BY DR. AISHA HAMDAN

　　Infertility from an Islamic Viewpoint

　　In the previous edition, we presented Iman's story in the struggle to conceive as well as various lessons that can be learned through such experiences. In this article, we will outline several issues that infertile couples often encounter, along with an Islamic perspective on each of these. It is important to point out that attempting to cure infertility is not only permissible, but may be a duty for the couple since procreation and preservation of the human race are principal goals in marriage. The treatment itself, however, should never go beyond the boundaries of what is permissible by Allah. The ends do not always justify the means, and in the case of infertility, this principle should be readily apparent.

　　Allah Almighty Says what means: “And We have enjoined upon man, to his parents, good treatment. His mother carried him with hardship and gave birth to him with hardship...” [Quran 46: 15]

　　Choice of procedures

　　In today's world of medical technology and advancement, there are many options available for couples who are struggling with infertility. Unfortunately, many of these options are morally and religiously unacceptable. Muslims need to be aware of the procedures that are allowed in Islam and those that are not. In general, it is easy to remember that any procedure that makes use of sperm or eggs that do not belong to the husband or wife is absolutely unacceptable in Islam. This would entail making use of what is commonly termed donor eggs or donor sperm. The obvious reasons for their prohibition is that they involve mixing of lineage, confusion as to who the real parents are and, in reality, an illegitimate child. The virtue of preserving genealogy is evident in the Quran. Allah Almighty Says what means: " And it is He who has created from water a human being and made him [a relative by] lineage and marriage. And ever is your Lord competent [concerning creation]." [Quran 25: 54]

　　Two permissible methods are as follows:

　　1) IUI (Intra-Uterine Insemination) wherein the sperm of the husband is taken and injected into a suitable place in the cervix or womb of the wife so that fertilization can take place internally, and

　　2) IVF (In-Vitro Fertilization) wherein the sperm is taken from the husband, and an egg is taken from the wife. Fertilization is done externally, and then the embryo is implanted in the womb of the wife. IUI is often used when the husband has low sperm count, or has normal sperm but is unable to deposit them in the genital tract for some reason. IVF may be used when there is some type of obstruction preventing access of the sperm to the ovum, which could occur in cases where one or both fallopian tubes are blocked and cannot be corrected by surgery.

　　An important issue to consider with IVF is that there a strong likelihood that not all of the fertilized eggs will be placed into the uterus. The goal of an IVF cycle is to harvest 15-20 eggs. Not all of these will fertilize successfully, but usually more than two or three will (which is the standard number implanted into the woman). This leaves the parents with two choices:

　　1) Discard the remaining embryos or

　　2) Freeze these embryos for future use (it would not be allowed to donate these for other couples). This issue leads to several questions, "Does a fertilized egg constitute a child, thereby making the act of discarding it Haraam? Is this a form of abortion? Most scholars have used the following definition of abortion, "Abortion means to terminate the life of the fetus deliberately, by any means, while it is still in the womb of the mother." The debate regarding abortion centers around the definition of fetus and not the womb, and so it would not apply to the IVF process since the fertilized egg is not in the womb.

　　It is necessary to note that this type of procedure is only permitted within the marriage contract, which is broken by death or divorce. If the husband dies, for example, the woman is not allowed to make use of these stored embryos since there is no longer a marital bond. She is, in fact, able to marry another man after the waiting period is completed. A child conceived in this situation would be denied its right to legitimacy.

　　Multi-Fetal Reduction

　　Another debatable issue is the use of multi-fetal reduction (terminating one or more of the embryos after implantation) which may arise when a woman becomes fertilized with more than one or two embryos. Scholars are in disagreement on this particular point. Some state its permissibility due to the medical risk for the mother, and others do not, basing their opinion upon the definition of abortion. It then becomes a decision that must be made between husband and wife with reliance upon their own thoughts and feelings about this issue after trusting in Allah and seeking His Guidance.

　　Imaan related that this type of phenomenon is rare since most clinics implant only two or three embryos at one time. This is likely to become the norm as clinics continue to develop standards to minimize the risks for mothers and their unborn fetuses. The issue of multi-fetal reduction will eventually lose its relevance as times goes on.

　　Surrogate motherhood

　　In recent years a new approach to infertility has developed that has sparked debates regarding its acceptability, legality and morality.

　　Surrogate motherhood or surrogate parenting involves making use of another woman's womb to bear a child for a couple who is having difficulty conceiving. This is most commonly used when a woman is unable to bear children due to blocked fallopian tubes or an absent or defective uterus. In one method, the surrogate mother is impregnated by the husband's semen, which, as outlined above, would be completely unacceptable in Islam. In another method, fertilization is completed externally between the sperm and egg of the couple and then the embryo is placed in the uterus of a woman who volunteers or is paid to carry it. The questions that then arise are "Who is the real mother of this child?", "Is the mother the one who contributed the genes or the one who bore and gave birth to the child?" This separation of the womb relation from the ovary relationship is a new phenomenon and lies at the center of the debate regarding surrogation. Various conclusions have been reached, but what is the Islamic perspective on this option?

　　Throughout the Quran, there are many references to the concept of motherhood. We find the following as examples. Allah Almighty Says what mean:

　　"…Their mothers are none but those who gave birth to them..." [Quran 58:2]

　　"And We have enjoined upon man, to his parents, good treatment. His mother carried him with hardship and gave birth to him with hardship, and his gestation and weaning [period] is thirty months..." [Quran 46: 15]

　　"And We have enjoined upon man [care] for his parents. His mother carried him, [increasing her] in weakness upon weakness, and his weaning is in two years. Be grateful to Me and to your parents; to Me is the [final] destination." [Quran 31:14]

　　In the Arabic language the term that is used for parents is derived from the verb "Wilaada" which means to give birth. "Waalid" is the father and "Waalidah" is the mother. Both parents are "Waalidaan." We are related to both the ovary and the womb of our mother, but the references in the Quran clearly emphasize the womb relation by stating that mothers are those who gave birth to us. The womb or uterus is "Rahim" ("Arhom" is the' plural) in Arabic and refers to a "value" based on relatives and the tie of compassion that binds them. "Rahmah" is another derivative, which means compassion.

　　Allah Almighty Says what means: "O mankind, fear your Lord, who created you from one soul and created from it its mate and dispersed from both of them many men and women. And fear Allah, through whom you ask one another, and the wombs. Indeed Allah is ever, over you, an Observer.." [Quran 4: 1]

　　"So would you perhaps, if you turned away, cause corruption on earth and sever your [ties of] relationship?" [Quran 47: 22]

　　So, again, we see the significance of the womb relationship and the understanding that the one who gives birth is the mother of the child. A child born under a surrogate contract would be illegitimate in Islamic law since the husband had not entered into a marital contract with the surrogate mother. Even if the surrogate mother were another wife of the husband, it would still not be allowed since this entails introducing a foreign egg, which is outside the marriage contract binding the husband and his second wife.

　　In addition to all of this, the contract entered into through surrogation would be considered Baatil (invalid) since it involves the "sale" of a free person. Some final points to consider are the evils that may result from this type of contract such as: reducing motherhood to a price, undermining the institution of marriage and family life, creating confusion in blood ties, encouraging surrogate mothers to claim legal rights to the child, and tampering with the Sunan of Allah in the normal process of procreation.

　　Inshaa` Allah (Allah willing), we will all be guided to the truth and to those actions that are within the limits of Allah's Law and which deserve Allah's Pleasure. May Allah bestow upon those who desire the role of mother or father from His bounties, for parenthood is truly a blessing that warrants gratitude and prostration to the Creator each and every day.

　　Infertility: the struggle to conceive – I