Orthodox and other observant Jews have specific clinical and emotional needs while dealing with infertility. The Biblical commandment ‘to be fruitful and multiply’ (Genesis 1:28) can affect Jews of all denominations, but particularly Orthodox Jewish couples who want to adhere to religious (halachic) interpretations.
Getting married and having children is a cultural and religious expectation in the close-knit communities in which they live. Not being able to conceive is very distressing and couples can feel isolated and alone. Accessing effective infertility treatment can be another challenge. Not all clinics have the ability to provide treatment that conforms to halacha and the laws of family purity( taharat ha-mishpacha)
We provide specialized services to members of the Jewish community who want to observe Orthodox rituals and laws.
Halacha and Infertility
These issues surround the laws of family purity, in which the menstruating woman (known as niddah) is required to avoid physical contact with her husband for that time period plus seven additional blood- free days, at which time she enters the Mikva, or ritual bath. The problem occurs when women detect ovulation before they can enter the Mikva. In consultation with their rabbi, the couple may be given special permission to enter the Mikva earlier, or have an intrauterine insemination for the purposes of procreation.
The evaluation of the woman follows standard testing procedures, including hormonal and ovarian (egg) reserve evaluation with blood tests. In addition, it includes an exam of the uterus and fallopian tubes with saline ultrasound or radiologic contrast (HSG). Assessing the male is more challenging due to the prohibitions of masturbation and sperm production outside of the woman's body. Therefore, a simple test known as the postcoital test can be performed initially as a rough estimation of semen quantity and quality. A sample of cervical mucus is examined microscopically four to eight hours after intercourse. If there appears to be sperm compromise, a semen analysis may be performed with the special condom (Milex) that does not kill sperm, and can be prepared with a small hole in the tip to allow some escape of the sperm.
When fertility treatments such as ovulation induction and intrauterine insemination fail to achieve a pregnancy after a reasonable trial, in vitro fertilization may be considered. This is halachically acceptable, and in keeping with today's technology.
Embryos developed in the laboratory may be tested via preimplantation genetic diagnosis, This is recommended if the couple shares adverse carrier states, such as Tay-Sachs, to ensure the transfer of a genetically normal embryo. This not only significantly lessens the chance of miscarriage, but also decreases the risk of a multiple gestation pregnancy , making single embryo transfer more acceptable. Multiple gestation carries its own risks to the mother and the newborns. Supervision by a rabbi or designated, trained individual may be present in the IVF laboratory at all stages, from procurement of sperm and eggs, through the process of embryo transfer and cryopreservation of excess embryos.
In the event of poor oocyte (egg) or embryo quality and if repeated failure of in vitro fertilization occurs, the couple may desire to use an oocyte donor. There is no halachic consensus in this area, with regards to using a Jewish or non-Jewish donor. The couple must consult with their rabbi with regards to this issue.
- Ovulation testing
- Sperm collection
- Intrauterine insemination
- In vitro fertilization
- Preimplantation genetic diagnosis/screening
- Egg donation
Our facility has been reviewed by Bonei Olam, and Dr. Blotner has been a sponsor and speaker for this organization. He has also been in contact with several rabbis involved in helping their community with infertility issues, as well as PUAH, an organization specifically designed for supervision in the in vitro fertilization process.
“Dr. Blotner and his staff are like family to me. I talk to Dr. Blotner every time I have an appointment. I am confident my care is in good hands and that important details won’t be lost because of poor communication. After driving eight hours to get to this office, I know he will be there at the end of my trip. A lot of clinics say they are with you every step of the way. But Dr. Blotner really lives that motto.”