The Unique Challenges of Infertility in the Orthodox Jewish Community

Rebecca* is a wife, a mother, and a practicing Orthodox Jew. She is also among the 11 percent of women in the United States who have experienced infertility.

The trajectory of infertility looks different for every couple. For Rebecca and her husband, whose family now includes three young children, their journey included a paradox familiar to those within the Orthodox community.

They had the advantage of a closely knit, built-in support network near their home in New York; however, infertility often remains a taboo topic within the community. Its sufferers tend to keep their struggles as private as possible. For Rebecca and her husband, finding support meant forging a different path through the maze of infertility.

The maze began, she said, with a common but complex endocrine condition. Polycystic ovary syndrome (PCOS) is a disorder affecting menstrual cycles and other reproductive hormones that often leads to fertility issues. When she was diagnosed with PCOS as a teenager, Rebecca’s doctor gave her a prescription for metformin, which is often considered for use in combating insulin resistance, a condition common in PCOS patients.

A few years later, Rebecca married. From the beginning, she and her husband Jacob* struggled to conceive. This can be especially difficult to conceal within an Orthodox Jewish community, where couples are expected to marry and conceive at a relatively young age (the average age of one’s first marriage is 22-24 among Orthodox Jews, and 29-31 among the general U.S. population).

Even within the U.S. Jewish population, the differences in family demographics are stark. A 2021 Pew survey revealed Orthodox Jews are five years younger, on average, when they give birth to their first child (23.6 compared to 28.6 among non-Orthodox Jews). Rebecca and Jacob waited three years to become parents. That was considered “late” within their community.

Couples who must wait longer, Rebecca said, “don’t so much keep it private. The rumors are so strong―either marriage problems, illness, or infertility―you’d have to say something. I know a few people who waited way longer than I did, but they did not keep it private.” Not wanting to arouse suspicion, Rebecca hid her struggle. She told only one friend and one cousin who had experienced infertility herself.

Rebecca and Jacob ended up using a nonprofit support services agency, Refuah Helpline, to find a reproductive endocrinologist within the Orthodox community who could prescribe a treatment regimen that conformed with written and oral Jewish laws. They were relatively fortunate in their first attempt to conceive. A timed intercourse cycle resulted in a successful, healthy pregnancy.

As a practicing member of the Orthodox community herself, their doctor was able to provide specialized, culturally-competent care to the couple, pairing her medical expertise with her unique knowledge of Orthodox tradition and law. This provided Rebecca and Jacob with an additional layer of comfort and support throughout the process.

A year and a half later, wanting to conceive again, Rebecca and Jacob returned for assistance. This time, they were unable to conceive through timed intercourse. Here too, their struggle was pronounced because of the cultural expectations around family building within the Orthodox community. Most Orthodox couples have at least three children. Families with 10 or more children are not uncommon.

After undergoing intrauterine insemination (IUI) treatment, Rebecca ultimately conceived again and gave birth to twins. The struggle was worth it, she said, and she appreciates the rare degree of specialized support and understanding she received during her journey to motherhood.

For Orthodox couples who need the assistance of fertility treatment to conceive, navigating the relationship between religious law and medicine can be challenging. “Our scholars have to interpret the law that exists, match it with the medical law that exists, and match it with a solution,” Jacob said. “It’s complicated, but from a lawyer’s perspective, sometimes you can find a middle way, a loophole, to make things work.”

For Orthodox couples who need the assistance of fertility treatment to conceive, navigating the relationship between religious law and medicine can be challenging.

In addition, certain common fertility-related procedures are not always an option for Orthodox couples. Something as simple as semen analysis, for example, may be prohibited or require special permission from a rabbi in order to comply with Jewish law. Fertility treatments like IUI and IVF also require an “observer” from within the Orthodox community to be in the fertility clinic’s lab during certain procedures or stages of the process, to make sure the chain of custody while handling a specimen is not broken.

The procedures Rebecca and Jacob underwent were all common among couples trying to conceive. Rabbis familiar with Orthodox law are abundant. Yet finding a rabbi with some knowledge of infertility issues and Jewish law was something this couple did not take for granted.

“Some people unfortunately never end up having kids because their rabbi didn’t allow certain things,” Rebecca said. “Find a rabbi who understands your personal situation. If it’s just a Jewish law issue, there’s a way to work around it.”

*Names have been changed at the couple’s request.

Dr. Ilana Ressler, a Reproductive Endocrinologist with Illume Fertility, is board-certified in Obstetrics and Gynecology, and in Reproductive Endocrinology and Infertility, in Connecticut and New York.