Fertility Treatments & Religion: How RMA of New York Provides Care for the Jewish Community
Jewish law requires that every couple attempt to have a family which makes the motivation to undergo fertility treatment that much stronger. When I consult with religious couples there are often concerns whether their religious faith will interfere with the assisted reproductive technology that we use. Patients who are new to our practice may be unaware of our understanding of Jewish law and our desire to practice within its constraints.
Jewish religious practice or Halacha –following the path of rabbinical teachings – requires that all fertility tests and treatments be in accordance with proper religious guidelines. Some basic concerns that present with orthodox Jewish patients include:
- The laws of the purification of the family (Taharat Mishpacha).
- Avoiding violation of the Sabbath when undergoing procedures.
- Diagnostic testing that necessitates sperm evaluation and concerns about masturbation.
- Some Rabbis will permit in Vitro Fertilization (IVF) or Intrauterine Insemination (IUI), but only if an independent religious observer (mashgicha) is present inside the laboratory.
The first issue that usually comes up is the practice of Taharat Mishpacha. In Orthodox Jewish families, the woman may not have physical contact with her husband during her menses and for 7 days after. Once they purify by bathing in a ritual bath (Mikva) they may be intimate. One common situation we encounter is that a woman might be ovulating prior to her being able going to the mikva. Consequently they can’t have intercourse until after ovulation. Fortunately, we have several medical treatments that can shorten the menses and delay ovulation until after mikva.
Semen collection may pose another challenge for orthodox couples. There is a range of customs that prescribe the permitted practices for semen collection. If masturbation poses a problem semen can be collected through intercourse. The man wears a special sperm collection device that is similar to a condom but made of material that is not toxic to sperm. It is up to the couple to speak with their rabbi and determine the best route to collect semen for them. At RMA of New York, we will do our best to accommodate their wishes while achieving their family building goals. In some cases, semen can be collected through intercourse directly from the woman. When used for IUI or IVF the semen must be collected on a precise date. If the couple must collect through intercourse and the woman is not able to go to mikva, a frozen semen sample can be used. This is usually done the month prior to the fertility procedure. Our laboratory will cryopreserve the sample that will be thawed for the fertility procedure.
Orthodox couples are prohibited from doing work on the Sabbath. This includes traveling, carrying materials to and from locations, signing forms, or using an elevator – activities that are a routine part of undergoing assisted reproductive procedures. Our first strategy is to avoid the situation altogether by manipulating the woman’s cycle to fit the allowed-for schedule. This is not a challenge in couples undergoing IVF. Birth control pills are given the month prior to IVF to make the egg retrieval procedure fall on a weekday. If needed, blood can be drawn at home and be transported to RMA when testing is needed on the Sabbath. A voicemail with instructions will be left on the patient’s phone to be picked up after sundown. The embryo replacement procedure is scheduled to be done with the patient’s physician and will never fall on the Sabbath or Jewish Holiday.
While many rabbis are accepting of IVF and other reproductive procedures, they want to ensure that the laboratory where the procedures are performed adheres to quality standards. Often, a rabbi will insist that an observer (mashgicha) who works for the couple be present in the lab to witness the procedures and ensure that the sperm and egg of the designated couple only are used. At RMA of New York, we perform a 2-person safety check on every procedure that we do. Every time an egg is moved from one dish to another or semen is moved from one container to another, 2 technologists witness the procedure. If one of our patients requests an observer, our technicians know not to start a procedure until the observer is present. Our own 2-person control check occurs followed by a third set of eyes; those of the religious observer. The observer can then report back to the couple that the procedure was done correctly, safely, and under religious guidelines. The sperm, eggs and embryos are locked in a separate location in the laboratory that can only be accessed when the observer is present.
Religion should provide a comfort to help the couple through a difficult time. At no time should a patient’s religious practice be at odds with her goal of creating a family. Sensitivity to and knowledge of the laws of family purity is something that RMA of NY is proud to participate in.