On a warm and overcast day in April last year, I sat on a hospital cot in a gown and grippy socks waiting for my doctor to perform a minor surgery on my uterus. My husband and I were three months into what evolved into a long year of doctor appointments, surgeries, ultrasounds, and lab work in an attempt to discover what was causing our infertility.
While I sat on my hospital cot behind a curtain, I listened to patients completing intakes, discussing questions about lifestyle and medications. A commotion suddenly broke out as a nurse announced that a patient had arrived in labor.
The medical staff buzzed about, debating where to put her. I could hear her thanking the nurses, breathing heavily, easing herself onto a cot. It felt emblematic of my journey as I waited for a surgery to scrape my womb of unneeded tissue while the nurses scrambled to attend to a woman in labor. It knocked the wind out of me. A similar feeling had come over me 15 months earlier as I watched an ultrasound tech confirm that my miscarriage was complete and my womb was indeed empty.
Infertility—medically defined as the inability to conceive after trying a year for those under 35 and 6 months for those over 35—is rising in the US. Some of this is due to rising maternal age, but this decade, data shows, all age groups are seeing more cases of infertility by as many as 3 percentage points (10 percent in 1995 to 13 percent in 2019). US fertility hit a historical low of 1.6 births per woman in 2023, a 2 percent decline from the previous year and well below the “replacement level” (reproducing to replace parents), which is 2.1 children per couple. Birth rates are higher globally but not much more promising—down from 5.3 births per woman in 1963 to 2.2 in 2023.
Some say we are simply collecting better data or discussing infertility more openly, as has been the case with many issues around women’s health, but others point to a rise in hormonal imbalances and autoimmune factors like polycystic ovary syndrome or endometriosis. Or, as my gynecologist put it: “There are so many things we just don’t know about the female reproductive system.” For example, there are dozens of causes of female infertility, and the more I’ve learned, the more I appreciate the miracle of conception and birth. Male infertility factors, too, are more openly discussed by physicians and in online infertility forums.
But in many evangelical churches, couples experiencing infertility still don’t know how to talk about it. A couple who desires kids can feel shame or embarrassment when well-meaning congregants inquire about when they’re going to start a family, but the church is often silent about solutions. While this might be due to ignorance (infertile people are often more educated on this topic than parents who easily conceived), it’s a silence with real consequences for those in our pews.
The Centers for Disease Control and Prevention found that the use of assisted reproductive technologies (ARTs) has risen by 5 to 10 percent annually since 2013. In some European countries, more than 5 percent of all births are due to ARTs. Yet few evangelical denominations provide guidance about these technologies, which include in vitro fertilization (IVF), intrauterine insemination, sperm and egg donation, egg freezing, or embryo adoption. Churches aren’t openly discussing ARTs, either positively or negatively.
Evangelicals generally have been thoughtful adopters of technology, including IVF. So when the Southern Baptist Convention (SBC) declared in 2024 that IVF was generally unethical, many pastors and church members were surprised. Like birth control, IVF is often treated as a matter of wisdom between pastors and church members or, in reality, a personal matter not discussed with others.
But some Christians are reconsidering ARTs, or at least, studying them more critically. As the holistic health movement grows and more Christians learn about alternative solutions such as embryo adoption, more couples are turning to alternative fertility treatments.
There’s No Shame in Talking About Pregnancy Loss
When my husband and I decided to start a family, I got pregnant quickly. That pregnancy ended in miscarriage at 10 weeks, and then—nothing. My ob-gyn shrugged it off since we were “young and healthy.” What could we do anyway? Our health insurance, like most US coverage plans, wouldn’t cover fertility appointments until a year of no pregnancies, which includes those that end in miscarriage. A year later, I pursued several doctors, most of whom booked months out: a naturopath, an acupuncturist, and a reproductive endocrinologist (traditional fertility doctor).
The naturopath took bloodwork and lab work, mocked up a plan with a nutritionist, and flooded me with more than a dozen supplements to take. She took my concerns seriously, but her primary goal seemed to be diagnosing and healing my body of its various autoimmune ailments. “Your problem is stress,” she told me. It seemed that pregnancy wasn’t an urgent priority for her. Still, I cut back on high-intensity workouts, swallowed my bowl of pills, cut out gluten entirely, and drank my magnesium-powder-and-cherry-juice concoction nightly.
The acupuncturist, who specializes in fertility treatment, had rave reviews about how successful her treatments had been in providing women with chubby, happy babies. She similarly offered a few more supplements, examined my tongue, and suggested I eat pineapple core. Acupuncture was relaxing—and expensive. I went for several months and then quit.
The endocrinologist at the fertility clinic was productive but colder, marching me through a highly structured routine of ultrasounds and more bloodwork, ruling out the main factors for infertility. A baby seemed to be the only necessary outcome for her, and she appeared uninterested in figuring out why I could not seem to get pregnant. After a year of visits, she concluded that IVF was my only option.
Then I found Caitlin.
Caitlin Estes has all the sunny warmth of a Southerner with the matter-of-fact nature of someone who talks with women about the most intimate physical details. She’s one of a rising number Protestants who practice FertilityCare, a historically Catholic enterprise aimed at avoiding or causing conception through tracking cycle biomarkers rather than birth control or ARTs, in addition to supporting women’s health more generally.
While natural family planning has long been common among all branches of Christian faith, there has been a resurgence in interest around alternative reproductive health care as women seek to learn more about their bodies. Now evangelicals and other Protestants seem to be increasingly aware of what is called restorative reproductive medicine.
Advocates say that this approach focuses on restoring the natural function of the reproductive system instead of suppressing or bypassing it. This may include diagnosing and treating autoimmune diseases (such as hypothyroidism), hormone imbalances (such as polycystic ovary syndrome), or more. For example, a patient might undergo traditional ultrasounds and bloodwork but also go for many more tests and examine lifestyle factors such as diet and exercise routine.
Some researchers believe endometriosis is the hidden cause behind many infertility cases. It impacts an estimated 10 percent of all women globally. Restorative reproductive medicine specialists say it’s underdiagnosed, and many advocate for surgical intervention to give women a chance at natural conception versus jumping to IVF.
When I asked my traditional fertility doctor about the possibility of endometriosis, which my newest (fourth) doctor recommended I investigate, she shrugged.
“I don’t think that’s necessary,” she said decisively. “We would do IVF either way.”
Over the past decade or so, interest in holistic health and in women taking charge of their own wellness has risen on a national level. This has coincided with the release of more studies on risks of IVF and the ethical implications of freezing embryos, leading to an increasing divide over how to “solve” infertility.
The New York Times reported in the summer of 2025 that this anti-ART approach was rising and opponents of IVF were becoming political in light of President Donald Trump’s promise to make in vitro fertilization more affordable and accessible.
Republicans in both the Senate and the House have proposed legislation to fund restorative reproductive medicine, and Arkansas passed a law last year that requires insurance companies to cover the treatments. The Department of Health and Human Services will soon incorporate restorative reproductive medicine into government-funded health clinics for low-income women.
“Today, an approach long confined to the medical fringe has unified Christian conservatives and proponents of Robert F. Kennedy Jr.’s Make America Healthy Again movement—and is suddenly at the forefront of the fertility conversation,” the Times summarized, quoting an IVF doctor and White House consultant who said he hadn’t heard of restorative reproductive medicine until early 2025.
Regardless of the divide over assisted reproductive technology, IVF remains a Band-Aid solution. Yes, it builds families and offers many couples the chance at becoming parents. As even the SBC statement observes, there is a way to participate in IVF that does not abandon frozen embryos. Some evangelicals who choose to pursue IVF but have moral concerns around freezing embryos or abandoning them in cryobanks have created only one or two embryos at a time—however many they can implant directly.
But many women on both sides of the political aisle still feel that ARTs do not address their root health issues.
“Revolutionary though it has been, IVF does not restore a would-be mother’s body to optimal health,” wrote Madeleine Kearns in The Free Press. She continued,
In fact, IVF is often a profoundly uncomfortable experience for women, not to mention an expensive one. It’s no wonder that many women with ‘unexplained infertility’ are left feeling that mainstream medicine has failed them, subjecting them to stressful, painful interventions, while leaving them in the dark about the mysteries of their own bodies.
Illustration by Grace J. KimCaitlin Estes began looking into the Creighton Model FertilityCare System, a popular way to track a menstrual cycle in natural family planning, when she was engaged and researching alternative family-planning methods that avoided birth control.
“I Googled, ‘How can you not get pregnant without birth control?’ ” she told me. “I called the Catholic diocese because that was the only number available [to learn about natural family planning].”
Her research turned spiritual, she said. As she had conversations with family and friends, the topic would turn to how God made the female body, and she realized God was calling her to educate women about their health and fertility. She became a practitioner through a 13-month process in 2017, later became formally certified, and founded Woven Natural Fertility Care in 2021.
“The reason I am so passionate about my work is I see it transform lives,” she said: “a woman who is terrified of getting pregnant before she’s ready, a woman who’s battling health problems but not getting the care she needs because she’s not sexually active, or a woman who’s struggling to get pregnant and doesn’t feel the process is dignified.”
Estes doesn’t think there’s necessarily a sudden growth in interest toward natural fertility care. She believes there has always been a similar level of interest as today. But the reasons may have changed. More women are questioning ARTs or feel they aren’t getting the answers they want from traditional doctors.
Even when Estes was first launching her practice and working full-time at a Christian ministry, her business quickly grew, mostly through word-of-mouth referrals like mine.
“It’s women telling other women,” she said, noting that that the desire for alternative health care has created interest on an even larger scale and in mainstream media. “This good, dignified work in the way of women has happened for a long time.”
And, she said, it happens for a lot of different reasons. Estes sees women of all ages at every stage of their reproductive lives. Most are engaged or married women who are either trying to avoid being pregnant in a certain season without birth control or trying to get pregnant without using IVF. But she also sees single women who want to learn more about their bodies, who have reproductive health issues, or who are working through perimenopause. “My youngest client was 14, and my oldest is 52,” she said.
“There are those that also have ethical and religious oppositions [to ARTs]. But the majority aren’t necessarily coming because of the ethical reasons,” Estes said.
Estes’ desire is to offer hope for all women, whether single, sick, or struggling to conceive. Many people, especially women, can feel a disconnect from their bodies.
We’re connected as mind, body, and spirit, Estes said, and feeling disconnected from one of these “deteriorates our connection between creation and our Creator.”
Finding alternative fertility methods is not new. In Scripture, we see infertile women attempt various external methods to bear children. Sarah, Rachel, and Leah, for example, all used surrogates (Gen. 16:2; 30:3–9). Rachel and Leah also used mandrakes, plants believed to be an aphrodisiac and fertility promoter (vv. 14–15).
Yet common to the stories of infertility in Scripture are three themes: sorrow and grief from cultural shame alongside a woman’s deep desire for children; a desire for control; and God’s ability to open or close the womb, with or without human assistance.
In all the biblical surrogacy cases, another woman bore children for an infertile couple but acted as a shortcut for God’s promises. For Hannah, who was unable to conceive, we see God in 1 Samuel 1 opening her womb: blessing her with a son after much prayer, grief, and torment from her husband’s other wife. In all the biblical accounts, it seems that bearing or not bearing children is as complicated as in our own times.
Our fertility—and the body generally—is subject to the Fall’s effects. Yet, we also need thoughtful guidance. Pope John Paul II wrote his 1980s treatise “The Theology of the Body” as a biblical understanding of our physicality, addressing everything from sex and procreation to lust and adultery. Previous to his work, the “Humanae Vitae” explained reproductive ethics to Catholics.
In the past decade or so, evangelicals—viewed in some circles as having a shallow stance and sometimes poor treatment of the physical body—have more heartily joined the discussion. One of the possible implications for wrestling through larger questions of the body, sex, and gender is that women can also learn more about the female body, including, for example, unexpected implications of hormonal birth control. That infertility can also be due to male factors. That in vitro fertilization often creates more embryos than a family can realistically birth.
Today, Christians debate how to pursue fertility treatment. But the underlying questions remain the same no matter what treatment or intervention Christian couples pursue—or whether they do at all. Do we truly believe God opens and closes the womb? Like Sarah in Genesis, do we laugh at what feels impossible (18:12)? Do we idolize the good gift of biological children? And how much money, time, and mental energy is wise to spend on this pursuit? For every person, the answers will be different, just as each solution will be according to one’s conscience.
Even though I have become pregnant once, medically I am considered to have a diagnosis of “unexplained infertility,” a result that about one in five women with infertility receive. (Women can also have “secondary infertility” if they struggle to conceive after one or more children.) Estes doesn’t settle for unexplained infertility as a diagnosis. She’s watched women conceive who’ve been told they’ll never have children and women take control of medical conditions naturally through learning more about their underlying problems. (Studies suggest the average infertile couple has up to five diagnosable contributing conditions.)
She believes it’s possible to conceive in many situations without resorting to IVF, which opponents say affects women’s hormones and can result in higher-risk pregnancies.
As practices like Estes’ grow, they offer options for women who want to learn more about their bodies and advocate for themselves in the doctor’s office. Churches, too, can play a role by offering the full picture of assisted reproductive technology and supporting families however the Lord leads them to face their infertility.
I don’t know how my family’s story ends. But I do know that it is God who opens and closes the womb. Whether he chooses to do that with help from ARTs or natural fertility care, he is still sovereign over the creation of life.
For all of Estes’ practical instruction in our appointments, her spiritual and emotional counsel stuck with me most. “You’re pursuing a lot of things all at once,” she told me pointedly. “It’s okay to have some grace with yourself.”
By the end of 2025, I decided to take a month off from my weekly smorgasbord of appointments. During Advent, my pastor preached a sermon about Elizabeth and Zechariah’s barrenness as they waited for their Messiah. I organized a baby shower for a friend from church. I turned my attention to buying Christmas presents for my niece and nephew. We asked the elders of our church to come to our home and pray with us for the good gift of children.
And I felt the weight tumble off my shoulders. I felt like I could breathe again.
Kara Bettis Carvalho is a senior features editor at Christianity Today.
This article appeared in the March/April 2026 issue of Christianity Today as "Without Child".
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