OUR CREATOR AND Lord, Allah, the Most Merciful, says in His Noble Book,

To Allah belongs the dominion of the heavens and the earth; He creates what he wills. He gives to whom He wills female [children], and He gives to whom He wills males. Or He makes them males and females, [both], and He renders whom He wills barren. Indeed, He is Knowing and Competent. [Sûrat Al-Shûra, 42: 49-50]

Approximately 15% of married couples who attempt to conceive will experience some difficulty. Infertility is defined as a “condition of the reproductive system often diagnosed after a couple has one year of unprotected, well-timed intercourse, or if the woman suffers from multiple miscarriages.”

There is no gender difference in relation to the prevalence rate of infertility. Various problems that cause infertility occur equally in men and women. In 40% of the cases, there is some concern with the husband; in another 40% it is with the wife; and in the remaining 20%, there are problems with both partners or the cause of infertility cannot be explained. Infertility also affects people from all socioeconomic levels and cuts across racial, ethnic, and religious lines.

Approximately one-third of couples who remain untreated will eventually produce their own baby, while one-third of those who do use medical interventions continue to be unable to conceive.

Infertility can be a major life crisis for those who are experiencing it. The infertility experience may involve many hidden losses for individuals, their loved ones, and society as a whole. These include loss of the pregnancy and birth experience, loss of a genetic legacy and loss for future contributing citizens of the next generation, loss of the parenting experience, loss of a grand-parenting relationship, loss of stability in family and personal relationships, loss of feelings of self-worth, loss of a sense of hope for the future.

It is natural for these couples to desire and yearn to have children. It is permissible to attempt to cure infertility, and it may even be a duty so that contribution may be made for the preservation of the race. Prophet Muhammad ﷺ said,

There is no disease that Allah has created, except that He also has created its treatment. (Bukhâri)

The treatment, however, should not trespass beyond that which is legitimate or legal as ordained by Allah. Here we discuss the various procedures available to treat infertility and the Islamic ruling related to these. We begin with references to infertility in the Noble Qur’an.

Infertility in the Quran

Verses 49 and 50 of the Sûrat Al-Shûra (Chapter 42, the Consultation) of the Qur’an clearly states that the very issue of who can or cannot have children is solely in the Hands of the Creator and Lord of humankind and that people do not have control over that. In addition, these as well as other verses, implicitly indicate that Allah may or may not reveal the reasons why one may or may not be able to have children. These two verses state,

For Allah only is the kingship of the heavens and the earth; He creates whatever He wills; He may bestow daughters to whomever He wills, and sons to whomever He wills. Or He may mix them, the sons and daughters; and may make barren whomever He wills; indeed, He is All Knowing, Able. [Sûrat Al-Shûra, 42:49-50]

Accordingly, since all that happens in this life emanates from the will of Allah –and certainly this is true for the creation of life– then if Allah has not decreed a life, it will not come into existence. Likewise, if Allah has decreed the creation of a life, nothing will prevent its coming into existence. All souls have been decreed and predetermined by Allah.

Some people may not accept this fact either because of lack of faith in Allah or because they believe this issue to be a matter of pure physical/medical essence that has a very thin relation to Allah’s decree and destiny—just like everything else in life. This misunderstanding can be easily clarified by considering:

• The ‘random’ nature in which infertility affects people with total disregard of any status, race, gender or power.
• The unpredictability of a reversal of infertility with respect to the people suffering from it and its behavior in responding to treatment.

How many people do we know that have sought offspring but could not achieve it? And how many people do we know who did not want to have children but—despite their serious efforts in contraception—ended up having them?

Commenting on the above two verses, some scholars have had long discussion regarding the wisdom in Allah keeping the decision of having children exclusively to Himself, parts of which we may easily see, like realizing the power of Allah and our need of Him and of having faith Him. Allah also wants to teach us that it is not up to us to decide whether to accept life or reject it. And even though, life-death issues are far from being simple or one-dimensional –for all those involved in whatever side they take of the abortion debate– there is great wisdom to be gained by contemplating infertility.

There are several stories in the Qur’an related to this issue that present beautiful lessons for mankind. Let us briefly consider two such stories. The first is about Prophet Ibrâhîm and his wife Sarah, and the second is about Prophet Zechariah and his wife Ishba.

Ibrahim and his wife Sarah

And his [Ibrâhîm’s] wife was standing, and she smiled. Then We gave her good tidings of Isaac and after Isaac, Jacob. She said, ‘Woe to me!  Shall I give birth while I am an old woman and this, my husband, is an old man? Indeed, this is an amazing thing.’ They [the angels] said, ‘Are you amazed at the decree of Allah? May the mercy of Allah and His blessings be upon you, people of the house. Indeed, He is Praiseworthy and Honorable.’ [Sûrat Hûd, 11:71-73]

And he [Ibrâhîm] felt from them [angels] apprehension. They said, ‘Fear not,’ and gave him good tidings of a learned boy. And his wife approached with a cry [of alarm] and struck her face and said, ‘(I am) a barren old woman!’ They said, ‘Thus has said your Lord; indeed, He is the Wise, the Knowing.’ [Sûrat Qâf, 51:28-30]

Zechariah and his wife Ishba

At that, Zechariah called upon his Lord, saying, ‘My Lord, grant me from Yourself a good offspring. Indeed, You are the Hearer of Supplication.’ So the angels called him while he was standing in prayer in the chamber, ‘Indeed, Allah gives you good tidings of John, confirming a word from Allah and [who will be] honorable, abstaining [from women], and a prophet among the righteous.’ He said, ‘My Lord, how will I have a boy when I have reached old age and my wife is barren?’ He [the angel] said, ‘Such is Allah; He does what He wills.’ [Sûrat Âl-ʿImrân, 3:38-40]

And [mention] Zechariah, when he called to his Lord, ‘My Lord, do not leave me alone [with no heir], while You are the best of inheritors.’ So we responded to him, and We gave him John, and amended for him his wife. Indeed, they used to hasten to good deeds and supplicate Us in hope and fear, and they were to Us humbly submissive. [Sûrat Al-Anbiyâ’, 21:89-90]

The main lesson we derive from these stories is that even in the seemingly most impossible of circumstances, Allah may answer our prayers and bless us from His bounty. Both Sarah and Ishba had been barren for many years, but nothing is beyond Allah’s Power to control. It is important never to despair of the Mercy of Allah and to always remain hopeful that Allah will change the situation. Making duʿâ’ is essential in relation to this. A Muslim in this situation should accept Allah’s Qadar, remain firm in faith, and maintain hopefulness.

And even though theses verses do not mention it, the fact remains that accepting Allah’s decree and destiny does not mean that one remains idle with regard to whatever may be facing him/her. All Islamic principles from the Qur’an and the Sunnah require and encourage that we do whatever we can to look after our needs and the needs of those we are responsible for. Believing in Allah’s destiny helps us to stay calm and focused while pursuing our goals and taking care of ourselves, because it enables us to remain content and hopeful. The Prophet ﷺ said,

Amazing is the affair of the Muslim! His affairs are all good. If he experiences ease, he is grateful, and that is good for him. If he experiences hardship, he faces it with patience and perseverance, and that is also good for him. (Muslim)

In essence Muslims believe that whatever happens to them in life could not have been avoided, and whatever does not befall them could not have been made to happen. Everything comes to pass according to the will and decree of Allah, the most merciful Creator and Lord –so their affairs are all good. It is this kind of deep faith and understanding that makes life bearable, regardless of how difficult its challenges and surprises turn out to be.

Types of Procedures

By the Mercy of Allah, an area of medicine has been developed (and continues to develop) for the treatment of infertility. Known as Assisted Reproductive Technology (ART), this field now offers more answers and treatment options for men and women trying to conceive a child. These include:

• Artificial insemination
• In-vitro fertilization
• Surrogacy
• Egg/sperm donation
• Embryo donation

ART is thus defined as any treatment in which there is a handling of the sperm and eggs to establish a pregnancy. We discuss each of the above treatment options of ART and their related issues.

Artificial Insemination (AI)

In the process of artificial insemination, the sperm of the man is injected into the vagina, cervix, or uterus of the woman at the time of ovulation so that fertilization may take place internally. This technique includes

• Artificial insemination using semen of the husband (AIH)
• Artificial insemination using semen of a donor (AID)
• And sometimes a mixture of semen from both the husband and donor (AIM)

AIH is appropriate when there are physical difficulties on the part of either the husband or wife (or both) that prevent successful intercourse, but the fertility of both is adequate. This would include premature ejaculation, physical impotence and obesity on the part of the husband and obesity, vaginal scarring or tumors, abnormal uterine position, or vaginismus on the part of the wife. The husband may also be sub-fertile due to defective spermatozoa. The opportunity for conception may be increased if the fertile part of the semen is separated from the less fertile, and a concentration of the more fertile semen collected for one insemination.

In the case of AID, the husband is infertile and does not possess semen that is capable of producing a pregnancy (low sperm count or no sperm at all). The husband may also carry the gene for a hereditary disease such as blindness or Huntington’s Chorea,  [i]    or the wife may have a history of spontaneous abortion due to abnormality in the husband’s sperm. Single women also use this method if they have a desire to bear children without marriage.

AIM is used when the husband’s sperm is ineffective, but the couple is uncomfortable about using a donor sperm. In most cases, the donors and recipients are unknown to each other and written consent is obtained from the recipient and her husband.

In vitro Fertilization (IVF)

In vitro is a Latin term which means “in glass.” In embryology, it refers to fertilization that is artificially performed outside of the woman’s body in a test tube. During in vitro fertilization, one or more ova are surgically removed from the mother through a small syringe and placed in a test tube. Then the sperm of the husband is introduced to fertilize the ovum. After fertilization takes place, the ovum is allowed to develop in a test-tube until the four-cell or eight-cell stage and is then delivered into the woman’s uterus. Three or four embryos may be deposited in order to increase the chances that at least one will successfully implant into the membrane of the uterus. The technique is also known as “embryo replacement” since the ovum is fertilized outside of the womb and re-implanted.

AIH 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 would occur in cases where one or both fallopian tubes are blocked or damaged and cannot be corrected by surgery. It has also been used for couples who fail to conceive despite the presence of normal fallopian tubes and after all possible causes of infertility have been excluded.

IVF can also be applied when the woman is sterile or unable to ovulate, but is able to carry a child to term. In this case, a donated ovum is fertilized and the resulting embryo is implanted in the uterus of the woman who will bear the child. This is known as “embryo transfer” or “embryo adoption” since the ovum is taken from another woman. Donated semen may also be used in IVF. If the male is sterile and the female has blocked fallopian tubes, the female’s ovum may be fertilized in vitro using donated semen.

Related Procedures

GIFT (Gamete Intra-Fallopian Transfer) in a process in which the gametes (sperm and egg) are transferred or placed into the fallopian tubes through an incision in the abdomen. Fertilization takes place in the tube and moves to the uterus. This procedure increases the chances that the egg will implant in the uterus.

ZIFT (Zygote Intrafallopian transfer) is similar to GIFT.  A zygote is a fertilized egg before the stage at which it begins to divide. In this procedure, the egg is fertilized in vitro and transferred to the fallopian tubes before its nucleus has fused with the nucleus of the sperm (not a proper embryo).

ICSI (Intracytoplasmic Sperm Injection) involves injection of a single sperm into single eggs in order to obtain fertilization. This is primarily used for male infertility.

To be continued…

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[i]    https://en.wikipedia.org/wiki/Huntington%27s_disease