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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

Hysteroscopy (Diagnostic or Operative)

  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?

Hysterosalpingogram (HSG)

  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?

Sonohysterogram

  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)

Postcoital Test (PCT)

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?

Pap Smear

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.)

Transvaginal Ultrasound

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?

Laparoscopy

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.)

Endometrial Biopsy

  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?

Dilation & Curettage (D& C)

  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

Semen Analysis

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?

Testicular Sperm Extraction

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

Assisted Reproductive Technologies (ART)

Using Hormonal Medication to Treat Infertility

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?

Intrauterine Insemination (IUI)

  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?

In Vitro Fertilization (IVF)

  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?

Frozen Embryo Transfer (FET)

  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