Infertility & Restorative Reproductive Medicine

In the beginning, God created man and woman in His image and likeness. He blessed them to be fruitful and multiply, referring not only to procreation but also to their work in the world. The command to “be fruitful and multiply and fill the earth” (Gen. 1:28) is best understood as a blessing or promise, directly tied to mankind’s creation in the image of God.

Understanding the Cultural Mandate—as Genesis 1:26–28 is often called—as a blessing rather than a command frees men and women from believing they must produce children by any means necessary. Instead, it invites them to view children as a gift from God, not an achievement of human will. 

While Christians affirm the desire for children, they also affirm that life begins at conception—not merely at implantation. Even in their most vulnerable stage, embryos are created in the image of God (Job 10:9–11; Ps. 41:5; 139:13–17; Jer. 1:5; Luke 1:41–44). Therefore, any procedure that destroys or disregards the dignity of embryonic life is morally and theologically abhorrent (Deut. 18:10–14; Eph. 5:3). Such practices should not be found among God’s people.

Anglican ethicist Oliver O’Donovan rightly notes that while God begets the Son of His same nature and substance, He creates man and woman in His image—but of a different nature. He blesses them to beget children (Gen. 5), making procreation a reflection of the Imago Dei. This blessing mirrors the fruitful, relational, and self-giving nature of the Trinity. However, the Bible distinguishes between begetting—of the same nature and substance—and creating—in one’s image, but of a different substance and nature. Men and Women created in God’s image are called to beget children, but O’Donovan warns that certain reproductive technologies may place humans in the position of creating, not begetting, children. Ultimately, O’Donovan argues that Christians are called to receive children, not manufacture them.

Fertility is a central Biblical theme, reflecting God’s intent for procreation in every dimension of life, especially childbearing.

But in Genesis 3, sin fractures the world. Where there was once unity—between God and man, husband and wife, labor and procreation—there is now division. To the woman, God said, “I will surely multiply your pain in childbearing” (Gen. 3:16). The Hebrew word for “pain” (בְּעֶ֖צֶב) is the same root word used in Gen. 3:17, describing Adam’s toil with the ground. This pain refers not only to physical pain but also to anxiety, hardship, and loss; especially as it relates to our desire and ability to bear children. In verse 16 in particular, the word for pain also includes the connotation of idolatry, hinting at the perennial temptation to idolize and control fertility apart from God. 

Throughout Scripture, God’s covenants with humanity often include the promise of children—either through biological offspring or spiritual legacy:

While childbearing plays a key role in each covenant, it is not the only way God builds legacy. Jesus, Paul, and many others show that spiritual parenthood and legacy are central to God’s redemptive work, even for those called to singleness.

Remarkably, many of the Bible’s central figures struggled with infertility—Abraham and Sarah, Isaac and Rebekah, Jacob and Rachel.

• Abraham and Sarah acted in fear, using Hagar, Sarah’s servant, to fulfill God’s promise. This attempt outside of God’s design brought pain and conflict.
  
• Isaac and Rebekah turned to prayer, and God answered them, as He did with Elkanah and Hannah.
  
• Jacob and Rachel, desperate for children, used mandrakes and her servant Bilhah. Though she bore two sons, her story underscores that it is God who opens and closes the womb.

As Ligonier Ministries notes:

The temptation to idolize fertility plagued Israel throughout the Old Testament. Worship of Asherah, a fertility goddess, reflected a desire to control fertility through pagan practices. In doing so, Israel rejected God’s provision, and faced judgment for their idolatry. Their pursuit of fruitfulness—of children and crops—apart from God only led to brokenness.

Yet, Infertility is not the end of God’s story.

God remains sovereign and compassionate. Moreover, God does not leave His children to wait passively. As Psalm 127 and 128 outline, God equips men and women with wisdom to discern biblically sound next steps to address their infertility.

In all this, it is important to remember: 

1. 1. Fertility is God’s idea. Sin introduced brokenness into the gift of procreation, bringing strife, loss, and difficulty into the experience, but it remains part of God’s good design.
   2. “Unless the LORD builds the house…” Desiring children is natural and good within marriage. Yet efforts to control conception—whether through natural or artificial means—can become vain if they ignore God’s sovereignty. He alone grants children (Ps. 127:3). As O’Donovan says, children are not an act of the will, but a gift received with open hands.
   3. Infertility can bring shame. It is a painful reminder of the world’s brokenness. Yet this shame is not from God. As bioethicist Gilbert Meilaender notes, Jesus refutes the idea that suffering is always linked to sin (John 9:1–3). Infertility is not judgment, but a sign of the world’s fallenness; that all is not as it should be. Indeed, infertility is not sin itself but a result of sin entering the world.
   4. “Blessed is everyone who fears the LORD.” (Ps. 128:1) If Psalm 127 warns against vain striving, Psalm 128 commends reverent trust. Indeed, the fear of the Lord is the beginning of wisdom (Prov. 1:7). Wisdom is active—seeking God, discerning His will, and responding faithfully. James promises that God gives wisdom generously to all who ask (James 1:5–6). Thus, Christian couples facing infertility are called not to passivity, but to faithful discernment, grounded in Scripture and guided by godly wisdom.

Infertility may never be fully resolved or explained, even in Scripture. But we can trust that God is present and active in our pain. He may not grant biological children to every couple, but He promises to be with them, to give wisdom, and to fulfill His purposes in ways often beyond our understanding.

When healthy, the natural state of a man and woman’s body is fertile–even though there are only certain days each month that a woman can conceive a child. Infertility, by contrast, occurs when specific conditions or factors make it difficult or impossible for a man and woman to conceive and bear a child. 

Notably, infertility is not a standalone disease. It is a symptom of underlying reproductive health conditions or factors such as a person’s age or the lack of viable reproductive body parts due to injury or at-birth (genetic) defects (though these are rare). 

Doctors typically diagnose a couple with infertility after 6-12 months of barrier-free intercourse. This does not mean that it is impossible for a couple to get pregnant, but it does mean that it will be very difficult, especially without proper treatments. 

For women, reproductive health conditions include endometriosis, adenomyosis, polycystic ovary syndrome (PCOS), blocked fallopian tubes, uterine fibroids, hormonal imbalances, body fat percentages (either too high or too low), and other lifestyle factors. 

For men, reproductive health conditions include low sperm count, low sperm motility, erectile dysfunction, and diet, lifestyle, and environmental factors. 

While it is common to think of infertility as a “woman’s problem,” men and women on the whole bear the burden of infertility equally, with one-third of cases due to women, one-third due to men, and the remaining one-third due to combined causes. 

Studies estimate that a couples’ diagnosis of infertility results from four or more reproductive health conditions, underscoring the need for comprehensive diagnostic approaches. Indeed, there is no one-size-fits-all solution to infertility.

RRM draws upon various methods for understanding and managing fertility. These include:

NaProTechnology (Natural Procreative Technology):

Developed by Dr. Thomas Hilgers at the Pope Paul VI Institute, NaPro uses the Creighton Model FertilityCare System to chart a woman’s cycle and guide medical diagnosis. It addresses hormonal imbalances, ovulation disorders, endometriosis, polycystic ovary syndrome (PCOS), and more through targeted, ethical medical and surgical interventions.

Creighton Model Fertility Care System:

A standardized, medically integrated form of fertility charting that relies on observing cervical mucus. It provides a shared language for both couples and medical professionals and is the diagnostic foundation for NaProTechnology.

Billings Ovulation Method:

One of the oldest and most researched methods, Billings trains women to identify their fertile and infertile phases by observing changes in cervical mucus, without requiring internal exams or temperature tracking.

FEMM (Fertility Education & Medical Management):

A newer method combining fertility education with hormone-focused health care. FEMM incorporates detailed hormone testing and seeks to address women’s reproductive and overall health through medical treatment based on cycle biomarkers.

FACTS (Fertility Appreciation Collaborative to Teach the Science):

Founded by Dr. Marguerite Duane, FACTS is a clearinghouse of evidence-based research and education on fertility awareness-based methods (FABMs). It aims to educate medical professionals on the scientific underpinnings of FABMs and their clinical applications. FACTS also helps promote informed consent and patient empowerment through education.

Each of these models empowers couples to understand fertility as a vital sign of health. They encourage couples to work with their bodies rather than against them, and they open the door to holistic healing and integrated care.