Imagine a couple that has been married for three years – or ten years – and they still have not been blessed with a child. Where do they turn for direction, advice, a shoulder to cry on? Oftentimes, one of the few people they confide in is their rabbi. But how will the rabbi know how to respond? To whom should he refer them? Baruch Hashem, many of our rabbanim have not personally gone through the journey of infertility themselves, and it can be quite daunting to help a couple navigate through the complex web of medicine, halachah, and emotions. With one in eight couples experiencing infertility across the nation, it is doubtful that any rabbis – or any of our Queens Jewish Link readers, in fact – have not had a close relationship with at least one couple that struggles with fertility issues.
Last Sunday, PUAH and the Vaad of Harabonim of Queens (VHQ) co-sponsored a workshop held at the Young Israel of Kew Gardens Hills for the local rabbanim to help them better understand and advise such congregants or talmidim. Continuous advances in fertility options have created halachic situations that were not fathomable in the past. With science and the halachic implications of various new treatments changing rapidly, especially in this field, a rabbi who may have learned about fertility treatments five or ten years ago has a lot of catching up to do. In many cases, this is where PUAH steps in: Rabbi Elan Segelman and his team are specifically trained with a detailed understanding of medical diagnoses, treatments, and of course, in-depth halachah, to provide a p’sak about a subject in which a couple’s personal rabbi may not be as knowledgeable. Rabbi Segelman is well known here in Queens as a former teacher at the Lander College for Men and at Yeshiva Madreigas HaAdam’s Night Seder, the founder and rosh kollel of the Queens Kollel Boker, and as the co-founder and mara d’asra of Kehilas Torah Temima (housed in the Yeshiva of Central Queens). He was brought onto PUAH’s international team as the full-time American rabbi to answer halachic questions regarding infertility. As PUAH’s main halachic advisor in the US, he answers many questions daily from doctors and patients alike.
Dr. Karen Wasserstein, a psychologist and educator who specializes in assisting couples going through infertility, traveled from Maryland to Kew Gardens Hills for the program. In addition to working on the mental health team at Shady Grove Fertility clinic in Maryland, she also teaches in similar training programs for students in the Yeshiva University s’michah program. In alignment with PUAH’s mission, she has made a personal and professional mission for herself as a frum woman to spread knowledge and awareness about infertility to clergy members across the United States.
Dr. Wasserstein primarily covered the emotional and psychological concerns for couples who often face medical challenges, as well as some level of social isolation in the frum community. In general, a rabbi can have a strong impact, not just in speaking sensitively with individuals, but in ensuring that couples without children feel welcomed and have a place in synagogue life. Given that many synagogues heavily emphasize programming for families and children, it’s easy for such a couple who has yet to be blessed with children (similar to singles) to often feel left out of events and conversations, and to see nothing but a sea of strollers around their shul and neighborhood.
The presentation began with an introduction to infertility and the various treatments that are commonly utilized. Dr. Wasserstein covered all sorts of other questions that sometimes come up for a couple, whether they are still exploring the different types of assisted reproductive technology (ART) available to them, imminently preparing for a procedure, or grieving over the failure of a recent treatment. Rabbi Yoel Schonfeld of YIKGH said, “Dr. Wasserstein helped open up the topics to rabbanim in matters of infertility, in-vitro fertilization, surrogacy and the like, to help us realize what’s on the table these days.” While many have heard of in-vitro fertilization, there are many other treatments a couple might try, such as hormonal supplements, various other procedures, variations on in-vitro, and finally, there are scenarios where a couple might need to use donor eggs, sperm, or both. She also posed questions that a couple might need to address either at the time of treatment or later in life, such as if/when does one share such information with their relatives or, more importantly, with the children who were only made possible through medical treatments.
There are a few points the presenter made that the rabbis interviewed thought could be useful information for many of our QJL readers:
The commonly-used premarital tests, such as Dor Yeshorim, are designed to cover about ten of the most common syndromes found amongst the Jewish population, but it is still possible for a parent to pass on a different condition, because they don’t test for every genetic disorder that exists. (There are a few hundred conditions that geneticists can test for.) In addition, certain genetic issues may not be passed down but could be the cause of spontaneous pregnancy loss (miscarriage). Many couples are shocked to learn that genetics could still pose an issue, even if they participated in the standard tests. If one has a true reason to be concerned, it is possible to take more complete genetic panels in a doctor’s office. And in many cases of genetic issues, certain forms of ART that involve genetic testing can allow a couple to ensure their progeny do not inherit the concerning genes.
The issue of infertility often comes up relatively early in a marriage – generally after just a year of trying. Their medical (and emotional) situation can be a real stress on the couple, as they haven’t yet fully developed the skills to work through such a challenge together. In contrast to when a couple that has been married 10, 15, or 20 years faces a significant obstacle, the shalom bayis of newlyweds facing infertility can be very vulnerable.
Sometimes, a couple can easily have one child and then struggle with having more. This is still considered infertility, and it’s termed secondary infertility. Oftentimes, this couple struggles with many of the same emotions – dashed hopes, feelings of isolation – as a couple that has yet to have any children. It might be less obvious that they are experiencing a problem since there is one child in the family, but it is important to address the couple facing secondary infertility with equal sensitivity.
Finally, in the Q&A portion of the workshop, the topic of public recognition came up. A note to those who are preparing to host a bris milah and want to invite a couple without children to be honored as kvatter: While performing the role of kvatter is considered an honor and a s’gulah and is welcomed by many, it can also be uncomfortable and even embarrassing for some because it publicizes their difficulty with having children. It’s always a good policy to discuss extending the invitation ahead of time, so that the couple has the opportunity to politely decline if they choose to. And, of course, operate with sensitivity.
Educational events like the one last Sunday are one of the major roles PUAH tries to fill in the Jewish community. A significant part of their organizational mission is to educate the rabbis and rebbetzins, and in turn, this helps the rabbis provide guidance, hadrachah, and up-to-date halachic options to potential congregants. For example, just this past week, Rabbi Segelman also gave a class at Yeshiva University for the s’michah students, and he has an upcoming trip to Los Angeles to speak with rabbanim. He also spoke at last year’s YU rebbetzin conference, and similar workshops are regularly given to community rebbetzins. While rabbis and rebbetzins do not need continuing education credits to retain their s’michah, the added education can provide so much value to both the rabbi and rebbetzin and their congregants or talmidim. Can you imagine if a couple went to their rabbi posing halachic questions about a procedure that their doctor suggested, and the rabbi was completely unfamiliar with such a procedure? With new scientific approaches constantly evolving, this happens frequently in matters of fertility, but with workshops like this, PUAH can help rabbis and rebbetzins remain fully prepared to help a couple handle their diagnosis and course of treatment medically, emotionally, and spiritually.
The workshop was attended by younger and more senior rabbanim alike. While some of them lead congregations, others are roshei yeshivah and teachers. According to Rabbi Segelman, “Everyone in the room had at least one personal case (of a talmid or congregant) to relate to, and all brought up various questions they’ve been asked and situations they have encountered. Many were curious to know more about how best to respond to sh’eilos and remain sensitive to de-stigmatize the issue.” Some of the more senior rabbis in the room also questioned the role of parents and grandparents of younger couples, who sometimes approach rabbanim with questions on behalf of their children and grandchildren. Rabbi Segelman pointed out, “As rabbanim, our level of sensitivity and openness can have a huge impact in breaking the stigma of infertility and helping couples feel comfortable to approach us.”
In an unplanned move, one rabbi shared that a congregant had recently left him a very distressed voicemail asking halachic sh’eilos regarding surrogacy – the only option her doctor felt she had. After obtaining the caller’s permission, he shared the voicemail with the other rabbanim present at the workshop, leaving everyone in tears. The recording was a moving experience for everyone present, because it took the conversation from the hypothetical to a very real situation that someone’s congregant is presently facing. Perhaps this is the most important lesson of all: These scenarios are about much more than “Should I proceed with option A or option B?” since the difference between the two choices could affect the future of the couple and the very existence of their long-anticipated children.
According to Rabbi Schonfeld: “This event will change how I approach couples [dealing with infertility]; now I know some more of the issues we will have to tread through. So much homework has to be done for each couple, each with their own unique set of issues to deal with. This event helped me gain an awareness of some of the potential options that exist, and equally importantly, what types of emotions this couple may likely endure. It was a good learning experience.”
“PUAH is devoted to helping the greater Jewish community fulfill their dreams of building a healthy family. Whether individuals are struggling with fertility, women’s health, men’s health, genetics, or intimacy, PUAH is here to help. PUAH advisors embody a unique synthesis of rabbinical knowledge and specialized training in modern reproductive medicine to provide the best guidance possible. Our counseling and guidance are free of charge, helping to ease the difficult journey. All that we do is carried out in accordance with Jewish law, and with deep sensitivity and compassion.” Additional information about PUAH can be found at puahonline.org.