FEATURE: Halachah can complicate infertility treatment

Religious and medical experts get creative in an attempt to find a happy medium between science and Jewish law.

For Orthodox Jews, keeping the laws of niddah (the menstrual period) is a sacred, holy practice between married couples that prohibits them from touching during menstruation and the days after, until she dunks in a mikvah, a ritual bath.

For a woman who has regular menstrual cycles, in the days following niddah, she is at her peak of fertility. But for women who don’t have regular cycles, who may ovulate earlier in their cycle, the practice of niddah – which keeps couples apart for the five days during menstruation, and an additional seven days until they visit a mikvah – can render them “halachically infertile.” 

Dr. Clifford Librach, director of Toronto’s Create Fertility Centre, said he has had hundreds of Orthodox Jewish clients over the years who have come to him with this issue and others.

“There is a lot of pressure on Jewish couples. They want, especially the Orthodox, to fulfil the mitzvah of having children, so in our culture, just like many other cultures, having children is critically important to people when they get married and have families,” he said.


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“But in the Orthodox group, going to the mikvah can have its pros and cons. If a woman… has short cycles, and during her fertile time, she’s not able to be with her husband… sometimes they have to try to manipulate the cycle using hormonal medication so that when she is fertile, that’s the time they can be together.”

Rabbi Yoseph Oziel, spiritual leader of Toronto’s Petah Tikva Anshe Castilla Congregation, offers moral support and guidance to couples struggling with infertility. He said he doesn’t think halachic infertility is as much of an issue today.

“We live in a time and a day when Halachah and science can work very much in harmony,” Rabbi Oziel said. “I’ve never yet encountered a situation where, because of a couple’s adherence to Halachah, they were sentenced to not being able to have children. It’s never happened.”

At Small Wonders, a Toronto-based non-profit organization that helps Jewish couples cope with infertility through financial, emotional, medical and halachic support, clients have access to rabbis who work with the organization to guide Orthodox couples.

“The couple will always consult with a doctor, and the doctor will tell the rabbi what the issue is. They will work together to see how it could possibly work. It doesn’t always work, but there is a lot of medicine that can tweak, let’s say, ovulation for a different day or something like that,” said Denise Levin, the couples director at Small Wonders.

She said the rabbis will not advise a client to forgo the rules of niddah, but will work around it instead.

“No one is making any kind of [decision] that if it doesn’t work, you can try [to conceive] five days earlier – we don’t do that… and we don’t want people to get the wrong impression,” Levin said.

Beyond the timing of a woman’s ovulation, another challenge posed by Jewish law is the process of testing a man’s semen.

“What the rabbis say is that having relations has to be an act that could result in pregnancy. Masturbation is not allowed,” Librach explained. “With sperm testing, we can do one of two things. We can look at sperm in the mucous of the cervix to see if [the sperm is] moving. The other thing we can do, when it is allowed, is to get a special condom we have that isn’t latex, because latex kills the sperm.

“So what they do is that they poke a pinhole in the condom so one or two sperm could get through and then we can collect the condom and get the sample.”

Librach said many rabbis will recommend testing the female for reproductive abnormalities first, but not the male.

“This goes against the medical advice. Just because there is a problem with the female, it doesn’t mean there isn’t also a problem with the male,” he said.

“There are a lot of things that get in the way. Some rabbis are strict about, if you have kids already, whether you can carry on with more advanced treatments, because they feel like you’ve already had children. If you have no children, they may be more liberal versus if you already have children.” 

Librach, who said he is open to talking to clients’ rabbis about their medical issues, said many rabbis are “quite knowledgeable,” but suggested couples do their research about a rabbi who deals with infertility “because apparently, once you get advice, you can’t really go rabbi shopping” for another opinion. 

But once a couple is ready to undergo treatment, Librach said there are many techniques to help a couple conceive.

The clinic has a new type of incubator, called an embryo scope. 

“It’s a technology from Denmark where you can take a picture of the embryo over a period of time… every 20 minutes. It makes a time-lapse video movie of the embryo.”

Using that technology, doctors can better identify which of the embryos are likely to implant and produce a baby. 

“An embryo should normally go one cell, two cells, four cells, eight cells and so on, but if an embryo goes from one cell to three cells, that is not a good sign. If that happens in the middle of the night, no one is there to see that. But this technology allows us to see it the entire time,” Librach explained.

He said in the year since his clinic began using that technology, the success rate has jumped by 25 to 30 per cent. 

Another technique they use is called pre-implantation genetic screening.

“We can now test an embryo before it goes in the uterus to see if it is normal or abnormal… This is a way of preventing miscarriage or a child with handicap,” he said, adding that Create is the only clinic that does the testing in-house. 

Medical treatments and moral support aside, Rabbi Oziel said when couples go through infertility, it is important to have faith.

“From a religious perspective, philosophically speaking, I find that sometimes… when a couple is going through infertility challenges, they have to know that most of the time there is a light at the end of the tunnel and that when the child finally comes, it sort of erases the past and the difficulties,” he said. “One needs to be positive. 

“The second thing is we believe that things like the miracle of creating life are not entirely in the hands of daddy and mommy. God plays a role… Couples have to be prepared to care for the child when they have the child – there is a reason why some couples aren’t able to conceive right away… Timing is very important in life.”

Librach recommended an organization based in New York and Israel for couples seeking rabbinical support.

He said the Puah Institute is “one of the most knowledgeable groups that specializes in fertility and helping couples who are Orthodox with Halachah issues with fertility.

“I recommend that if you have a rabbi you want to confer with, any help is amazing. Because it is very stressful and anything that can keep your stress level down, rabbinical help or counsellors, friends and family – they can be really supportive.”