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.”

Fertility loan fund pays it forward

Alan and Emily Feit tried four times to have a child through in vitro fertilization (IVF), an infertility treatment that can cost well over $10,000 per attempt. On the fifth try, however, they ended up with twins — and now they want to help others in similar situations.

The San Fernando Valley couple has provided $100,000 in seed money to create the Feit 4 Kidz Fertility Loan Fund through the Jewish Free Loan Association (JFLA), which provides interest-free microloans to Southern California residents.

Beginning this past spring, the L.A.-based JFLA has been offering loans of up to $15,000 to Jewish couples who need help paying for an in vitro procedure, which is used when other methods of reproductive technology have failed. It can cost up to $20,000, or an average of $12,400 according to the American Society for Reproductive Medicine.

“It’s very exciting. It kind of allows us to turn something that was such a negative experience for us, heart-wrenching at times, into something really positive,” Emily Feit told the Journal. “Thankfully, we’re on the other side of things, but that connection to our experience and to be able to empathize with those individuals and couples going through that traumatic experience, I think that linkage will always be there for us.”

The Feits’ twins, Kara and Zachary — the “k” in “Kidz” stands for Kara, and the “z” stands for Zachary —turned 1 in June.

Rachel Grose, associate director at JFLA, said the importance of the new loan program cannot be understated.

“It allows JFLA to invest directly in [the] Jewish community, Jewish continuity, new Jewish babies and Jewish families,” she said. 

Previously, JFLA gave out loans for IVF procedures — which includes the remote fertilization of a woman’s eggs into embryos and the transfer of those embryos into the uterus — through its Lerner Family Adoption and Fertility Assistance Loan Fund. That program’s original purpose, however, was to provide financial assistance for couples seeking to adopt. Now with the establishment of the Feit fund, the Lerner fund will return to helping exclusively with adoptions, Grose said.

As of earlier this month, five couples had taken out loans from the Feit fund to help pay for IVF operations — which means about $75,000 has been given out thus far — and up to five additional couples were in the midst of interviewing for a loan, according to the Feits and to Grose. 

While many of the organization’s loan programs are nonsectarian, Feit loans are limited to the Jewish community — at least until the organization raises more money for the fund, Grose said. 

“One day, when we raise millions of dollars, we will open it to everyone,” she said.

On Nov. 16, JFLA and the Feits are partnering on a gala event with the hope of raising at least $250,000 for the fund. Currently, it has more than $200,000, with additional support coming from friends and family of the Feits who gave to the fund in lieu of birthday gifts for their twins’ recent birthday.

The November event, which will be held at the Luxe Sunset Boulevard Hotel, will also honor the Feits’ infertility doctor, Robert Boostanfar, a reproductive endocrinologist based in Encino. 

The Feit 4 Kidz fund became JFLA’s 34th loan fund when it was launched in April. Other JFLA funds include emergency and veteran loans, student loans, home health care loans, small-business loans and more. Currently, there is $11.5 million in loans circulating among JFLA clients, according to Grose. The money given out for loans is recycled, which means that the money repaid by a client is loaned out again to a new client. The organization claims to have a repayment rate of more than 99.5 percent.

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