There is something uncomfortable about watching a relationship become a public debate because two people discover they are both AS. Suddenly, relatives, doctors and religious advisers have something to say about a future the couple had already begun imagining. Their affection has not changed, yet the conversation now includes inheritance, hospital admissions and decisions that could affect children they have not conceived.
My honoured brother (may Allah elongate his life upon khayr), @alabbaad_X, approaches this dilemma with welcome compassion in his write-up. His distinction between marriage and biological parenthood deserves consideration, as does his argument that reproductive medicine has widened the available choices. Nevertheless, some questions need more attention before a medical possibility becomes the foundation of a lifelong commitment.
The first concerns how we understand probability. A 25% chance of SS in each pregnancy can sound manageable, particularly when people know an AS couple whose children do not have sickle cell disease. However, across four independent pregnancies, the probability of having at least one child with SS is approximately 68%. This does not predict what will happen in any household, and the risk remains 25% in each pregnancy. It does explain why another family’s experience provides little reassurance about our own. Having three children without SS does not reduce the fourth child’s risk, however comforting that conclusion might feel.
IVF with preimplantation genetic testing for monogenic conditions (PGT-M) offers a way to reduce this reproductive risk. While my brother acknowledges that treatment can fail, I would take that discussion further into the couple’s future. What happens if repeated attempts consume their savings without producing a pregnancy? Would both partners remain comfortable postponing biological parenthood? How would they respond to an unintended natural pregnancy? These conversations deserve to happen while there is still time to disagree honestly, rather than when disappointment and family pressure have made every answer more painful.
The woman’s experience also deserves greater space. Discussions about affordability can overshadow the person undergoing ovarian stimulation, monitoring, and egg retrieval. Agreeing to finance treatment is different from agreeing to undergo it repeatedly. Her willingness cannot simply be assumed because the couple wants children. Furthermore, PGT-M is not infallible. The American Society for Reproductive Medicine recommends offering prenatal testing to confirm the result. Couples also need to distinguish avoiding SS from insisting on AA, since AS generally indicates sickle cell trait rather than disease; excluding AS embryos further limits their choices.
From an Islamic perspective, the question of precaution brings to mind Umar ibn al-Khattab’s journey towards Syria. On learning of an epidemic, he consulted the companions and decided to return. When Abu Ubaydah questioned whether he was fleeing Allah’s decree, Umar explained that they were moving from Allah’s decree to Allah’s decree. Abdur-Rahman ibn Awf then reported the Prophet Muhammad’s (pbuh) instruction against entering a plague-stricken land. Although this was an epidemic rather than a matter of inheritance, it illustrates how taking precautions can coexist with faith.
The Prophet’s (pbuh) instruction to pursue what benefits us while seeking Allah’s help offers further guidance (Sahih Muslim, 2664). Seeking medical advice need not diminish reliance upon Allah, just as prayer does not remove the responsibility to investigate available options. Yet conditional permission for IVF should not be stretched into an answer to every question surrounding embryo testing. Shaykh Ibn Uthaymin stressed the need for safeguards when discussing assisted reproduction (Ibn Uthaymin, Majmu Fatawa wa Rasaʾil, vol. 17, pp. 27–28). Embryo selection, storage, and the handling of unused embryos therefore deserve consideration with qualified scholars familiar with the procedure.
Throughout this discussion, we must remember the people already living with sickle cell disease. Preventing illness must never become a way of suggesting that their lives are regrettable, nor should a family’s inability to afford IVF become evidence of deficient faith. Couples deserve counselling that respects their choices while clearly explaining the consequences. Before advising two people either to separate or proceed, we should help them examine what their proposed future would require medically, financially, and religiously, including the possibility that their preferred plan may not succeed.
That is a conversation worthy of the love they hope will sustain their marriage.
