A silent grief: Pastoral reflections on infertility

When a couple marries, they pray for the gift of children. What happens when the answer to that prayer is ‘no’? How do we cope with the disappointments of infertility? And to what extent is today’s biotechnology causing more problems than it solves?

Philip Wheeler looks at the issues facing infertile couples and what Christians can do to show their love for each other in this painful situation.

Bradley and Elaine were married in their late 20s and enjoyed three happy years as a couple before they decided they would like to start a family. They embarked enthusiastically on this enterprise, thanking God for their love for each other and the opportunity to share that love with new little lives. Six months went by, with no success. They had heard that it could take a while to fall pregnant, but six months seemed too long. Elaine asked her doctor about it and received some suggestions about how to improve their chances.

They tried this for six more months. Still nothing. After that, they lost interest a little, and found that talking about sex made them both feel angry. Bradley wondered whether in fact he wanted to be a father, and threw himself into longer hours at work instead. As a result, they didn’t make much of an effort with each other for another six months or so.

Two years after their decision to start a family, Bradley and Elaine were starting to wonder whether God was keen on the idea. How would they know what their lack of ‘success’ meant? They prayed, and talked, and decided that it was time to look at medical intervention. They were advised to try IVF. They did; it was expensive. Nothing happened. Most of their friends were onto their second child now, and Bradley and Elaine’s marriage was fraying at the edges. Church didn’t help—all those Sunday School programs and family picnics—so they started attending less regularly.

One Sunday afternoon, Bradley got a call from his pastor: he hadn’t seen them for a while; was everything all right? Holding back tears of anger and embarrassment, Bradley started to explain …

When no cry is heard

Infertility is a crisis in the life of many Christian people that receives very little attention. It is often an unspoken grief that afflicts at least some couples in every congregation. It is an issue not just for those couples unable to conceive (primary infertility). Those who have had a previous pregnancy, which may or may not have resulted in the birth of a child, but who seem unable now to conceive again (secondary infertility), can find it almost as painful as never having conceived.

In Australia, infertility rates are between 12-15 per cent of couples and on the rise, although the increased incidence may well be explained by the increased willingness of the population to come forward for investigation.1 Research suggests that about a third of fertility problems can be traced to the would-be mother, about a third to the father and the remaining third to some combination.2 Studies in the UK reveal that approximately 1 in 10 couples fail to conceive after a year, and of these, about 50 per cent may never conceive. This means that in almost every congregation, there will be several couples who are presently struggling, or who have in the past struggled with this heartbreaking situation.

Technology: friend or foe?

While technology offers some hope through IVF programs and improved fertility drugs, medical science is still unable to solve all the problems. Ironically, sometimes the technology now available contributes to the pain experienced by many couples. Going on such a program can lead to a roller-coaster ride of emotions. There is no guarantee of success. The technology offers much, but may not deliver quickly, or ever, and the hopes of the couple are once again dashed.

Couples must weigh up the cost of the various IVF programs—both financial and emotional—against the obvious benefits and joys of having a family. Hard ethical choices often have to be made about how far to go with the programs on offer, and when to stop the procedures and say enough is enough. This is made more complex as both husband and wife are involved, and often have different levels of desire and commitment to having children.3

Many of the fertility programs present very complex ethical issues that can be difficult for Christians to think through. What should be our guiding principles as Christian people in making decisions about these forms of technology? How do we use the Bible in seeking to do what is right? This article cannot deal with the technical issues, nor the complex ethical decisions an infertile couple may face (see box at the end for recommended references on these issues). Instead, here we focus first on the pastoral implications as I have experienced them, before looking to the Scriptures.

Pastoral issues

Infertility raises important pastoral issues for Christian couples and those who pastor them through this difficult experience. Infertility is a form of grief, but it is a complex one. It is made more complex by:

  1. Its intangible nature. The infertile couple has not actually lost a baby; they have lost a hope and a dream. They have lost ‘what might have been’. This can in some ways be worse than actual loss. “Hope deferred makes the heart sick”, says Proverbs 13:12.
  2. Its ongoing and indefinite time frame. Infertility can cause ‘chronic grief’, for it has no particular start nor end. Couples remain in a state of emotional turmoil. Each month hopes are raised, only to be dashed with the onset of menstruation. They try to stay cheerful—‘there is always next month’—but as the months go by, the frustration, disappointment and sadness begin to rise. Couples oscillate between hope and failure, and need to learn to handle the (sometimes) long-term emotional stress.
  3. It is a silent grief. There are not usually any visible signs of infertility, so it can remain a secret suffering. No-one sends flowers or a card. It is not openly discussed, and for many, it is a taboo subject. Who is willing to raise the issue with a childless couple? Is it that they don’t want children yet, or at all? Are they trying? For how long? It is easier to say nothing. A sense of isolation can develop. Who can the couple trust to be understanding on this most personal of subjects?
  4. It involves two people. The husband and wife are both involved in this grief, and may well differ in terms of how strongly they desire children and so how they view the experience. The sort of emotions involved and the degree of intensity may vary for men and women. Communication, conflict resolution and decision-making skills become very important for a couple facing infertility and treatment for it. Almost every marriage will be put under considerable strain by infertility. It is all too easy to blame, attack and displace anger onto your partner or, conversely, to withdraw and not communicate at all.4

Like all forms of grief, various strong emotions are raised by infertility. Infertility strikes at some core issues for individuals and couples. It can be a crisis of identity for individuals. What does it mean to be a woman and a wife, and not be a mother? What does it mean for a man not to be able to have children? Is his ‘masculinity’ in question? If our ‘self-worth’ and sense of fulfilment in life are tied to having a child, clearly infertility will strike us hard.

It often strikes at the core of a marriage as well. What happens to our notion of being a ‘family’ if it is just the two of us without children? What happens to our sexual relationship now that we are on a program that tells us when to have sex? Far from being fun or spontaneous or romantic, sex can become a dissatisfying, task-oriented, timetabled activity and a subject of open discussion with various specialists.

For some of us, children represent our link to the future; infertility raises questions therefore about our mortality, about our future (who will care for me in old age?), and so about the whole purpose and direction of our lives.

For Christians, it obviously raises issues for our faith. If children are a blessing from the Lord (Psalm 128), then what is God saying to us? Why us? What have we done wrong? It can seem so unfair. An unmarried teenager has her second unwanted child, and we are a loving, committed couple who cannot have any! We can feel God has denied us something that is so good and that we want so much. Many people grow up expecting one day to have children, and consider it either as routine or almost as their ‘right’. The absence of children becomes a major challenge to our expectations.

In an age that prides itself on being in control and solving all our own problems, this can be an area of life that is outside our control. For some successful, achievement-oriented people, this can be very disturbing. Infertility can be a powerful challenge both to the ‘self-made man’ syndrome and to a self-righteousness that says that good people deserve God’s blessing. Of course, not all infertile couples struggle with such feelings, but it can be surprising what deep-seated beliefs and emotions will rise to the surface under pressure.

Added to this for most infertile couples are the constant reminders of their childlessness. Birth announcements, Christmas, Mother’s Day, Father’s Day and family get-togethers are repetitive reminders of one’s own situation, and can at first be very upsetting, and after that, very wearing. The media, too, sends out mixed messages about children. Sometimes parenting is depicted as less important than career ambition and recreational pursuits. Yet at other points, children are highly esteemed, and those without them can seem less than human. Supermodels can talk about the fulfilment of motherhood, and imply that it is the ‘next step’ in the journey to becoming the perfect woman.

The pressures on the infertile couple come from many directions. Those who have children are often not aware of all these pressures, and may unwittingly cause all sorts of difficulties and sadness for their friends. We may need to make more effort in our churches to bring some of these issues to light in order to serve each other better.

God’s children

There is not room here to deal in detail with the ethical issues arising from infertility programs. However, we can briefly turn to God’s word and examine what it says under three headings: God’s view of children; responses to childlessness; and the family in gospel perspective.

God’s view of children

When we turn to the Scriptures, we see a very positive attitude towards children and parenting. From Genesis 1 onwards, there is an expectation, even a command, to be fruitful and multiply and fill the earth, as part of the mandate given to mankind. There is an expectation that from a marriage union will come children, for God desires godly offspring (Mal 2:15). Children are a blessing from the Lord (Ps 127:3, 128:3-4). They are given by God and ought not be considered a right, but rather a gracious blessing and gift, for God is the one who opens and closes the womb (Gen 30:1-2, 25:21).

Responses to childlessness

The Bible is full of stories of women who were infertile and who experienced the pain of childlessness. Look at Sarah (Gen 11:30, 18:11), or Rebekah (Gen 25:21), or Rachel (Gen 29:31, 30:1, 30:22) and how distressed she became at the taunts of her rival, or Samson’s mother (Judg 13:2), or Hannah (1 Sam 1:1-20) or Elizabeth (Luke 1:7, 24, 36-37). In each of these cases, the woman was eventually able to conceive and give birth, for nothing is impossible with God (Luke 1:37, Gen 18:14). With these women, God’s plan for them involved initial inability to bear a child.

The example of Hannah is particularly instructive as we see her patient trust in God and her prayerfulness in the face of such sadness and ‘bitterness of soul’. Her prayer is not a ‘deal’ with God to somehow force his hand; it is a genuine prayer and offer to God. Her song later reveals that she understands fully the complete sovereignty of God, who is the great reverser of fortunes. Other childless women in the Bible reveal exactly the opposite, as we see bitterness and anger take hold of them. For example, Rachel and Leah exhibit a failure to understand God and his plans and promises (Gen 29:11ff).

Infertility is not particularly a modern problem but, like all of life for a Christian, it is an issue that challenges our faith in God. God will answer the prayers of his people, but we must be willing to accept his answer in the light of his sovereign will and his love for his people. God will remain faithful to us, but his faithfulness may look different to our own desires.

The family in gospel perspective

The Bible reminds us that real satisfaction comes not from having a child but from being a child. To know that you are a child of God is of far greater worth than being a parent. Isaiah 54:1 (cf. Gal 4:27) teaches us that because of the work of God through his servant king, the Lord Jesus, there will be a time of joy and singing, even for the barren woman, for God will raise up a great family with many descendants, of which the childless person can be a part. Similarly, in Mark 10:29-30, Jesus directs the disciples’ attention towards the new family of brothers, sisters and children that the believer gains in this life, and especially in the next. These ought to outweigh the losses we experience in this life.

The Christian family is of greater eternal importance than our earthly ones which, while bringing to many of us joy and a sense of fulfilment, bring to others heartache, pain and sadness. Throughout the Bible we are reminded that the future glories that are ours as children of God are far greater than anything this life has to offer, and far outweigh the sufferings we must endure for a little while in this life (Rom 8:18ff; 1 Pet 1:3-7)5. Is it possible, then, for our churches to be a ‘foretaste of heaven’ where the humanly impossible can happen—the single person doesn’t feel lonely and the childless couple rejoices in the children who surround them? This may be a goal for us to work towards.

As in all the troubles of this life, it is to the gospel and the God of all comfort that we must turn and find hope, looking always to see how God is both strengthening our faith and training us so we can be of comfort and help to others (2 Cor 1:3-11; 1 Peter 1:6-9).

Offering some help

This leads to the question “How can those brothers and sisters who are facing infertility best be cared for by their Christian friends?”

  1. Friends and family of those facing infertility ought to educate themselves about the issues and difficulties such people experience. This article is a start. The aim, then, is to be a trustworthy friend. Become a good listener. Show your interest and love, and build a relationship of trust such that when they feel ready, or perhaps when you feel equipped, the subject can be raised. You need to listen to them and what their needs are rather than offer advice. All too often this is exactly what does not happen. All too often friends stay quiet, not quite knowing what to say, or barge in with uninvited and unhelpful advice.
  2. Promote fellowship over this issue. Because it is a ‘silent grief’, the childless couple easily becomes isolated. Their grief and sadness needs to be acknowledged and in ways that are appropriate for them. Many couples do not know whom to talk with about it. It may be possible in some churches to arrange a get-together of people facing this problem to talk about the struggles and the ethical issues. For some couples, however, this might be the last thing they want!
  3. Pastors may need to familiarize themselves further with some of the pastoral and ethical issues an infertile couple face. Often the couple are called upon by medical specialists and hospital administrators to make quick decisions about how many embryos to implant, or what to do with the remaining ones, and whether they would consider donating such embryos to other couples. These complex issues need prayerful and theological consideration.
  4. Above all, we should pray for our friends and let them know of our prayerful concern for them. In the end, it is in God’s hands whether they will have a child, and it is God alone who will comfort and strengthen them to face this crisis and trust in his goodness and love.

A glossary and some references

  • IVF (in-vitro fertilization) is the general name given to a variety of different procedures. Basic IVF involves harvesting the eggs and semen and fertilizing the egg in the laboratory, and returning several embryos to the uterus and freezing other embryos for future cycles.

  • GIFT is gamete intrafallopian transfer, and involves collecting eggs and selecting several to be mixed with the sperm with the mixture then returned to the fallopian tube for fertilization to occur.

  • AIH is artificial insemination with husband’s sperm.

  • DI is donor insemination.

  • ICSI is intracytoplasmic sperm injection where a single live sperm is injected deep into the substance of an egg and then the embryo implanted.

The ethical and theological issues involved with each procedure can be quite different. Recommended further reading on the subject is available at www.hannah.org and the Center for Bioethics and Human Dignity in USA at www.bioethix.org. Also see ‘Bioethical Issues’ in kategoria #11, 1998, pp. 11-24.


1 Dr Martyn Stafford-Bell, ‘How to Treat Infertility’, Australian Doctor (Oct 1998), II

2 CN Atton, ‘The Pastors Opportunities’, Exp Time 100 (1989) 448.

3 In Australia, recently, a debate has been raging over whether unmarried mothers and lesbian couples ought to have access to fertility programs.

4 These points are made in a helpful article by Nancy Gieseler, ‘Pastoral Care for Infertile Couples’, The Journal of Pastoral Care, Winter 1994, Vol. 48, No.4 p. 355-360.

5 Interestingly, such thinking leads Paul to say in 1 Corinthians 7 that although marriage is clearly good and given by God for our well being, the urgency of the times and the hope that we have in Christ will lead, at least, some people to say singleness is better. Does this help the childless couple see their situation more positively, for the sake of the gospel, just as it might help the single person to view their situation as an opportunity rather than a burden to endure?

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