The biblical matriarch Sarah is perhaps history's most famous infertile woman. As a member of a tribe that valued family above almost anything else, she must have tried every ancient remedy; as a last resort, she gave her maid Hagar to her husband Abraham so at least he could father children. When Abraham brought Sarah a message from God, saying they would have a son even though she was past childbearing age, the old woman laughed. "After I am worn out and my master is old, now I will have this pleasure?" she asked herself.

We talk often about religion and fertility, but only in the heated context of politics and bioethics—rarely in the context of the drama facing the couples themselves. One in eight couples has trouble conceiving; it stands to reason that, for some percentage of these couples, intense religious belief informs the way they approach this problem. For Orthodox Jewish women, having children is critical to identity. "Not having children is unheard of," explains Michelle Friedman, a New York City psychiatrist who sees many Orthodox Jews in her practice. "The continuity of the covenant is bedrock." That's why so many Orthodox Jewish couples enthusiastically embrace reproductive technology. Mormons support in vitro fertilization but "strongly discourage" the use of donor eggs or sperm. Focus on the Family's James Dobson, in his "Complete Marriage and Family Home Reference Guide," writes that IVF is OK but the use of donor sperm and egg are "morally indefensible from a biblical perspective." For traditional Roman Catholics, IVF is, of course, forbidden. Some deeply religious couples take the Biblical injunction not to "spill seed" literally; for them, clinics can provide special condoms so that sperm can be collected during intercourse. In all of these cases, marriage is a requirement.

Women who sincerely want to bear children on their God's terms, then, face excruciating choices. Can an Orthodox Jewish woman use a donor egg from a non-Jewish donor? Can a conservative Christian adopt frozen embryos, knowing that some of those embryos might die in utero? When Eileen Lyon, who is Catholic, was trying to conceive, her ob-gyn pressured her to try IVF but she said no. Her Catholicism, she says, gave her a sense of the sacredness of her marriage and of her own body, which she was not willing to violate. "You feel kind of brutalized by physicians who dismiss your religious views. If you choose against IVF, it's your fault you will have no baby," says Lyon, who is a history professor at SUNY Fredonia. Lyon finally sought treatment at the Pope Paul VI Institute, a clinic in Nebraska that seeks to help infertile couples without IVF. After surgery for her endometriosis, Lyon had a baby boy. Even though she tried—and failed—to get pregnant a second time, Lyon says she is glad she made the choices she did. "I feel a real sense of contentment," she says. "It's God's will if you have a baby."

Conventional fertility clinics may be dismissive of the Nebraska institute's approach, but one thing appears to be true: a religious or spiritual mind-set may help infertile women. In a study of nearly 200 women published in 2005, psychologist Alice Domar and her colleagues found a high correlation between women who said they were religious and those with low rates of anxiety and depression during fertility treatment. Here, then, is the million-dollar question: does being religious actually help infertile women get pregnant? Domar says it's possible. If religious women have less depression and anxiety, and lower rates of depression and anxiety correlate to higher pregnancy rates, "it stands to reason that religious and spiritual women should have higher pregnancy rates." No wonder Sarah laughed.

© 2008