This is a difficult and emotionally charged area. One of the most important points to remember is that this couple has already experienced a great deal of emotional and psychological pain. We must be sensitive to this and respond to them with compassion and love. We need to treat them both together, assessing their emotional, psychological and spiritual needs.

What are their main concerns? Is her biological clock ticking and time running out for them to conceive? Are they feeling failures or perhaps even thinking that their infertility might be some kind of punishment? We might be able to reassure them that God loves them independent of their fertility. Remember there is still a social stigma surrounding infertility.

The couple needs careful counselling about IVF treatment. They need to be aware that a baby is not guaranteed. IVF has a success rate of one live birth for every six cycles. At £2,000 - £4,000 per cycle it is not cheap and the level of disappointment can be huge. They need to be sure that they can cope both mentally and financially.

The couple in question has been trying for five years, but some couples may ask for fertility treatments too early. About one in six couples fail to conceive after a year of regular sexual intercourse, but recent studies have suggested that after two years there is a much greater chance of success.[1] It may often be worth simply waiting a bit longer.

There are further ethical issues. A new genetic code for a human being is formed at fertilisation and from this time on the embryo should be treated with the utmost care and respect. The research that led to IVF becoming a possibility involved the experimentation on and disposal of many embryos; indeed thousands of frozen embryos have been destroyed because their maximum storage time has elapsed (five years or ten if the couple specifically requests).[2] If an IVF cycle produced only two embryos and they were both implanted that might be acceptable to some Christian couples. Others would say that the end (a new baby), though good in itself, is not justified by the means (destructive embryo research).[3] For some couples the IVF option will involve gamete donation and this is a separate, though important, issue.

Then we must consider the potential child. IVF completely separates the act of making love from procreation. Does this make the child a product of technology? If it does, will he or she have more or less value than one conceived naturally? I have heard midwives and nurses refer to a child as a 'special baby' due to the nature of their conception. But all babies are special. They are all made in God's image.[4] IVF pregnancies are more likely to suffer from fetal abnormality and sometimes only become 'special' to the parents when the scans and amniocentesis are normal. It is not uncommon for IVF babies to be aborted and the thinking can be that 'it just has to be perfect'. God calls us to love each other unconditionally in the same way that he loves us, not to put greater worth on those who are without physical defect.

I only had one reply via email on this issue. Thank you to Bruce Helme from Newcastle who wrote: 'To deny IVF to the couple is both ethically and morally wrong if it is based purely on one's own beliefs. However, as Christians we must express our views on this emotive issue. Inevitably, with some people God would use this opportunity to express his love to the couple, and show the other options available to them, such as adoption.'

The key points in this debate seem to be:

1. God is in control
2. The significant expense and failure Cdrates
3. Is the child seen as a product?
4. Do the ends justify the means?

I hope I've demonstrated the need for a doctor to treat the couple with kindness and respect. We need to explain carefully all the issues (which many doctors don't) and meet as many of their needs as we can. If after all this has been done they still want to go ahead I don't think I could deny them referral to a fertility specialist. A final thought: since there is a need for 5,000 more adoptive families per year (many of these with special needs)[5] and the chance of IVF success is so slim, some couples might well be better off looking at this option.