A recent report from the World Health Organization concluded that approximately 16% of the global population, that is, 1 in 6 people, are or have been affected by infertility.1 Furthermore, the study shows that infertility does not discriminate, affecting high-, middle-, and low-income countries in similar ways.2 Because infertility is experienced by so many, it’s an important topic for Christians to understand from a biblical perspective.  

Nearly all current discussions on infertility classify it as a disease and attribute its cause to either physiological or psychological factors.3 Thus, any cause of infertility involving the work of God’s providence is denied. On the one hand, reproductive endocrinologists, psychologists, and some Christians argue that infertility is the result of physical or psychological factors. In contrast, the Bible presents infertility as a result of God’s purposeful sovereignty.4 As Hannah prayed, having been delivered from her infertility, “The Lord kills and brings to life; he brings down to Sheol and raises up” (1 Sam 2:6). In summary, then, the issue is whether the cause of infertility should be understood as a result of physical or psychological factors or as a result of God’s purposeful sovereignty.  

This article will argue that the cause of infertility is in line with the Bible and ultimately the result of God’s purposeful sovereignty. Though I would concede that the cause of infertility does involve physical and psychological factors (i.e., “secondary causes”), I will still argue that infertility comes as a primary result of God’s sovereignty. As the Bible demonstrates repeatedly, God is sovereign over both the physical and psychological. With regard to the physical, as the apostle Paul said, “[God] gives to all mankind life and breath and everything” (Acts 17:25). And, regarding the psychological, Solomon wrote, “The plans of the heart belong to man, but the answer of the tongue is from the Lord” (Prov 16:1).

Although some might struggle to accept that God is the ultimate or “primary cause” of infertility, I would reply that the God of the Bible is sovereign over all things, even infertility. And as noted above, this issue is important because infertility is so common and because couples experiencing infertility long to understand the reasons for their infertility. Therefore, it’s my hope that this brief article will help such couples understand that their infertility is in the hands of a God who is not only good, but interested in giving them what is best. 

God’s Purposeful Sovereignty 

In this article, I’m using the term “purposeful sovereignty” to capture the biblical doctrine of God’s providence. John Piper highlights the difference between the doctrine of God’s sovereignty and God’s providence, “[T]he term sovereignty does not contain the idea of purposeful action, but the term providence does.”5 Thus, in arguing that infertility is the result of God’s providence, I’m arguing that infertility is the result of God’s purposeful action.

The Westminster Confession of Faith offers the following definition of providence, “God the great Creator of all things doth uphold, direct, dispose, and govern all creatures, actions, and things, from the greatest even to the least, by his most wise and holy providence, according to his infallible foreknowledge, and the free and immutable counsel of his own will, to the praise of the glory of his wisdom, power, justice, goodness, and mercy.”6 To say that God governs all action and things is to say God is sovereign, and to say that He does so “to the praise of the glory of his wisdom, power, justice, goodness, and mercy,” is to say that His sovereignty is a purposeful sovereignty. Similarly, MacArthur and Mayhew say, “Divine providence is God’s preserving his creation, operating in every event in the world, and directing the things in the universe to his appointed end for them.”7

In other words, God is preserving, operating, and directing the things related to infertility to His appointed end.  

To that point, we can demonstrate the extent of God’s purposeful sovereignty from a number of passages. To start, God’s providence is seen in nature. The psalmist speaks of God’s purposeful sovereignty over such natural occurrences as lighting strikes (Ps 135:7) and plant growth (Ps 104:14). Jesus said that it is God who “makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust” (Matt 5:45). The Bible proposes that God’s providence extends to the wild animals. Jesus said the Father feeds the birds of the air (Matt 6:26). Even events that, from our perspective, seem random, fall within the scope of  God’s purposeful sovereignty. For example, Proverbs 16:33 says, “The lot is cast into the lap, but its every decision is from the Lord.”  

And yet, the question remains, “Does the Bible speak of God’s purposeful sovereignty over infertility?” The answer is a resounding, “Yes.” And, this truth can be demonstrated from the opening pages of Scripture. When Eve gave birth to Seth, she said, “God has appointed for me another offspring…” (Gen 4:25). When Job’s children were killed, he declared, “The Lord gave, and the Lord has taken away; blessed be the name of the Lord” (Job 1:21). Job understood rightly that it was the Lord who gave him children. The Psalmist declared that “[God] gives the barren woman a home, making her the joyous mother of children” (Ps 113:9). And, Solomon wrote, “Children are a heritage from the Lord, the fruit of the womb a reward” (Ps 127:3).  

Furthermore, it’s also clear that those who experienced infertility in the Bible understood it to be the result of God’s purposeful sovereignty, although that’s not to say they readily accepted it. As Rachel declared, “Give me children, or I shall die!” (Gen 30:1). Yet, it was Jacob who responded to her, saying, “Am I in the place of God, who has withheld from you the fruit of the womb?” (Gen 30:2). In speaking of Hannah’s barrenness, 1 Samuel 1:5 says, “The Lord had closed her womb.” And, upon the Lord opening her womb, she declared in prayer, “The Lord kills and brings to life” (1 Sam 2:6).  

While some have rejected the notion of God’s purposeful sovereignty over infertility, Scripture portrays such a pervasive view of God’s sovereignty that we have no choice but to see God as the primary cause of infertility. And, while it may be hard to accept that God is the cause of such pain, Scripture gives us examples of God using various afflictions—even sin—to bring about his purposes. Genesis 50:20 may be the chief example. While Joseph’s brothers were trying to destroy him, God was sending him to Egypt to save them. Paul’s ministry provides another example. While his opponents were trying to thwart his ministry and thereby the work of God, Paul wrote from a jail cell, “What has happened to me has really served to advance the gospel” (Phil 1:12). More broadly, Colossians 1:16 says, “For by him all things were created, in heaven and on earth, visible and invisible, whether thrones or dominions or rulers or authorities—all things were created through him and for him.” When Paul mentions “thrones or dominions or rulers or authorities,” he has in mind the angelic forces of both good and evil.8 It is these that he says “were created through him and for him.” Arguing from the greater to the lesser, if God created the forces of evil and used them for His divine purposes, it should not be hard for us to accept that God is sovereign over infertility and likewise uses it for our good and for His glory. 

The Dark Providence of Infertility 

Commenting on the fact that it was God Himself who kept Sarah childless, Stephen Charnock wrote, “Providence is mysterious because God’s ways are above our human methods. Dark providences are often a smoldering groundwork laid for some excellent design that God is about to reveal.”9 Charnock has captured infertility well with the words, “dark providences.” Many women who experience infertility say it is the most upsetting experience of their lives.10 Writing as someone who has experienced infertility firsthand, Matthew Arbo summarizes the range of emotions infertile couples experience: “Eagerness, worry, hope, disappointment, confidence, despair, embarrassment—they felt it all—and always, everywhere the irrepressible shame of not being able to complete the basic human task of reproduction.”11 And yet, as we have discovered, we cannot remove God’s hand from such dark providences.  

While we must guard against offering truth as some platitude, we cannot shy away from accepting what the Bible clearly teaches concerning infertility. All things do, in fact, work together for good, for those who are called according to God’s purpose (cf. Rom 8:28). And, it is true, “The Lord gave, and the Lord has taken away, blessed be the name of the Lord” (Job 1:21). John Piper has written, “the ultimate goal of God’s providence is to glorify his grace in the spiritual and moral beauty of Christ’s undeserving, blood-bought bride as she enjoys, reflects, and thus magnifies his greatness and beauty and worth above everything.”12 May this sweeping view of God’s providence capture the hearts and minds of those experiencing childlessness and prepare ministers of God’s Word to shepherd them through these trials.  

References

[1] World Health Organization, Infertility Prevalence Estimates, 1990–2021. Geneva: WHO, 2023, xi. 

[2] Ibid., xii. 

[3] The American Society of Reproductive Medicine (ASRM) defines infertility as “a disease defined by failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse” ( https://www.reproductivefacts.org/browse-resources/frequently-asked-questions/faq-about-infertility). 

[4] In this article, I’m using the phrase “purposeful sovereignty” to capture the doctrine of God’s providence. See John Piper, Providence (Wheaton, IL: Crossway, 2023), 29. 

[5] Piper, Providence, 29.  

[6] “Of Providence,” 5.1, in The Westminster Confession of Faith and Catechisms (Lawrenceville, GA: The Orthodox Presbyterian Church, 2007), 19-21. 

[7] John MacArthur and Richard Mayhue, Biblical Doctrine: A Systematic Summary of Bible Truth (Wheaton, IL: Crossway, 2017), 218.  

[8] C. Fred Dickason, Angels: Elect and Evil (Chicago, IL: Moody Publishers, 1995), 92-93.  

[9] Stephen Charnock, Divine Providence: A Classic Work for Modern Readers (Phillipsburg, NJ: P&R Publishing, 2022), 34.  

[10] Harvard Medical School, “The Psychological Impact of Infertility and Its Treatments,” https://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatments. 

[11] Matthew Arbo, Walking through Infertility: Biblical, Theological, and Moral Counsel for Those Who Are Struggling (Wheaton, IL: Crossway, 2018). 

[12] Piper, Providence, 693.