On Tuesday evening, June 4, community members gathered to hear a fascinating lecture on fertility and the latest treatments, along with a halachic perspective on these issues.
Mel Breite, MD, Founder and Director of the Navigating the Medical System Lecture Series, welcomed everyone.
Rabbi Elan Segelman, rav of Kehilas Torah Temimah in Kew Gardens Hills and Rabbinic Advisor for PUAH, spoke next. He shared that PUAH is not just the name of one of the midwives in Parshas Sh’mos, but it is also an acronym for Poriyus (fertility) U’r’fuah Al pi Halachah.
Rabbi Segelman explained how a couple suffering from infertility in the Jewish community is surrounded by children. Each Yom Tov centers on children. Everywhere they go, they are surrounded by children. “Our calendar is very focused on children. And it is very difficult for an infertile couple.” Besides the emotional difficulties these couples are experiencing, we must be cognizant of how fertility treatments involve a whole slew of Jewish laws that they have to navigate. There are many complicated issues and questions. Rabbi Segelman shared that his phone is constantly ringing with sh’eilos, especially as we approach a three-day Yom Tov. He stated that it is a privilege for him to be able to help couples with these issues.
He began his presentation with the medical definition of infertility, which is when a couple under age 35 is trying to conceive for 12 months and there is no conception. Infertility also includes couples who are unable to achieve live pregnancies due to recurrent miscarriages. One out of seven couples suffers from infertility.
He explained that a common cause of infertility is age. By age 35-40, female fertility drops. After age 44, success rates are low. Other factors can be causes that include irregular periods, early ovulation, varicoceles for males or abdominal surgery or hernias for males. There are also genetic syndromes such as Turner syndrome or Klinefelter syndrome, which cause infertility. Contrary to popular belief, studies indicate that 30-40 percent of infertility is actually a male issue.
He then explained how we are able to solve the common issue of early ovulation, when a woman ovulates prior to her mikvah time. Rabbi Segelman works together with a doctor who prescribes medications that help push off ovulation. Some of the medications that are used include clomid or estrogen supplements. He then spoke about IUI, which stands for Intrauterine insemination, which is done for many reasons, such as males with low motility or unexplained infertility. Rabbi Segelman stated, “The cause of infertility can also be intimacy issues, in which case the couple needs sensitive guidance.” If none of the above interventions work, then there is IVF (in vitro fertilization). In vitro fertilization is a process of fertilization where an egg is combined with sperm outside the body, in vitro. The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova from the woman’s ovaries and letting sperm fertilize them in a laboratory.
Rabbi Segleman shared that there are common sh’eilos that people ask regarding IVF. If a baby is conceived in a test tube, does this satisfy the mitzvah of P’ru u’R’vu? Is the child considered the child of this father? There can be IVF mix-ups.
PUAH started 30 years ago in Israel and around 15 years ago in the United States. To deal with this issue of possible mix-ups, there are rabbinic supervisors in 60-plus labs around the United States. He shared some common questions including: What is the halachically preferable method to collect seed and can you do fertility treatment during nidus. Questions also arise about third-party reproduction, such as egg donation, sperm donation, and surrogacy. We have technology for these procedures, but this has to be done with the guidance of a rav. Rabbi Segelman imparted, “There are a myriad of issues couples navigate when dealing with fertility.” He shared that Jews of all levels of observance contact him and want to do things according to Jewish law with regard to having a child. We should all be sensitive to the fact that there are so many issues. “PUAH takes calls every day from all over the world and offers guidance and services. Baruch Hashem, we get good news every day.” He concluded, “Anything is possible with the hand of HaKadosh Baruch Hu.”
Following this, Tony Tsai, MD, Obstetrician-Gynecologist Director of Reproductive Endocrinological Infertility at NewYork-Presbyterian Queens, noted, “The most important thing, Infertility 101, is asking the rabbi. I work with ATIME and Bonei Olam.” He stated, “We do have a lot of technology. The biggest problem I see is helping the patient, so she can make it to the mikvah at right time.” He shared that 50 percent of infertility problems are attributed to the female, 35 percent to the male, and 15 percent to both. After the age of 42, it is a lower percentage of people who become pregnant with IVF. He shared that fertility apps and websites are common and free. None are verified or vetted out. Out of 50 fertility apps and websites, only three websites are found to be accurate. He shared the definition of the fertility window when a woman can become pregnant, and it is six days. Apps are unreliable in calculating the fertility window.
The lecture was followed by a lively question-and-answer session.
May Hashem bless every couple with healthy, beautiful children.
By Susie Garber