September 24, 2018

A new era for Torah-based fertility treatment

As modern couples are marrying later and often postponing having children, the use of cutting-edge fertility treatments, such as in-vitro fertilization (IVF) and embryonic genetic testing, is gaining widespread popularity and acceptance.

But for Orthodox Jewish couples who wish to pursue these options, the process can be complicated. 

Jewish law, halacha, restricts certain acts of sexual expression and can make routine medical procedures tricky to perform. If, according to the Torah, a man can ejaculate only during marital sex and is not permitted to spend his seed on anything but procreation, how might doctors test for male infertility?  

Further complicating the issue, Jewish modesty laws known as tznius, intended to elevate and consecrate intimate relationships, can stigmatize public discussions. But addressing these medical issues in a religious context might help them create families.

Such topics were at the heart of the Puah Institute’s Fertility, Medicine and Halacha Conference, held June 8 at the Orthodox Beth Jacob Congregation in Beverly Hills. The event offered a series of workshops dealing with Jewish medical ethics and was the first of its kind on the West Coast. It attracted nearly 80 people of various ages — both men and women — who were seeking to bridge the gap between Jewish law and modern medicine.

“God gave us two things — the Torah and the world,” Beth Jacob’s Rabbi Kalman Topp said during his opening remarks Sunday morning. “That means there can’t be any contradiction between Torah and science.” 

But, until recently, Topp’s view represented a marginal view in the Orthodox world, which interprets nature as the result of divine will. “If a couple cannot naturally have a child, it is a decree from God and we should not interfere,” Topp said, citing one talmudic opinion, then countered: “But Rabbi Akiva says, ‘No,’ God is inviting us to be partners with him; if someone is going through difficult times, we have to become partners with God to find cures for things, to find solutions.” 

Akiva’s view paved the way for the Puah Institute, headquartered in Israel, whose mission is to help Torah-observant Jews fulfill the mitzvah of pru urvu — the commandment in Genesis to be fruitful and multiply — by seeking innovative ways for Jews to remain true to halacha and still take advantage of what science, technology and modern medicine offer. Founded in 1990 by Rabbi Menachem Burstein, who was trained by the Chief Rabbinate of Israel, Puah now operates satellite offices in France and the United States, offering couples a range of services, including education, rabbinic counseling and kosher lab supervision that aims to minimize human error. 

“There are unique challenges for Torah-observant Jews going through this process,” Dr. Philip Werthman, director of the Center for Male Reproductive Medicine, said during a morning session focused on male infertility. “There has to be sensitivity [among physicians] and a willingness to work with the Rav.”

Each session paired a medical practitioner with one of Puah’s rabbis, who would explain — and sometimes alleviate — halachic challenges related to each topic. Regarding sperm analysis, a basic and often early procedure in the course of diagnosing infertility, Werthman raised some of the controversial issues couples must contend with regarding how and when to collect samples. Weitzman offered the Torah view (various sources suggest couples should wait 10, five or two years before attempting sperm analysis), as well as several rabbinic responsa addressing the laws’ particularities.  

The first thing Puah asks is: “What possible potential averot [transgressions] would be [committed] by fulfilling this mitzvah?” Weitzman said. Echoing the medical presentation, he stressed the importance of beginning with less-fraught procedures, such as examining lifestyle choices, before resorting to more invasive and problematic options. 

In the end, though, Weitzman offered a solution that honors both the Torah commandment and the couple: Either collect post-coital sperm with a non-spermicidal condom, or a woman can immediately collect a sperm sample from her own body after intercourse with her husband — a method Puah pioneered. 

Puah also offers interpretive guidance to procedures like cryopreservation (freezing sperm, eggs or embryos) and pre-implantation genetic diagnosis (PGD), which can often be complex,  depending upon the specifics of individual cases. What if an unmarried woman in her 30s wishes to freeze her eggs in case she wants to become pregnant later? What if an embryo tests positive for a disability? Naturally, some of the solutions offered can be “tricky,” to borrow a word used frequently throughout the conference, but even “in extreme cases,” as these things are seen, a solution usually can be found. 

“People think that Judaism is this ancient, stodgy, even misogynist religion, but these very Orthodox, holy, spiritual rabbis have been able to get on board [with this] and help couples go through treatments,” Dr. Michael Feinman, a reproductive endocrinologist and fertility specialist who helped establish Puah’s presence in Los Angeles, said. “The fact that a major religious figure can get up in front of a room and use actual words for male genitalia is mind blowing!”

By contrast, Feinman said, “the answer of the Catholic Church to all this was no. Simply, no.”

Although the crowd included many medical professionals and people connected to the Puah Institute, others came to learn about their own personal options. “I’m just pre-educating myself before starting a family,” said a 32-year-old speech therapist who asked that her name not be used for privacy reasons. “Much of it is reaffirming things I already know, like taking prenatal vitamins early, but it reinforces taking those first steps.”

A 25-year-old married woman who recently became pregnant through IVF said she was there to support the Puah Institute and Beth Jacob’s rabbis, who had supported her. “In general, the feeling is if a couple can’t bear a child, it’s the woman’s fault — her fault, her fault, her fault,” she said, also requesting anonymity because she had not yet told her family the details surrounding her pregnancy. “I wasn’t going to go through IVF without male testing,” she added, even though once her husband proved fertile, they faced other issues regarding protocols for Shabbat. “Your cycle doesn’t wait for you,” she said. 

Although organizers were pleased with the conference turnout, Lea Davidson, Puah’s New York-based executive director, said a similar conference in Israel attracts nearly 1,800 people, and the one in New York, 250. Some wondered why more Angelenos would not attend a free conference, which corporate and community organizations — including EMD Serono, a division of Merck, along with the Jewish Community Foundation Los Angeles and the Florence Presser Baby Fund — created at a cost of nearly $25,000. 

“L.A. is still considered a small town in the Orthodox world,” Feinman said. “Women leave L.A. to find a husband in New York. It’s always hard to get turnouts here.”

But Weitzman suggested a different reason for the absence of both young and older couples who might have benefited from the discussions. “There are many people who are not here because they’re embarrassed to admit and publicize to the community that they have a problem,” he said, urging those present to tell their family and friends about Puah. 

“For the woman who sits behind you in shul who doesn’t have a child; for the man behind you in the beit midrash who is a genetic carrier; for the young couple who has intimacy issues — these are all crises. And when it’s difficult for us, that’s when we rise to the challenge. If there’s a Jew somewhere who needs our help, we want to help as many people as we can.”