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Suggestions for how to use this guide:

Below you will see a list of common procedures that are part of fertility treatments and/or diagnostic workups.

Note: If you are undergoing a procedure that is not included in this guide, please let us know (yoetzet@yeshtikva.org) so that we can make our resources even better.

When you first schedule a test or procedure, we suggest calling your Halakhic Advisor.  You may review together the list of “halakhic questions you might have” under that procedure and discuss which questions might be relevant for you.    Your halakhic advisor might ask you to go back and ask the doctor the questions from the “ask the doctor” list.    (Some details may only be available after the procedure is over.)

Your halakhic advisor might have some additional questions of his/her own for you to ask the doctor. To ensure accuracy, it is highly recommended to obtain this information directly from your doctor, as opposed to the support staff (nurses, medical assistants, receptionists, etc.)  Now that you have this medical information, you may call back your Halakhic Advisor.    He or she may wish to consult this Guide as well- there are notes just for him/her.

Although planning ahead by having these discussions as soon as possible is the best way to avoid potential halakhic issues, you may certainly also use this guide at any time that questions arise.

Female Diagnostic Workup

  1. If I find blood after the procedure, must I assume I am niddah?
  2. What should I do if I have this procedure during the Seven Clean Days?
  3. Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding?

 

  1. If I find blood after the procedure, must I assume I am niddah?
  2. What should I do if I have this procedure during the Seven Clean Days?
  3. If I need to use contraception before the procedure, what are my options?
  4. Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding?
  1. If I find blood after the procedure, must I assume I am niddah?
Ask the Doctor:
  • Is the procedure expected to cause bleeding?
  • If so, where is the bleeding coming from?  
  • How long is the bleeding expected to last?
  1. What should I do if I have this procedure during the Seven Clean Days?
  1. If I need to use contraception before the procedure, what are my options?
Ask the doctor:
  • If abstinence is halakhically preferred over contraception, when would be the time frame to abstain?
  1. Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding?
Ask the doctor:
  • Was the cervix dilated, and if so, to what degree? (see above note)

 

The test is done in the office soon after having sexual relations.   If we as a couple are normally strict not to have sexual relations during the daytime, may we do so for the purposes of this test?

If I bleed after the procedure, does that mean I’m niddah?

Ask the doctor:
  • Is the procedure expected to cause bleeding?
  • If so, where is the bleeding coming from?  
  • How long is the bleeding expected to last?

What should I do if I have this procedure during the Seven Clean Days?

(Note: If possible, it is generally preferable to schedule a pap smear for AFTER the mikva.)

 

If I bleed after the procedure, does that mean I’m niddah?

Ask the doctor:
  • Is the procedure expected to cause bleeding?
  • If so, where is the bleeding coming from?  
  • How long is the bleeding expected to last?

If I find blood after the procedure, must I assume I am niddah?

Ask the Doctor:
  • Did the procedure involve entering the uterus at all?
  • Is the procedure expected to cause bleeding?
  • If so, where is the bleeding coming from?  
  • How long is the bleeding expected to last?
  • Was a dye used in the procedure?

What should I do if I have this procedure during the Seven Clean Days?

Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding? (Laparoscopy may or may not involve entering the cervix at all.)

 

  1. If I find blood after the procedure, must I assume I am niddah?
Ask the Doctor:
  • Is the procedure expected to cause bleeding?
  • If so, where is the bleeding coming from?  
  • How long is the bleeding expected to last?
  • Was “endometrial scratching” performed?
  1. What should I do if I have this procedure during the Seven Clean Days?
  1. Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding?
Ask the doctor:
  • Was the cervix dilated, and if so, to what degree? (see above note)
  1. If I need to use contraception before the procedure, what are my options?
Ask the doctor:
  • If abstinence is halakhically preferred over contraception, when would be the time frame to abstain?

 

  1. If I find blood after the procedure, must I assume I am niddah?
Ask the Doctor:
  • Is the procedure expected to cause bleeding?
  • If so, where is the bleeding coming from?  
  • How long is the bleeding expected to last?
  1. What should I do if I have this procedure during the Seven Clean Days?
  2. Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding?
Ask the doctor:
  • Was the cervix dilated, and if so, to what degree? (see above note)
  1. If I need to use contraception before the procedure, what are my options?
Ask the doctor:
  • If abstinence is halakhically preferred over contraception, when would be the time frame to abstain?

 

Male Diagnostic Workup

Is it permitted for me to undergo semen analysis at this time? If not, at what point in the diagnostic process may it be done?

Ask the doctor:
  • Is it medically recommended for the husband to undergo semen analysis at this time?
  • Regarding the particulars of this couple’s situation and history, does it make sense for the wife to undergo any testing and/or treatment before a semen analysis is performed?  What treatments could be undergone without semen data?
  • Based on the husband’s history, is there reason for concern about severe male factor (yielding a  poor semen analysis)  that could possibly be progressive? If so, would it be recommended to do a semen analysis as soon as possible in order to diagnose the problem and save sperm before the condition worsens?

After the semen analysis, is it necessary to save the sample for intrauterine insemination (IUI)?

Ask the doctor
  • Is the sample of high enough quality to be useful in IUI?

What is the best method to procure a semen sample for analysis? (See notes on “Postcoital test” in Part I if that method is being used.)

Ask the doctor:
    • What method(s)  is/are medically preferable, if any? Why?
    • If there is a known or suspected male factor, is there a method that will better preserve the sample in case it needs to be saved after analysis?

 

  1. Is it permitted for me to undergo this procedure?

Assisted Reproductive Technologies (ART)

If I find blood while using the hormones, must I assume I am niddah?

Ask the Doctor:
  • Is the procedure expected to cause any bleeding from dryness,  irritation, etc?

What should I do if I’m in the Seven Clean Days while using the hormones?

What if I’m taking hormones via injections while I’m niddah, can my husband help me?

Ask the doctor:
  • What is the best place on the body to perform the injection?  Are there other possible spots?

What about Shabbat and Yom Tov?

Ask the doctor:
  • Is there anything that can be done medically, such as the timing of medication, to eliminate or minimize the chance of procedures and/or monitoring being scheduled for Shabbat/Yom Tov?

 

  1. See “hormone treatments” if hormonal treatments are used in conjunction with IUI.
    1. Birth Control/Estrogen Patch use (sometimes used prior to treatment in order to regulate the cycle)

    1a.  If I find blood while using the birth control/ patch, must I assume I am niddah?

    Ask the Doctor:
    • Is the procedure expected to cause any bleeding from dryness,  irritation, etc?

    1b. What should I do if I’m in the Seven Clean Days while using the hormones?

    1c. If I am using an estrogen patch, how should I proceed during mikva immersion?

    Ask the Doctor:
    • May the patch be removed for the duration of immersion?
    1. May I undergo IUI while niddah (note that this includes being in the seven clean days prior to mikva immersion), if I don’t have a sperm sample frozen?
    1. What is the best method to procure sperm sample ( if husband’s sperm, as opposed to donor sperm)  is being used?
    1. If the IUI is performed during the Shiva Nekiim (Seven Clean Days), can I go to the mikvah on time?
    Ask the doctor:
    • Is it expected for semen to be expelled from the woman’s body following the procedure, or is it inserted too deeply?
    • If there will be a halakhic issue with IUI in the seven clean days, is it possible to delay the procedure until after mikvah?
    1.  If I have bleeding from the procedure, must I assume I am niddah?
    Ask the Doctor:
    • Is the procedure expected to cause bleeding?
    • If so, where is the bleeding coming from?  
    • How long is the bleeding expected to last?
    1. What should  I do if I have this procedure during the Seven Clean Days?
    1. Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding?
    Ask the doctor:
    • Was the cervix dilated, and if so, to what degree?  (see above note)
    1. What about Shabbat and Yom Tov?
    Ask the doctor:
    • Is there anything that can be done medically, such as the timing of medication, to eliminate or minimize the chance of procedures and/or monitoring being scheduled for Shabbat/Yom Tov?
    1. Do I need hashgakha (supervision of the staff in the laboratory facility) during IUI? If so, at which points?

 

  1. What about Shabbat and Yom Tov?
Ask the doctor:
  • Is there anything that can be done medically, such as the timing of medication, to eliminate or minimize the chance of procedures and/or monitoring being scheduled for Shabbat/Yom Tov?
  1. What is the best method to procure sperm sample ( if husband’s sperm, as opposed to donor sperm)  is being used?
  2. Birth Control/Estrogen Patch use

(sometimes used prior to treatment in order to regulate the cycle)

3a.  If I find blood while using the birth control/ patch, must I assume I am niddah?

Ask the Doctor:
  • Is the procedure expected to cause any bleeding from dryness,  irritation, etc?

3b. What should I do if I’m in the Seven Clean Days while using the hormones?

3c. If I am using an estrogen patch, how should I proceed during mikva immersion?

Ask the Doctor:
  • May the patch be removed for the duration of immersion?
  1. If I need injections while I’m niddah, can my husband help me?
Ask the doctor:
  • What is the best place on the body to perform the injection?  Are there other possible spots?
  1. Oocyte Retrieval Surgery

5a.  If I find blood after the procedure, must I assume I am niddah?

Ask the Doctor:
  • Is the procedure expected to cause bleeding?
  • If so, where is the bleeding coming from?  
  • How long is the bleeding expected to last?

5b.  What should I do if I have this procedure during the Seven Clean Days?

5c.  Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding? (note: in most instances of oocyte retrieval surgery the uterus is not entered at all, so this question is usually not relevant)

Ask the doctor:
  • Was the cervix dilated, and if so, to what degree? (see above note)

5d.  If I need to use contraception before the procedure, what are my options?

Ask the doctor:
  • If abstinence is halakhically preferred over contraception, when would be the time frame to abstain?
  1. Embryo Transfer

6a.  If I find blood after the procedure, must I assume I am niddah?

Ask the Doctor:
  • Is the procedure expected to cause bleeding?
  • If so, where is the bleeding coming from?  
  • How long is the bleeding expected to last?

6b.  What should I do if I have this procedure during the Seven Clean Days?

6c.  Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding?

Ask the doctor:
  • Was the cervix dilated, and if so, to what degree? (see above note)

6d. If I bleed while using progesterone suppositories/gel inserts, must I assume I am niddah?

Ask the doctor:
  • Is it typical for this product to cause irritation to the vaginal lining?
  1. Do I need hashgakha (supervision of the staff in the laboratory facility) during IVF? If so, at which points?

 

  1.  What about Shabbat and Yom Tov?
  1. If I need injections while I’m niddah, can my husband help me?
Ask the doctor:
  • What is the best place on the body to perform the injection?  Are there other possible spots?
  1. The Procedure

3a.   If I find blood after the procedure, must I assume I am niddah?

Ask the Doctor:
  • Is the procedure expected to cause bleeding?
  • If so, where is the bleeding coming from?  
  • How long is the bleeding expected to last?

3b.  What should I do if I have this procedure during the Seven Clean Days?

3c.  Does the procedure make me a niddah [or interrupt seven clean days] due to a concern of petikhat ha-rekhem (“opening the uterus”), even without bleeding?

Ask the doctor:
  • Was the cervix dilated, and if so, to what degree? (see above note)

3d.  If I bleed while using progesterone suppositories/gel inserts, must I assume I am niddah?

Ask the doctor:
  • Is it typical for this product to cause irritation to the vaginal lining?
  1. What are my contraceptive options before beginning medications or performing the procedure, if relevant?
Ask the doctor:
  • Is contraception/abstinence necessary, or will a pregnancy test at the proper time suffice?
  • If abstinence is halakhically preferred over contraception, when would be the time frame to abstain?
  1.  Do I need hashgakha (supervision of the staff in the laboratory facility) during FET? If so, at which points?

Note: If donor embryos are being used, additional questions will arise for you which you should consult with your Halakhic Adviser  

 

Fertility Treatments & Jewish Law: A Comprehensive Guide

https://yeshtikva.org/what-is-infertility__trashed/fertility-treatments-jewish-law-a-comprehensive-guide/

A Project of the Yesh Tikva Infertility & Jewish Law Program

This guide was prepared  by Yoetzet Halakha Dalia Shulman for Yesh Tikva  under the guidance of Rabbi Gedalyah Berger and Dr. Ilana Ressler *.

The mission of Yesh Tikva’s Infertility & Jewish Law Program is to help YOU, members of our YT community on a fertility journey, navigate any halakhic (Jewish Law) issues that may arise without unnecessary stress.   The key is asking the right questions- but how? Where do you begin? What information do you need first? It can be overwhelming, and that’s why Yesh Tikva is here to help.

If you are a patient , this guide will help you to ask the right questions to your halakhic advisor.  If you are a halakhic advisor, this guide is designed to assist you in guiding individuals with questions pertaining to Jewish Law and infertility. Please click HERE to contact a Yoetzet Halakha from YT if you need help getting started.

Please note that in the many instances where there are various halakhic opinions, this guide does not provide a ruling (psak halakha).   If you are undergoing a procedure that is not included in this guide, please let us know! We are always striving to improve the resources we have to offer you.  For general issues relevant to all fertility tests & procedures, please see our general guide.

*  Thank you to Yoetzet Halakha Penina Dienstag, MD and Yoetzet Halakha Tova Warburg Sinensky for their helpful suggestions.

Halakha (Jewish Law) & The Infertility Journey: A General Guide

https://yeshtikva.org/halakha-jewish-law-the-infertility-journey-a-general-guide/

The following is general advice for couples undergoing fertility testing and treatments.  Many of these points are directed specifically to women, who, due to the nature of reproductive medicine, are the ones undergoing the mainstay of the treatments. Keep in mind that this is the case whether treatments are undergone to resolve female factor infertility, male factor infertility, a combination of male and female factors, or unexplained infertility.

For women:
  • Any time you experience bleeding (aside from a regularly expected period) do NOT assume that you are a niddah[1] without asking. This is for two reasons:
  1. The source of blood matters a lot in halakha.  Some medications & procedures might cause bleeding that is not uterine in origin; only uterine blood is problematic in halakha. There are even instances in which uterine bleeding may be permissible if caused by certain types of wounds.  Your advisor may ask you to verify the source of bleeding with your doctor before providing a halakhic answer.  It is always a good idea to speak directly with the doctor as opposed to the nursing staff in order to obtain the most accurate information.
  1. Under general laws of niddah, even regular uterine bleeding may be permissible depending on the amount, color of the blood, location that the blood is found, as well as other factors.  If you are not sure about these laws, please consult with your advisor! (Note that it is advisable for women to wear colored undergarments and avoid tampon use unless they have confirmed niddah status; blood found on white garments or internally may be treated more strictly.)
  • Ask your doctor if bleeding is expected following each diagnostic or therapeutic procedure and, if so, what the source of the bleeding will be.   If bleeding does occur, you will already have this information when you talk to your halakhic advisor and you might be able to avoid more phone calls to the doctor.
  • Consult in advance with your halakhic advisor if you will be in your shiva nekiim (seven clean days prior to mikvah immersion) and using medications or undergoing a procedure that might cause bleeding.   Normally, bedikot (internal checks) are performed regularly and white undergarments are worn during the shiva nekiim, but under pressing circumstances there is room for leniency; it is worthwhile to have a plan in advance of bleeding occurring.   Again, do not assume a bad bedikah makes you a niddah under these circumstances- always ask!
  • According to most poskim (halakhic authorities), it is rare for a procedure to cause petichat ha-rechem and this is unlikely to come up in the course of fertility treatments.[2] You may consult with your halakhic advisor to find out if any of the planned examinations or procedures carry this concern (there is absolutely no concern with transvaginal ultrasounds.)
  • Please consult with your halakhic advisor if you are undergoing an intrauterine insemination (IUI) during the shiva nekiim (seven clean days); there are different opinions regarding the permissibility of going to the mikvah on time following this procedure.[3]
For couples:
  • If a semen sample is needed for either analysis or a procedure, keep in mind that there are multiple options of procurement, each with halakhic, medical, and logistical implications. Feel free to discuss this with your halakhic advisor to find the most appropriate method for your circumstances.    If there is a chance that the wife will be niddah (thus limiting the procurement options) when the sample is needed, discuss the possibility of freezing a sample in advance (note that many doctors encourage or require this anyway in case there is any problem of procurement on the day of the procedure).
  • If the wife is a niddah when undergoing self-injections and the husband would like to help her, please consult with the halakhic advisor regarding the best way to go about this.
  •  Shabbat: Depending on the particular treatment protocol, it may or may not be possible to attempt to avoid coming into the office on Shabbat for procedures and/or monitoring.   Sometimes, but not always, it is possible to avoid Shabbat with advance planning on the doctor’s part.  If your doctor is not observant, raise this issue early on, before you have begun a treatment cycle.   If it is necessary to have monitoring or a procedure performed on Shabbat, consult with your halakhic advisor to figure out the best way to handle the situation. If Yom Tov season is approaching, discuss with your doctor if it makes more sense to wait until the holidays have passed.
  • The necessity of Halakhic Supervision (known as hashgachah or shmira) of fertility treatments is an area of controversy amongst halakhic authorities. For those who hold that hashgachah is not strictly necessary under halakha, there is debate as to whether it still has value.    Some feel that it adds an extra layer of security in the laboratory to prevent mix-ups beyond government requirements, while others feel that this is not the case.   Some couples are comforted by the presence of women from  a halakhic organization during their procedures; other couples feel burdened by the extra expense.  Feel free to discuss this matter with your halakhic advisor if you wish.
This guide was prepared by Dalia Shulman under the guidance of Rabbi Gedalyah Berger.
[1] Niddah is a term that refers to a state of “ritual impurity” in Jewish Law caused by uterine bleeding (most commonly, but not limited to, menstruation).  A couple avoids physical contact, especially intimacy, while the wife is bleeding and for seven days after, at which point she immerses in a mikvah (ritual bath) and regains a status of ritual purity.
[2] Petichat ha-rechem literally means “the opening of the uterus,” i.e. cervical dilation. In theory, if an instrument penetrates the uterus, there is the concern that bleeding has occurred, even if not observed. In reality, most poskim limit this concept to procedures done with an instrument that is large enough to require anesthesia, and thus it is rarely an issue.
[3] This is due to the potential concern of expelled sperm interfering with the seven clean days; opinions differ.

Intro to Infertility & Jewish Law

https://yeshtikva.org/infertility-jewish-law/intro-to-infertility-jewish-law/

Infertility and fertility treatments can be very stressful.  For Jewish couples and individuals, there is the added pressure of keeping within the strictures of Halakha (Jewish law).  However, asking Halakhic questions (questions pertaining to Jewish law) will go a long way in mitigating the stressful nature of the fertility journey. It is critical that the person consulted  is familiar with current developments in reproductive medicine and the details of the specific halakhic issues involved OR will readily consult with somebody who is.  Without consulting an expert, people undergoing fertility treatments are often stricter than necessary  in halakhic  matters because they have nobody to ask or are too embarrassed.

Yesh Tikva is here to help.  The Infertility and Halakha program was established to provide support in obtaining  halakhic guidance.

  • See our General Guide to get started asking the right questions.

  • To contact a Yoetzet Halakha for Yesh Tikva email yoetzet@yeshtikva.org.

Our yoatzot (advisors)  are here to guide you through any questions you may have relating to Halakha, fertility, and infertility treatments.   When complex situations arise that require an individual ruling, they will provide support in reaching out to rabbinic authorities (such as the couple’s own rabbi).

  • New resources are in the works- please check back often!

The Jewish Law & Infertility Program is under the direction of Dalia Shulman, Yoetzet Halacha and Penina Dienstag, MD, Yoetzet Halacha.

Our Yoatzot are in consultation with the following Rabbis & Physicians:

Rabbi Kenneth Auman

Rabbi Gedalyah Berger

Rabbi Baruch Simon

Rabbi Richard Weiss, MD

Anate Aelion Brauer, MD, MS, FACOG

Diana Chavkin, MD, FACOG

David Reichman, MD, FACOG

Ilana Ressler, MD, FACOG

 

Dalia Shulman was trained as a Yoetzet Halacha at Nishmat’s  Miriam Glaubach U.S. Yoatzot Fellows Program in Teaneck, NJ.  She currently serves as a Yoetzet for five synagogues in Westchester County, NY.  

Penina Dienstag, MD was trained as a Yoetzet Halacha at the Nishmat Keren Ariel program in Jerusalem. A physician and graduate of The Sackler School of Medicine at Tel Aviv University, she began her residency as an OB GYN at NYU Lutheran Hospital, and completed her residency at SUNY Downstate in anesthesia. Penina is currently a board certified anesthesiologist practicing on Long Island. 

Fertility Treatments & Jewish Law: A Comprehensive Guide

https://yeshtikva.org/fertility-treatments-jewish-law-a-comprehensive-guide/

A Project of the Yesh Tikva Infertility & Jewish Law Program

This guide was prepared  by Yoetzet Halakha Dalia Shulman for Yesh Tikva  under the guidance of Rabbi Gedalyah Berger and Dr. Ilana Ressler *.

The mission of Yesh Tikva’s Infertility & Jewish Law Program is to help YOU, members of our YT community on a fertility journey, navigate any halakhic (Jewish Law) issues that may arise without unnecessary stress.   The key is asking the right questions- but how? Where do you begin? What information do you need first? It can be overwhelming, and that’s why Yesh Tikva is here to help.

Please note that in the many instances where there are various opinions, this guide does not provide a ruling (psak halakha).  If you are undergoing a procedure that is not included in this guide, please let us know! We are always striving to improve the resources we have to offer you.

*  Thank you to Yoetzet Halakha Penina Dienstag, MD and Yoetzet Halakha Tova Warburg Sinensky for their helpful suggestions.

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