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.