trust in the Lord with all your heart and lean not on your own understanding. And I would say sometimes lean not on all of our scientific understanding, but in all ways acknowledge him and he'll make your path straight. That has proven just incredibly helpful, important, and a timeless truth in counseling patients.
[00:49:32] Speaker B: Thanks to both of you for joining us this week on Faith and Healthcare. Great discussion. Thank you.
[00:49:37] Speaker C: Thanks Mike.
[00:49:37] Speaker D: Thank you.
[00:49:47] Speaker B: Thanks again to Dr. Ward McClellan for joining us and to Dr. John Pierce for co hosting today's episode.
Infertility and IVF are emotionally heavy topics and we hope this conversation helped you think with both compassion and conviction, honoring life and keeping Christ at the Center.
We're going to link to CMDA's position statement that we referred to frequently on IVF in our show Notes.
You know, if this episode was helpful, please share it with a friend or a colleague and be sure to subscribe to our YouTube channel and follow the podcast on your favorite platform so that you don't miss the next episode. And here's just a little bit of history also for Dr. McClellan. You know he shared with me that he's been listening to CMDA Matters and then Faith and Healthcare for five or six years and it was several years ago that he heard an infertility doc speak share with us on this program and it led him to believe I can be a reproductive endocrinology OB GYN just like that doctor. And that led him down a path. So think about sharing this episode with a medical student or a resident, an OB or anyone else you know that might be interested to hear that there are pro life doctors in this subspecialty within obstetrics and gynecology.
Well, next week theologian Dr. Al Mohler, who is president of the Southern Baptist Theological Seminary, joins us to talk about where our culture is headed, what that means for those of us in health care, and how we can remain faithful as well as courageous as Christian healthcare professionals in a time of growing cultural pressure and tension.
I do want to thank you for listening to Faith and Healthcare Today where our mission is to bring the hope and healing of Christ to the world through committed Christ followers within healthcare. We'll see you next time, friends, Lord willing.
[00:52:01] Speaker A: Thanks for listening to Faith in Healthcare, the CMDA Matters podcast.
If you would like to suggest a future guest or share a comment with us, please email cmdamatterscmda.org and if you like the podcast, be sure to give us a five star rating and share it on your favorite social media platform.
This podcast has been a production of Christian Medical and Dental Association.
The opinions expressed by guests on this podcast are not necessarily endorsed by Christian medical and dental associations.
CMDA is a non partisan organization that does not endorse political parties or candidates for public office.
The views expressed on this podcast reflect judgments regarding principles and values held by CMDA and its members and are not intended to imply endorsement of any political party or candidate.
