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.”

Rabbinical marriage counseling works — up to a point

Rabbi Karen Fox remembers the moment when she decided she needed to pursue a master’s degree in counseling psychology.
In the late 1980s, Fox, a rabbi at Wilshire Boulevard Temple, decided to create a support group for several couples who had privately sought her out to discuss their fertility problems and the resulting strain on their marriages. By bringing those temple members together, Fox did what scores of rabbis across the country do daily: She tried to improve congregants’ relationships and lives by offering free counseling.
Problem was, Fox now admits, she didn’t really know what she was doing. Having received only the most basic training in marital and other counseling during her rabbinic studies, she lacked such vital tools as empathetic listening and a deep understanding of the form and function of families. Much to her chagrin, Fox could do little more than offer sympathetic words of encouragement.
“Just as doctors specialize, I think it’s important that rabbis interested in counseling study it and train for it,” said Fox, who earned her master’s in 1991 and later became a licensed marriage and family therapist. “Otherwise, they might not have a broad enough vision and a wide enough ear to understand what’s going on with a couple.”
Like other clergy, rabbis have dispensed marital and other advice to congregants for generations. With a deep knowledge of Jewish texts and values, they have long played an important role in helping couples headed to the chuppah learn how to incorporate God and Judaism into their lives. Those premarital interventions, spiritual and otherwise, often increase the odds for marital success by teaching Jewish couples how to make their union sacred and loving, rabbis and their supporters say. Overall, rabbis earn generally high marks for premarital counseling, which focuses on the rudiments of good communication.
However, critics say rabbis are less suited for long-term marital counseling, even though desperate couples with crumbling marriages often turn to them for salvation. Although rabbis can play a positive role in brokering a reconciliation in couples with relatively minor problems, they are generally ill-equipped, both educationally and often temperamentally, to grapple with spousal abuse, depression, bullying and other serious issues that can destroy marriages and souls. Untrained in these areas, rabbis can do congregants a great disservice when they fail to refer them to professionals for help, experts say.
“The rabbinate encourages pronouncements and directives, but counseling is about listening and hearing subconscious messages,” said Rabbi Mel Gottlieb, dean of the Rabbinical School and Chaplaincy Program at the Academy for Jewish Religion, California. “So, if as an authority figure you tell someone what to do, you might curtail the process of emotional expression that is essential for a couple’s growth.”
Judaism considers marriage to be a holy union with partners entering into a sacred relationship with one another and God. Several texts enshrine institution’s centrality in Jewish life. Genesis 2:18, states: “It is not good for man to be alone; I will make a fitting helper for him.” The Babylonian Talmud Yevamot 62b, says: “Any man who has no wife lives without joy, without blessing and without goodness.” Midrash, Yalqut Shimoni, Ruth 606: “He who marries a good woman is as if he fulfilled the whole Torah from beginning to end.”
Given Judaism’s emphasis on marriage, it is hardly surprising that many rabbis offering premarital counseling infuse their sessions with religiosity. Rabbi Michael Menitoff, an instructor in the psychology departments at the University of Judaism and the Academy for Jewish Religion, said that when he worked as a congregational rabbi he would encourage couples to make their future home sacred by observing Shabbat and keeping kosher.
Sinai Temple Rabbi David Wolpe said he also emphasizes the importance of Shabbat, which he calls “an opportunity to not be tyrannized by the modern world and to create a space in which personal interactions can exist away from the constant [inundation] of information and opinion and all the things with which we are bombarded day-to-day.”
In his nearly two decades as a congregational rabbi, Rabbi Mark Diamond would discuss the meaning and importance of Jewish wedding rituals before the big day. For instance, Diamond, now the executive vice president of the Board of Rabbis, would explain that the sixth blessing recited under the chuppah teaches that newlyweds begin married life with a clean slate and rejoice together. But the seventh blessing, Diamond says, suggests that Judaism also calls on partners to celebrate their individuality and give one another space to grow. Diamond’s point: Understanding the meaning behind Jewish marital customs gives couples a roadmap to better navigate their futures together.
In the bad old days, rabbis received scant counseling training of any type in the seminary. That meant they relied on little more than gut instinct when advising couples on how to grapple with issues such as alcoholism and infidelity. In recent years, observers say, rabbis and rabbis-in-training have received better pastoral counseling education. The Academy for Jewish Religion, for instance, now requires rabbinical students to take two counseling courses, which, among other subjects, address such topics as the power of active listening, the therapeutic process and crisis management. In recent years, the Board of Rabbis sponsored a series called, “The Rabbi as Counselor: Issues & Challenges,” which dealt with issues ranging from marital counseling to infertility to mental illness and depression.
The improvements notwithstanding, congregants coming to rabbis with serious marital and other problems have often come away disappointed, said Rabbi Abner Weiss, former rabbi at the Orthodox Beth Jacob Congregation in Beverly Hills.
In a 1999 survey of more than 200 Jews at Beth Jacob, University Synagogue and Valley Beth Shalom, Weiss found that the majority of temple members who had gone to rabbis and licensed professionals for advice found the marriage counselors, psychologists and social workers to be more helpful, although the majority of Orthodox congregants preferred going to a rabbi.
Despite rabbis’ good intentions, some temple members complained that clergymen had betrayed them by using their personal dramas as the basis for sermons, Weiss said. Others said that even if rabbis respected their privacy, too many temple members saw them going in and out of his/her offices for counseling and gossiped. Finally, many groused that rabbis knew far less than the trained professionals.
“When there’s a real problem, what’s really required is a good referral,” said Weiss, himself a licensed marriage and family therapist. “Rabbis often can’t recognize what’s really going on in a relationship and should be honest enough to say so.”

Market Yourself Into Marriage

Why are you single?”

The woman who recently hurled this accusation at me, I suppose, intended it as a compliment: how could someone as ________ as me not have a husband? We were both attending a baby shower for a mutual friend, and I hadn’t seen this woman since our mutual friend’s wedding; now she planted herself in front of me and spit out a question many of my friends probably want to know the answer to, but are too classy to ask:

“So, why are you single?” she said again.

I suppose I could have come up with a number of snappy comebacks (“Why are you married?”), but instead I smiled politely, as if I agreed with her assessment that since that I am of no obvious defects (club foot, third eye, running sores) I, too, am mystified (!) that I possess no husband or serious boyfriend. So in the name of maturity (and because I’m not quite sure the answer isn’t “because I want to be single”), I simply shrugged and replied, “I just haven’t met the right guy.”

If only I had read Rachel Greenwald’s new best-seller, “Find a Husband After 35 Using What I Learned at Harvard Business School,” I could have told this woman what Greenwald writes in the opening of her 311-page book: “Why are you still single? It doesn’t matter.”

“I think that women can get stuck on trying to analyze why,” Greenwald told me by telephone from her home in Denver. “I encounter this a lot — women who love to sit about and talk about it. They go to therapists, talk to friends — but procrastinating and stalling is [their] problem,” said Greenwald, who will be speaking in Los Angeles on Oct. 21. “I think they get into a rut.”

Why you are single doesn’t matter. What matters, Greenwald writes, is what you are going to do about it.

A Harvard MBA who worked as a marketing executive at Evian and Carolee Jewelry, Greenwald, 39, proposes that what women do is devote the next 12-18 months of their lives to her “Simple 15-Step Action Program” and market themselves down the aisle.

Her figures shout epidemic: There are 28 million single women over the age of 35 in this country, compared to 18 million men of the same age. The disparity grows when you figure that men can date younger women; and when you add the ugly facts that for women over 35 the biological clock is nearing its final hour, “Finding a Husband” can even send a pre-35-year-old reader like myself into taking Greenwald’s “Program” seriously.

American Jews tend to marry later than the general population, according to the recently released National Jewish Population Survey (NJPS 2000-1). The largest gap between Jews and non-Jews marrying is in the 25-34 age range, followed by the 35-44 age range. Meanwhile, when it comes to fertility, nearly twice as many Jewish women between the ages of 30-34 are childless (54 percent), as compared to their non-Jewish counterparts (28 percent). And while the gap narrows at the 35-39 age range (16 percent), it never really closes, even at the 40-44 age range (7 percent). What all this means is that whatever the “unmarried/fertility epidemic” is for American women, it’s even more so for their Jewish subsection.

Perhaps these latest NJPS figures will force the Jewish community to consider the state of marriage and fertility a crisis, just as it did with assimilation in its 1990 study, when dozens of organizations directed funding to combat the assimilation over the last 10 years. If not, unmarried Jewish women will have to rely on secular matchmaking tactics like “The Program.”

“You, the reader, are ‘The Product,’ and ‘The Program’ is a strategic plan to help you market yourself to find a future husband,” Greenwald writes. The Program requires you to package, brand and advertise yourself, as well as conduct market research, employ event planning and perform quarterly reviews to your dating life, just as any successful company would create, plan and launch a new product — from toilet paper to cars — into the marketplace.

We’ve come a long way, baby. Having fought for decades against the objectification of women, The Program urges us to reobjectify. See Step No. 3: Packaging: “Packaging may be the most underappreciated marketing tactic. Surprisingly, packaging can be more important than the product itself…. Given all the competitive products [i.e., other women] on the shelves, your package must stand out and be appealing enough to prompt a first-time purchase…. I wish I could tell you that your inner self is what really counts — and later in a relationship it is what counts most — but the truth is that how you look makes all the difference in getting noticed in the beginning.”

Like everything else in our capitalist society — religion, politics, education — finding a husband comes down to good marketing.

“Finding a Husband,” No. 7 on The New York Times Best-Seller List, with press from People to “The Today Show” and a movie development deal from Paramount, speaks to the current national debate between feminism and its backlash: On the one hand we have Laura Kipnes’ thoroughly modern “Against Love,” a treatise arguing against monogamy and for adultery. On the other hand, there is Sylvia Ann Hewlett’s “Creating a Life: Professional Women and the Quest for Children” on the epidemic of childlessness due to women’s devotion to their careers.

Exemplifying the tensions between feminists past and present, last Sunday’s New York Times Style section featured “Out of Step and Having a Baby,” an essay by Molly Jong-Fast, daughter of feminist Erica Jong (“Fear of Flying”) who wrote that she was bucking the trend of all her 35-45-year old friends, and having a baby quell horror at age 24.

As the ’90s-defining show “Sex and the City” comes to a close with a “happy” ending likely for most of the characters, no one has successfully answered the question of whether women can have it all or what they must choose between.

To her credit, Greenwald, a happily married (to a fellow Jew) mother of three, does not bother with the question of what feminism has wrought. She neither blames women for their careers or hang-ups or lives or whatever has kept them single for so long, nor does she see marriage as the panacea for all women.

“This book is not trying to suggest that women need a husband at any means, but it’s addressing a subpopulation who have already decided they want a husband,” she said.

So what does one have to do to snag a husband? Basically, The Program suggests enlisting everyone you know — and she means everyone, from your hairdresser to your grandmother’s neighbor — to help you find “someone wonderful” (the main criteria in searching for a man; The Program requires you to “cast a wider net” and rethink “requirements” such as type, age, height, location, occupation and religion). Not only do you have to advertise this with forthright requests such as a “Flag Day/ Halloween/Secretary Day letter:

“Dear Sandy: Are you still enjoying your new job? It sounds wonderful! I have a special favor to ask you. This year, I would like to find someone special to spend my life with. Do you know any single men you could introduce me to? I would truly appreciate your help….”

But with less direct gambits for promoting your “personal brand,” those three main positive and distinct adjectives about yourself that set you apart as a quality, marriageable woman. You should tell a co-worker, “When I lived in Argentina…” thus letting the co-worker know that your brand is “international woman.”

Like many bestsellers such as “The Celestine Prophesy,” or “Dr. Atkins New Diet Revolution,” “Finding a Husband” is not meant to be a literary work; yet with its detailed charts and do and don’t lists, it certainly succeeds in helping women expand their social network, thus increasing their odds of meeting “someone wonderful” (not to mention of meeting “someone horrible” as well).

Greenwald recycles some old advice (don’t make the first move) but with a modern twist (unless you can make it seem like it’s not the first move or only once in any given relationship) and even tailors it to the modern age (she says that if you only take one thing from the book, it’s that you should join an online dating service). She can be exasperating (men love feminine women with long hair and nice — but not too nice — nails) and crafty like her predecessor, “The Rules” (discuss sports figures, sign up for a woodworking class where all the men are and flirt with them during the break). Her Program certainly seems tiring — imagine being “on” for a year, accepting all dates and projecting an “upbeat” attitude all the time. Yet whatever you think of The Program, don’t call it desperate.

“I never use the word desperate. I call it proactive,” Greenwald said.

But do Jewish women really need to be more “proactive?” Greenwald said she noticed from her research that

“Jewish women are a lot more likely to embrace this program because it’s proactive and assertive,”

“A lot more Jewish women have chutzpah,” she said, and I believe it. But to paraphrase “Sex’s” Carrie: “Sometimes I wonder … is Jewish chutzpah a good thing?”

Case in point: A male friend of mine who was dating a non-Jewish woman said that what he found most attractive was that “she doesn’t have that emotional and physical aggressiveness that many Jewish women possess.”

Indeed, if you looked around your egalitarian synagogue this High Holiday season, you might have seen those intermarriage statistics in the form of the blonde bombshell or the “Asian Shiksa” phenomenon. I don’t mean to imply that WASPS and Asian women are docile, but perhaps they might be a bit less, ahem, “proactive” than Jewish women — myself included.

Of course we Jewish women are not solely at fault for our unmarried status — despite what Jewish mothers say, Jewish men are not all princes — but I don’t know that a no-holds-barred, take-no-prisoner, leave-no-stone-unturned campaign to get a Jewish husband is the right path to take.

The real question is, why should we have to? Why should we resort to such emergency measures when we belong to a community that is supposed to take care of the “convert, widow, the orphan?” (Exodus 21:1-24:18). Unlike pure capitalism, which reveres individualism, Judaism sanctifies matrimony, as it says in Genesis 2:18, “It is not good for man to be alone.”

Indeed, if the Jewish community is so family oriented, and if belonging to it means that you are taken care of by the larger family and you are never really alone, shouldn’t the one to be more proactive in this singles epidemic be the community? I’m not only talking about the usual suspects such as synagogues and organizations, but the building blocks of the community itself: the family unit, the couple and the individual who comes up to you at a baby shower and asks, “So, why are you single?”

It is here that Greenwald’s interests and those of the Jewish community might diverge.

Julie, a 47-year-old Jewish Wall Street exec who hired Greenwald as a marriage consultant, had searched all her life for a male counterpart: a smart, successful Jewish investment banker. One day she went to return a broken cell phone at RadioShack and, one year later, married the non-Jewish manager.

So when Greenwald advises you to commit to The Program above everything, does that mean above your religion as well?

Greenwald paused thoughtfully on the phone before she answered.

“If finding a Jewish husband is very important to you, then I certainly hope you can achieve that — so that’s Plan A, and you should give it your best shot,” she said. Giving it your best shot means exploring all possibilities — including dating outside your city and state and preferred professions and age ranges.

“This is something that Jewish women don’t often think about,” she said.

But, if all that fails, and every shadchan and yenta in the community can’t find a suitable boy for you, “you move to Plan B,” she said, noting that it’s not all black and white: some men, like the RadioShack manager, may convert (although in a different chapter she writes, “The only way you can ‘change’ a man is if he’s in diapers.”); some may decide to raise the children Jewish, and for other intermarried couples, “there are people who fall in love and religion will always be an issue,” she said. “I think that God would sometimes choose happiness for you than staying in your religion.”

While “Finding a Husband After 35 Using What I Learned At Harvard Business School” may serve as a wake-up call to single Jewish women — and men, who are welcome to do The Program — it should ring a loud-and-clear clarion call to the Jewish community at large.

Because “The Program” may deliver us results we do not want: fewer unmarrieds, more intermarriage. Perhaps it is time to seriously focus on our own “Programs” and “market” our own Jewish singles, divorcées and widows. Some organizations do, for sure, but not enough have, not in our segregated society of “families” and “singles.”

For if you listen to the message of this book, and you note the shrinking fertility rates in the Jewish community (NJPS puts it at 1.9 — below the necessary replacement rate of 2.1 percent), you can hear the cry of the growing unmarried Jewish population. And if you listen real close — in their cry, you will hear your own.

Rachel Greenwald will be speaking and signing books on Oct. 21, at 7:30 p.m. at Borders Books and Music, 1360 Westwood Blvd. For more information call (310) 475-3444.

Supervising Life

Two women shared a room in a major Israeli hospital some
years ago, both awaiting the insemination portion of in vitro fertilization
(IVF) treatment. One of the women, “Mrs. Cohen,” was undergoing the procedure
under the supervision of a mashgiach [religious supervisor] from Machon Puah — 
an Israeli religious fertility institution —  and the other, “Mrs. Rabinovich,”
was not.

Mrs. Cohen was scheduled to be inseminated first, but she
went to use the bathroom moments before the process started, so  the doctor
scheduled Mrs. Rabinovich to go instead. The laboratory assistant, who had
prepared the test tubes, had not been informed of the change, and so he handed
the doctor the syringe for Mrs. Cohen.

The doctor stood there with the syringe in his hand, about
the inject it into the second woman, when the mashgiach stopped the process,
reminding the doctor that the correct procedure before insemination is to ask
the woman’s name. “Is your name Mrs. Cohen?” the doctor asked, reading the name
off the tube in his hand, forgetting that Mrs. Cohen was in the bathroom. The
woman, who was in a state of utter drowsiness, nodded her head. The doctor
repeated the question, and again, she answered in the affirmative. Finally, the
mashgiach said, “What is your name?” and she answered “Mrs. Rabinovich.”

“The tube the doctor was about to inject in her was for Mrs.
Cohen,” said Miriam Ben David a volunteer and fundraiser for Machon Puah. “The
mashgiach really prevented a terrible mistake.”

Preventing terrible, life-altering mistakes is the raison
d’etre of Machon Puah, an institutition named after the midwife who defied
Pharoah’s orders to kill the male Hebrew babies, as well as the Hebrew acronym
for Poriut Urefuah Al Pi Halachah — fertility and medicine in accordance with
Jewish law. The Machon was established in 1990 by Rabbi Menachem Burstein under
the auspices of Rabbi Mordechai Eliyahu, the chief rabbi of Israel, to address
fertility needs in the ultra-Orthodox community in Israel, and to assuage the
consciences of religious Jews who had preconceptions about fertility

“The rabbis were seeing that a lot of infertile religious
couples were unwilling to undergo fertility treatments, for two main reasons,”
said Rabbi Gideon Weitzman, the head of the English-speaking section of Machon
Puah. “The first was that there was really no clear comprehensive guide,
neither written nor verbal about what fertility treatments and testing were
permitted halachically, and the other problem was that there was a serious
concern that there would be mistakes made in the lab resulting in the wrong
embryos being transferred to couples.”

So Burstein started to identify all the available fertility
treatments to ascertain their halachic viability and a “kosher” supervision
service on IVF treatments was established.

Today Machon Puah, which is located in Jerusalem and funded
by donations, offers a number of services to couples that are having difficulty
conceiving. The first is a free counseling service, where couples can meet with
one of eight rabbis well-versed in all matters of gynecology and fertility who
can advise the couples about the different treatments available, and can direct
them to the top doctors in Israel who deal with the problems.

“Many of the doctors who are seeing patients often don’t
have enough time to explain a game plan to the patients,” Weitzman said. “We
have the time to do that, because we are not clinical, so we can explain to a
couple what the process is, and we can build a long-term strategy with them.”

The other service that Machon Puah offers is the
aforementioned supervision, where a religious supervisor checks the artificial
insemination proceedings to ensure that no mistakes happen. This service costs
$30 for an intrauterine insemination, and $80 for IVF. In the 12 years that
Machon Puah has been offering the service, its supervisors have caught 19
errors in the thousands of inseminations they supervised.

“Nineteen is not a huge number, but it is definitely a
significant number” Weitzman said.

So has the terror in Israel dampened the desires of couples
wanting to conceive?

“If anything, just the opposite,” Weitzman said. “We have
seen a baby boom. The answer to the problem that the Jews are having in Israel
is to increase the population. The answer to terrorism is to have more

For more information, call (718) 951-6421; or visit www.puah.org.il/indexeng.asp

Findings Reveal Demographic Shift

This is the American Jewish world, by the numbers, as revealed in the just-released National Jewish Population Survey 2000-2001 (NJPS)

The Jewish population now stands at 5.2 million, down
5.45 percent from 5.5 million in 1990.

Jews represent 2 percent of the general U.S.
population, which stands at 288 million, an increase of 33 million from 1990.

The Jewish population resides in 2.9 million Jewish
households, with a total of 6.7 million people in all those households.

This means that 1.5 million of those people — one out of every five people living in a Jewish household on average — are not Jewish.

The United Jewish Communities, the umbrella organization of local Jewish federations and sponsor of the study, released only the demographic findings this week.

Other parts of the study, which will address issues of Jewish identity and affiliation, will be released at the group’s annual gathering in Philadelphia at the end of November.

Among the key findings released on Tuesday:


The median age of U.S. Jews is 41, up from 37 in 1990,
and in contrast to the median age of 35 in the general U.S. population.

19 percent are age 65 and older, up from 15 percent in
1990, compared with 12 percent in the general population.

19 percent are age 17 and younger, down from 21 percent
in 1990, compared with 26 percent in the general population.

Gender and Marriage

51 percent of U.S. Jews are female, 49 percent are
male. The gender distribution is the same as the general population and is
unchanged from 1990.

54 percent of U.S. Jews aged 18 and older are married,
compared with 57 percent in the general U.S. population.

26 percent aged 18 and older are single and never
married, compared with 24 percent in the general population.

30 percent of Jewish men are single compared with 22
percent of Jewish women.

9 percent of Jewish adults are divorced, 4 percent are
separated and 7 percent are widowed. All of these figures parallel those in the
U.S. adult population as a whole. The NJPS numbers regarding Jews who live with
their boyfriend or girlfriend have not been released.

59 percent of Jewish adults have married once, 13
percent twice and 2 percent three times or more.


Jewish women approaching the end of their childbearing
years, aged 40-44, have an average of 1.8 children, which is below the
replacement level of 2.1.

52 percent of Jewish women aged 30-34 have no children,
compared with 42 percent in 1990 and 27 percent among the general population in

National Origin:

85 percent of Jewish adults were born in United States.

Of the 15 percent of foreign-born Jews, 44 percent come
from the former Soviet Union ( 20 percent from the Ukraine, 13 percent from
Russia, the rest from other parts of the former USSR) and 10 percent each from
Israel and Germany.

Population by Region

There has been little change in the regional distribution of Jews since 1990:

43 percent of Jews live in the Northeast, compared with
19 percent of the total population.

22 percent of Jews live in the West, compared with 23
percent of non- Jews.

22 percent of Jews live in the South, compared with 35
percent of non-Jews.

13 percent of Jews live in the Midwest, compared with
23 percent of non-Jews.

38 percent of Jews live in a different region of the
country from where they were born.


The average number of people per Jewish household is
2.3, down from 2.5 percent in 1990, and compared with 2.6 percent in non-Jewish

30 percent of Jewish households have one person,
compared with 26 percent of non-Jewish households, up from 24 percent in 1990.

38 percent have two people, 13 percent have three, 12
percent have four and 8 percent have five or more (compared with the general
population, where 14 percent have four people and 11 percent have five or more).


24 percent of adult Jews have a graduate degree, and 55
percent have earned at least a bachelor’s degree, as compared with 5 percent and
28 percent, respectively, in the general population.


62 percent of Jews are employed full-time or part-time,
just 1 percent higher than in 1990; broken down by gender, 68 percent of Jewish
men are employed, 56 percent of women are.

21 percent of Jews are retired, up from 16 percent in
1990 and compared with 16 percent of non-Jews.

59 percent of Jews work in management, business and
professional/technical positions, compared with 46 percent of non-Jews who work
in those areas.

Of the 59 percent, 41 percent work in professional or
technical positions.


$50,000 is the median income among Jews, compared with
$42,000 among non-Jews.

19 percent of U.S. Jews are defined as low income,
earning $25,000 annually or less, compared with 29 percent of non-Jews.

Better With Age

"You’re the oldest of all my friends’ moms," my son, Danny, 11, tells me.

Like I don’t know this. Or have a card for senior discounts or billions of cells that have lost their elasticity to prove it.

A year and a half ago, I was a trendsetter. The Wall Street Journal reported that many women — women who already had children or even adolescents — were short-circuiting a potential midlife crisis by giving birth to another child. "Nationwide," the paper stated, "the number of women between the ages of 40 and 44 giving birth again is up 23 percent since 1995."

But now, according to Time, I’m an aberration. The article states that the ticking of the biological clock, like the ticking of the crocodile in "Peter Pan," portends trouble, as fertility begins to decline at age 27 (along with brain cells, which expire at the rate of 50,000 per day).

The magazine reports, with statistics from the Centers for Disease Control, that by age 42, 90 percent of a woman’s eggs are chromosomally abnormal. As a result, one in five women age 40 to 44 is currently childless, and only a small percentage by design.

Some of us older moms had no choice. I, for instance, didn’t meet my husband until I was 34. And though we moved quickly and dutifully in fulfilling the biblical injunction (Genesis 1:28) to "be fruitful and multiply," I was pushing 43 when my fourth son was born.

In retrospect, those early years were the easy ones.

For here I am at age 54, where biologically and psychologically I should be at that peaceful stage of life with near-grown children.

Instead, I am working "24-7-365," as my son, Jeremy, says, as drill sergeant, chauffeur, caretaker, social secretary and nonstop negotiator for boys now 11, 13, 15 and 18. And knowing that, when my youngest graduates college, I’ll be eligible for Social Security and a room at the Jewish Home for the Aging.

"You’re a lot younger than Sarah," my husband, Larry, says, referring to the first Jewish mother and matriarch. "She had Isaac at age 90."

"Yes, and what was her reaction?" I answer. "She laughed — because she knew, even 3,716 years ago, that giving birth as an older woman is antithetical to nature, gravity and sanity."

But just because science (or divine intervention or luck) can stretch the limits of a woman’s childbearing years, that doesn’t mean it’s right or desirable.

"Would you rather be young and stupid or old and exhausted?" a friend of mine asks.

"That’s like asking if I’d rather have 12 weeks of round-the-clock morning sickness or 24 hours of excruciating back labor," I respond.

And like the subjective and morally ambivalent values clarification answers, there’s no right response to this childbirth conundrum.

Yes, the Bible, in Ecclesiastes 11:6, exhorts us to "Sow your seed in the morning and don’t hold back your hand in the evening." Talmudic rabbis have interpreted this to mean that we should bear children when we’re young and produce more when we’re older.

Yes, easy for him, the undoubtedly male author of Ecclesiastes, to say. A man who, I’m sure, never had to drive a car pool or repeatedly tell his children not to slurp their sodas, pummel their brothers, throw balls in the house or pierce their ears.

But life is full of conflicts and compromises, risks and restrictions. And not all women have control over when — and if — they can give birth.

As the Rolling Stones sing, "You can’t always get what you want."

Though that doesn’t stop our children from trying.

"Mom, can you drive me to Century City on Sunday?" asks my son, Gabe, 15.

"Gabe, my life is devoted to your well-being," I answer.

"As it should be," he says, only half-facetiously.

But, in truth, whether a trendsetter or an aberration, as an old and exhausted mom, I take pride in knowing that I can still muster up the enthusiasm to drive to Century City and back, to help build a medieval castle out of Styrofoam, to spend the day on the soccer field and to plan a third bar mitzvah.

I take pride in knowing that I, along with my husband, have raised four solid citizens and four committed Jews.

And I take pride in being the oldest mom in Danny’s fifth-grade class.

Because, as the Rolling Stones continue, "If you try sometimes, you just might find, you get what you need."