From the stories of the earliest church, we’ve told ourselves that breadth and depth of the human experience is welcome, our big feelings, our powerful experiences, the fullness of our stories- each has a place within this sacred community. And yet, the reality has not always played out that way. There remain stories that feel unwelcome and excluded; stories that carry the weight of silence, secrecy, and shame. For families undergoing fertility treatment, the complexity of their experiences can often feel left out of how the church celebrates families. Pastors can play a particular role in not only supporting families undergoing treatment, but fostering an environment in which the stigma of fertility treatment can not only be dismantled, but a culture of support can be nurtured.
Key Terms
Modern fertility treatment has expanded significantly in the last four decades. The medical options available to families experiencing fertility challenges for diagnosable and undiagnosable reasons and the removing of barriers for same-sex families and single-mothers by choice has grown dramatically. A few of the most common medical interventions include:
Intrauterine Insemination (IUI) is the process by which sperm is placed directly into the uterus in an effort to increase the odds of fertilization. Some IUI procedures include stimulating hormones through medication to encourage egg release and follicle growth. The American Society of Reproductive Medicine states that “success rates can be as high as 20% per cycle, depending on whether fertility medications are used, age of the female partner, and infertility diagnosis, as well as other facts that could impact the success of the cycle.”¹
Injecting hormones to stimulate follicular growth.
In vitro Fertilization (IVF) involves the fertilization of an egg outside the body before it’s then implanted directly into the uterus. IVF requires stimulating egg release through external hormonal stimulation, egg retrieval, fertilization, and embryo transfer. The Society for Assisted Reproductive Technology collects data from 358 member clinics across the United States; their preliminary 2020 data reports 291,484 cycles of IVF performed, resulting in 73,602 live births.²
Assisted Reproductive Technologies (ART) serves as an umbrella term for the variety of different paths a family might travel in their fertility journey. These can include the above, but also third-party assisted technologies including sperm donation, egg donation, embryo donation or adoption, and surrogacy or gestational carriers.
What about Hannah (and the others)?
Six women in the Bible are lifted up as struggling with fertility: Sarah, Rebekah, Rachel, Hannah, and Samson’s mother in the Hebrew Bible and Elizabeth in the Christian Scriptures. The primary personality trait of these six women is their barrenness, in some cases we also learn they are old. Apart from the status of their fertility, their stories and personalities are limited to the men in their lives.
While it might seem obvious from a pastoral perspective to reach for the stories in scripture that mention infertility, taking these stories at face value can be deeply harmful to families struggling. These are stories that can best be distilled into some version of infertility related shame, praying hard enough, God hearing the prayers and deciding to answer them, and a healthy baby. The perspectives, feelings, and most of the words of these women are missing from these texts and the oversimplification of their stories makes them hard to relate to. They frame fertility as a blessing and implicitly or explicitly then assume infertility to be punishment. Theologian Karen O’Donnell reminds us that, “Pregnancy is not a reward for righteousness.”³
In acknowledging that when we take the texts related to infertility at face value they are as likely to do harm as be comforting, we have to then ask which texts are helpful. For those facing a journey of fertility treatment, some texts to consider might be:
Exodus: As a story filled with reminders of God’s enduring presence, families going through fertility treatment can find comfort in God’s faithfulness in challenging and uncertain circumstances.
Job: For a person in the midst of treatment, Job’s faithfulness in the midst of grief can feel particularly relatable; for others Job’s anger about everything that has befallen him is permission giving to feel anger about their season and a reminder that God can handle their anger and remains present in their lives.
Psalms: The wide diversity of emotions expressed in the Psalms gives a home to the wide diversity of emotions felt by people undergoing fertility treatment.
Miracle Narratives of Jesus: In some instances the miracles of Jesus are an important reminder of the ways Jesus sees the people who are so often marginalized and cast aside in our society. It’s worth noting that for some people these miracles can also bring up questions about why some are healed and some are not.
What to say or not to say
When a spiritual leader has the privilege of being invited into the journey of a family undergoing fertility care, the language they choose to use can greatly impact whether a family feels heard and honored and the extent to which they feel their story will be taken seriously. Conversely, the language a pastor or faith community chooses to use, either intentionally or inadvertently, can do deep damage to those who are experiencing infertility and moving through treatment.
Some examples of the kind of language that does harm:
It will happen in God’s time. The presupposition that God opens or closes the door to reproduction based on a divine calendar implies God does or does not want someone to become a parent.
Just relax. Similarly to “It will happen in God’s time,” telling a person or couple to “just relax” places blame and ignores or dismisses the very real medical diagnosis and treatment decisions a family is weighing.
Complain about pregnancy or children. It is not comforting to tell someone struggling to conceive that pregnancy is awful or children are expensive or a lot of work. Minimizing the experience of pregnancy or parenthood or making it sound like a punishment to someone who so deeply wants to experience it shuts down pathways to support.
Just do IVF/adopt. Pushing particular solutions without fully understanding the physical, emotional, economic, or social realities of an individual family shut down conversation. The variety of factors that play into what options are available to those growing their family are an important part of their process and unique to their circumstances and story.
Some examples of invitational language:
Ask how they’re feeling today. The range of emotions are vast, not presuming how someone felt yesterday is the same as how they feel tomorrow validates the present reality.
Be interested. Not talking about fertility treatment does not make it go away. Be interested in what they are experiencing, let them draw lines around details as they choose.
Ask if you can pray for them. As spiritual caregivers we have the joy and responsibility of holding people in prayer, even when we don’t know exactly what we’re praying for. Using prayer as a reminder that God is holding this family and their story, regardless of outcome, and loves them because of who they are today is a powerful act of solidarity and accompaniment.
Actively hear them. Fundamental to the pastoral relationship is active listening. Using invitational statements like “tell me more about that” or “I hear you saying” makes space for further reflection and revealing of the larger experience.
Affirm their decisions. It is not the job of the caregiver to give advice, but rather to be a place where that choice is acknowledged, affirmed, and trusted. 
Families facing fertility treatment are in the midst of a season filled with complicated emotions, big questions, and uncertain answers. Pastors invited into that season have the opportunity to care for a family by actively and intentionally making space to receive their stories, being honest about the ways Scripture is not a panacea, and modeling language for hope and prayer that stays grounded in the present and moves beyond outcomes. Pastors can also, whether by naïveté or carelessness, add to an already present sense of shame, stigma, or hurt. Caring for a family in a season of fertility treatment is a profound opportunity to be present, listening for joy, hope, and sorrow, proclaiming God’s faithful accompaniment in the journey.
¹“Intrauterine Insemination,” Fertility Answers, accessed December 19, 2022, http://www.fertilityanswers.com/wp-content/uploads/2016/04/intrauterine-insemination-iui.pdf.
²“National Summary Report,” accessed December 22, 2022, https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?reportingYear=2020.
³Karen O’Donnell, The Dark Womb: Re-Conceiving Theology Through Reproductive Loss (Scm Pr, 2022).