Infertility: the struggle to conceive

BY DR. `AA`ISHAH HAMDAN

Have you ever wanted something so badly that you would do anything to get it? Would you spend all of your time and money just to get that one thing? Have you ever felt a yearning that would never go away? Would you pray so often and so intense that tears would come to your eyes? Read the following story to find out the struggles that some couples face:


Imaan's story

“I always knew I wanted children – maybe because I come from a large family. When I was looking for a husband, how he dealt with children was very important to me. In fact, seeing how my husband handled someone's newborn baby was what made me interested in talking to him about marriage. After being married about two years we started trying to have children. We tried for about one year to get me pregnant. With no success, we went to a reproductive health clinic so my husband and I could get tested. (It is normal to take that long to conceive, so, unless there is an obvious problem, most clinics will not test before the couple has tried for one year). Many different tests were done. The doctors only found a minor problem that they assumed would be easy to deal with. We thought that I would get pregnant quickly and were very hopeful.

At this time, we decided to go with a procedure called Intra-Uterine Insemination or IUI. After one trial of IUI in the United States, we moved to Kuwait. It was at this time that I saw a picture above the steps to that clinic in Kuwait. On it was the following Qur'anic verses which mean: "To Allah belongs the kingdom of the heavens and the earth. He creates what He wills. He bestows female (offspring) upon whom He wills, and bestows male (offspring) upon whom He wills. Or He bestows both males and females and He renders barren whomever He wills. Verily, He is the all-Knower and is Able to do all things." [Quran 42:49-50]

It was a reminder that whatever was to happen would be the will of Allah and that I would accept whatever he had planned for me. After two more IUIs I was pregnant. With my doctor's permission, I went to Makkah for `Umrah. While there, I began bleeding and was told that I'd had a miscarriage. However, after returning to Kuwait, I experienced spotting and pains on my right side. While it was thought that I'd had a miscarriage, it turned out to be an ectopic pregnancy. Surgery was carried out and they were able to save the tube since they had caught the pregnancy early enough. I was grateful they saved my tube, but was becoming disappointed. I think I had not yet really accepted Allah's will or learned to appreciate all the things I was able to do because I did not have children (help start an Islamic school, study in an intensive Arabic program, go for `Umrah at the last minute, etc).

We went back to the states for a consultation and then returned to Kuwait where we completed 2 more IUIs and then a trial of IVF or In-Vitro Fertilization. Alhamdulil_lah, I got pregnant from the IVF trial. Sadly though, after six weeks we lost the baby through miscarriage. It was after this trial that I really started to be more accepting of Allah's will. I found ways to cope with the many side effects of the drugs used in the procedures (moodiness, night sweats, and sadness). I realized that getting pregnant may take a while. (Not getting pregnant ever was still kept in the back of my mind.) With the acceptance of Allah's will came the ability to consider more seriously what my life would be like without children, to focus on the positive possibilities of this outcome, and what I would be able to contribute to the community with the available time.

We went back to the States again and did 4 more trials of IUI. At one point during the IUIs we were faced with the issue of Multi-Fetal Reduction, as my ovaries had produced too many eggs so there was a slight possibility of multiples if I were to get pregnant. We spoke with a scholar in the field and he related that the scholars disagree on this topic. We were told that we needed to make our own decision. This was a difficult issue to deal with, but I knew if I had multiples there was no way I could do it. (I didn't get pregnant, so we never had to make that choice). We then did a trial of IVF with ICSI. This too was unsuccessful. More sadness and disappointment; then again, acceptance.

And, while others didn't like to hear us say it, we were beginning to accept the fact that we may not ever have our own children. We still kept trying, but had accepted Allah's will - whatever it may be. We then moved to another state and found a clinic that was well-known for its pioneering work in the field of infertility. We did one IVF trial there with different drug combinations and I became pregnant. Alhamdulil_lah! After four years and lots of prayer we had finally obtained what we wanted. Alhamdulil_lah, the pregnancy went well and we were blessed with a beautiful baby boy.

My advice to anyone trying: be informed about the drugs and the procedures, be prepared to have this as a big part of your life (for a while anyway), know that there will be ups and downs, be patient with "fertile" people's advice (especially when they try not to think about it, but every is structured around shots or ultrasounds), try and appreciate of gifts/opportunities Allah has given you, and most of all know that Allah is with you and He is the best planner your life."


Islamic lessons to be learned

Gratitude: For those who are able to have children and enjoy them, it is important to remember that they are gifts from Allah. We should always be grateful for what Allah has given to us and not take these things for granted. The sight of a newborn baby should make us awe at Allah's Power and how to His Generosity. How many times have we looked at our children and really thanked Allah for them? How many times have people complimented us on our children and we have said Alhamdulil_lah rather than feeling pride. Gratefulness is an important characteristic of a believer. There are many verses in the Qur'an of this nature. Allah Says (what means): "So remember Me; I will remember you. And be grateful to Me and do not deny me." [Quran 2:152]
Patience: Mankind is tested in many ways. The believers are those who are steadfast during times of trial and adversity. The Prophet salallaahu `alayhi wa sallam said: "Wonderful is the case of a believer - there is good for him in everything, and this is only for the believer. If he experiences a blessing, he is grateful to Allah - which is good for him; and if he experiences an adversity, he is patient - which is also good for him." [Muslim]

Infertility is obviously a burdensome trial given to certain men and women, and those who remain patient and steadfast in faith will be the successful. "Indeed, Allah is with those who are patient."


Remembrance of Allah's Will:

The verses from the chapter of Ash-Shoora summarize this point. Allah Almighty Says what means: "He creates what He wills. He bestows female (offspring) upon whom He wills, and bestows male (offspring) upon whom He wills. Or He bestows both males and females, and He renders barren whom He wills." [Qur'an 42: 50]

All that happens in this life emanates from the will of Allah. Oftentimes we have to accept this even if we find it difficult and are unaware of the wisdom behind such happening. This also means that others should not shun, shame, or ostracize a woman or man who is experiencing infertility. This is something, in particular, that husbands should remember in relation to their wives as demonstrated in the stories of Ibraaheem and Zakariyya (outlined below). This is the will of Allah and we are not in a position to judge others, particularly for something over which they have no control. Allah Knows what is best for His creation.

Understanding: The Prophet sallallaahu `alayhi wa sallam ( may Allah exalt his mention ) said: “Whatever trouble, illness, anxiety, grief, pain or sorrow afflicts a Muslim even if it is the pricking of a thorn - Allah removes in its places some of his sins."

The first understanding to have is that through pain, sadness, and struggle comes the reward from Allah, The Exalted, and expiation for sins. The struggle itself then becomes a blessing from Allah, although we may not be aware of this and it may be difficult for us to comprehend. The second understanding is that Allah has a plan and a reason for all things. One example is that of 'A'ishah may Allah be pleased with her the wife of the Prophet sallallaahu `alayhi wa sallam. 'A'ishah was young, but she did not have children.

The wisdom behind this may be that Allah had another purpose for her. One only needs to look at the numerous Hadeths that she transmitted and the knowledge that she shared throughout her lifetime to understand what this purpose may have been. There are other areas of life beyond child-rearing where a person can share his or her talents and skills.

Hopefulness and Reliance upon Allah: It is important to never despair of the Mercy of Allah and to always remain hopeful that Allah will change the situation. Making Du'a (supplication) is essential in relation to this. There are several stories in the Qur'an that present beautiful lessons for mankind. The first is about Ibraaheem and his wife Saarah, may Allah exalt their mention: "And his wife was standing (there) and she laughed: But we gave her glad tidings of Isaac and after him, of Jacob. She said "Alas for me! Shall I bear a child, seeing I am an old woman, and my husband here, is an old man? That indeed would be a wonderful thing!" They said: "Do you wonder at Allah's decree? The grace of Allah and His blessings on you, O you people of the house! For He is indeed worthy of all praise, full of Glory!" [Qur'an 11:71-73]

The second is of Zakariyya and his wife, may Allah exalt their mention: "There did Zakariyya pray to his Lord, saying: "O my Lord! Grant unto me from You a progeny that is pure: for You are He that hears prayer! While he was standing in prayer in the chamber, the angels called unto him: "Allah gives thee glad tidings of Yahya, witnessing the truth of a Word from Allah, and (be besides) noble, chaste, and a prophet,-of the (goodly) company of the righteous." He said: "O my Lord! How shall I have son, seeing I am very old, and my wife is barren?" "Thus," was the answer, "Does Allah accomplish what He wills." [Qur'an 3:38-40] "[This is] a recital of the Mercy of your Lord to His servant Zakariyya. Behold! He cried to his Lord in secret, Praying: "O my Lord! Infirm indeed are my bones, and the hair of my head does glisten with gray: but never am I unblest, O my Lord, in my prayer to You!" [Qur'an 19:2-4]
"And (remember) Zakariyya, when he cried to his Lord: "O my Lord! Leave me not without offspring, though thou art the best of inheritors." So We listened to him: and We granted him Yahya: We cured his wife's (Barrenness) for him. These (three) were ever quick in emulation in good works; they used to call on Us with love and reverence, and humble themselves before Us." [Qur'an 21:89-90]

There are several lessons to be learned from these stories, but the main one is that even in the seemingly most impossible circumstances, Allah may answer our prayers and bless us from his bounty. Both Saarah and Ishba were barren for many years, but nothing is beyond Allah's Power to control. We should obviously not obsess ourselves about having children to the point where it is harmful for ourselves and others, but we should continue to accept Allah's Destiny, remain firm in our faith, and maintain hopefulness.

If Allah does not bless us with children in this life, we have the next life to look forward to. It is important to remember that our goal in this life is to obtain Paradise in the Hereafter. This life is but a fleeting moment in the cycle of existence.
The Prophet sallallaahu `alayhi wa sallam said: "Surely I know a verse (from the Qur'an) which, if people would have followed it, would have sufficed for them concerning everything (in life): `For those who fear Allah, He provides a way out for them (for everything, and) He also provides them provisions from (sources) that they could never have imagined." [(65:2-3); Ahmad and Ibn Maajah]

BY DR. AISHA HAMDAN
Infertility from an Islamic Viewpoint

In the previous edition, we presented Imaan'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...” [Qur'an 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 Qur'an. 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]." [Qur'an 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 Haram? 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 Qur'an, 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..." [Qur'an 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..." [Qur'an 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." [Qur'an 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 Qur'an 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.." [Qur'an 4: 1]

"So would you perhaps, if you turned away, cause corruption on earth and sever your [ties of] relationship?" [Qur'an 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.

Insha 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.