"You can always adopt." "Are you sure you want kids? You can borrow mine this weekend." "I know you're going to have a child. I can just sense it from the Lord."

These are just a few of the comments that many infertile couples hear when they share their pain with others. Authors Sandra Glahn and William Cutrer, M.D., include a list of such remarks in their revised edition of When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility (Kregel Publications 2010).

Couples dealing with infertility often face inadequate responses to their pain. Scholarly arguments about the moral dimensions of reproductive technology are often dry, and the complex, emotional stories of actual people often absent. Fertility clinicians focus on how their services will end patients' pain by helping them conceive healthy babies. Perhaps offering resources for emotional healing and reflection is not the clinician's job, but it ought to be somebody's. Glahn and Cutrer attempt to fill the gap by covering the marital, emotional, theological, and moral questions surrounding infertility.

Cutrer teaches at Southern Baptist Theological Seminary and was for many years an ob-gyn practicing fertility medicine, and Glahn, a professor of Christian education at Dallas Theological Seminary, was one of his patients. Their straightforward language and reliance on personal experience, along with questions for readers at the end of each chapter, make this book an accessible read.

The book opens with its strongest material: several chapters on emotional and marital health in the midst of infertility and treatment. One chapter, for example, discusses the different ways that men and women express their emotions (in short, women like to talk it out and men don't), and provides concrete suggestions, such as setting a 20-minute limit for discussions about infertility.

The chapters covering sexual intimacy, romance, anger, grief, and insensitive comments are equally good. I appreciated the frankness the authors use in addressing sexual concerns (the same frankness found in their classic book Sexual Intimacy in Marriage). The chapter on anger opens with a scathing letter an infertile woman wrote to God. "Nothing you schemed was quite as treacherous as the human heart," she writes. In other words, when the innate longing for children goes unsatisfied, "All that is left is a great gaping hole that will never be filled." Glahn was taken aback by the letter, but Cutrer said, "I saw it as an honest expression of pain, which God welcomes. He's big enough to handle it." The chapter on insensitive things others might say includes an excellent section on "What Infertility Patients Want from Others" (simply "be there," have patience, be direct, and so on).

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The next sections, on the theology of suffering ("Why me?" "Is our infertility God's will?") and the ethics of assisted reproduction, are less strong. The authors assure couples that their infertility is not a punishment, but also say that infertility can be part of God's plan, and that God can give people babies if he so wills. Perhaps God's choosing to withhold a baby is not a punishment per se, but I imagine it could feel like one, especially given the ample evidence that people who have no business being parents often have babies. The authors also say insisting that God answer our "whys?" is idolatrous, but then spend a whole chapter speculating about why God allows infertility.

Some people find comfort in this theology, which assumes that all suffering, even if it is not caused by God, is allowed by God and therefore part of his redemptive plan; indeed, the authors include quotes from several people who were comforted by the idea that God allowed their infertility, or even the death of a newborn, for a reason. Having a very different theology of suffering, I was more angered and confused than comforted by these chapters. They might be problematic for any reader who does not share the authors' theology.

In the chapters on the ethics of IVF, donor gametes, and surrogacy, the authors reduce moral deliberation to procedural thoroughness, giving the impression that couples need only to think through technical issues, such as cost, the chance of multiple pregnancies, how to avoid "leftover" frozen embryos, and the legal status of children conceived with third-party help. When the authors do address bigger ethical questions, they do so unevenly. For example, the chapter on donor insemination addresses whether it is morally problematic to separate sex and procreation, but the authors don't mention that question in the previous chapter on IVF, which requires the same separation. The authors also repeatedly encourage readers to consider moral questions "prayerfully." Of course prayers are important, but so are knowledge and context to inform those prayers. The authors needed to be either much more comprehensive on moral questions, or less so (perhaps including only one chapter summarizing significant questions and providing resources for further study and reflection).**

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Despite these problems, the new edition of When Empty Arms Become a Heavy Burden has much of value for infertile couples. I most appreciated the authors' encouragement that couples can find resolution and acceptance even if they don't become parents through birth or adoption. Glahn reveals that, while she and her husband remain childless, they no longer experience constant despair and longing. The hope provided by her story, and the practical emotional advice provided by both authors, should encourage readers to feel they are not alone, or helpless, in their suffering.

**To learn more about the ethical questions at stake with assisted reproduction consider the following books. I have a longer list of resources on my blog.

Meilaender, Gilbert. Bioethics: A Primer for Christians. Grand Rapids: William B. Eerdmans, 1996—This is a short, readable classic text on a Protestant response to major bioethical questions, including both beginning- and end-of-life decisions.

U.S. Conference of Catholic Bishops. Life-giving Love in an Age of Technology. November 2009—A statement by the American Catholic bishops arguing against the use of any reproductive or genetic technology. Even if readers don't agree with all of the bishops' conclusions, this document provides an accessible introduction to moral questions related to sexuality, marriage and procreation.

Mundy, Liza. Everything Conceivable: How Assisted Reproduction is Changing Our World. New York: Alfred A. Knopf, 2007—This book provides a comprehensive, journalistic, and readable discussion of available reproductive technologies and the people who use them.