Category: Halacha & TTC/IF

Infertility Support Organizations

Infertility Support Organizations

A TIME : USA

A TIME is the premier, internationally acclaimed organization that offers advocacy, education, guidance, research, and support through our many programs to Jewish men, women, and couples struggling with reproductive health and infertility.

A TIME is strongly endorsed by leading Rabbonim and physicians and is widely recognized as an organization that is sensitive to the privacy of each couple while providing a wide array of essential services in a caring and professional manner.

Services:

  • Medical referrals
  • Support groups
  • Hashgacha/Supervision
  • Insurance advocacy
  • Therapy
  • Adoption services
  • Rabbonim referrals

http://www.atime.org/

US Phone: (718)-686-8912

Puah Institute: USA & Israel

PUAH Institute, established in 1990, has helped thousands of couples suffering from infertility through the process of building a family. Staff members have an extensive breadth of knowledge enabling PUAH Institute to handle everything from complicated medical inquiries to relevant halachic questions. Couples receive the benefit of PUAH Institute’s expertise in a private and compassionate environment conducive to their needs. Professional expertise is also available to the general public through a wide variety of lectures, seminars and training courses. Participants at these sessions include rabbis, physicians, healthcare providers, and couples, all of whom share the common goal of raising awareness about reproductive health issues at both the social and medical levels.

Services:

  • Medical referrals
  • Hashgacha/ Supervison
  • Counseling
  • Events
  • Rabbonim

https://www.puahonline.org/

Bonei Olam: USA & Israel

Bonei Olam today is recognized in the worldwide medical arena for its leadership role at the forefront of reproductive medicine, research, and technology. Our myriad programs cover every step up the process including financial assistance, work up, medication, high-risk pregnancy, preimplantation, genetic diagnosis, pre-and-post cancer fertility, education, awareness, and adoption assistance.

Services:

  • Financial assistance
  • Insurance advocacy
  • Fertility preservation
  • Free loan program
  • Advanced genetic testing & research
  • Adoption services
  • High-risk pregnancy care

http://www.boneiolam.org//

Brooklyn NY Phone: (718)-252-1212

Lakewood NJ Phone: (732) 942-7773

Monroe NY Phone: (845) 751-1212

Spring Valley, NY Phone: (845) 388-1212

West Coast CA Phone: (323) 673-1212

Canada Phone: (514) 312-2977

Israel Phone: 1-800-300-307

Chana: UK

For 22 years, Chana has been giving emotional and practical support to Jewish couples who are experiencing primary or secondary infertility. Many couples in the Jewish community are affected, often dealing with their situation in silence and alone. Chana is here to help.

Services:

  • A strictly confidential helpline
  • Specialist medical support and information
  • Confidential counseling for individuals and couples
  • An expert Medical Advisory Panel
  • Information events

http://www.chana.org.uk/

Helpline: 020 8201 5774

Office London Phone: 020 8203 8455

Halachic Infertility

Halachic Infertility

Halachic Infertility refers to a case where a woman ovulates prior to immersion in the mikva. Since studies have shown that relations must occur before ovulation in order to result in conception, this “early ovulation” results in infertility.

A woman who suspects that she ovulates before she can immerse in the mikvah should first determine her date of ovulation. There are several ways to do this:

1) She can measure her temperature upon arising every morning (the “basal body temperature”). There is generally a rise of about 0.3 degrees Centigrade (0.5 degrees Fahrenheit) just prior to ovulation. This method can be cumbersome for women who wake at irregular times, and body temperature can be affected by other factors, such as illness. Therefore, other methods are more popular today.

2) She can use an “ovulation prediction test,” which measures the surge in lutenizing hormone (LH) that precedes ovulation by 12-24 hours. These kits are readily available in pharmacies or Amazon without a prescription, and may be used in the privacy of one’s home.

(Here you can find many types of ovulation test) https://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=ovulation+test

3) A physician may order blood tests to determine hormone levels on particular days of her cycle.

4) Under direction of a physician, she may undergo a series of ultrasounds which follow the development of the ovarian follicle and record ovulation directly.

A woman who discovers that she is ovulating before immersion should next verify that her menses really last as long as she thinks. Any color other than bright red on a hefsek taharah or other internal examination should be brought to a rabbi to check whether it is, in fact, problematic. The rabbi should be aware that she cannot conceive due to early ovulation, as certain leniencies may apply in this situation. Many cases of halachic infertility can be solved by avoiding unnecessary delay of mikveh immersion.

What are the causes of “early ovulation” and what can be done within halacha to treat this issue?

There are two scenarios that result in early ovulation:

  • Short Cycle
  • Long Bleeding

Normal or Average Menstrual Cycle

On average, a regular menstrual cycle occurs every 28 days and lasts from 2 to 7 days. In most cases, women ovulate 14 days prior to their upcoming menstruation, or on the 14th day of her monthly cycle.

According to halachot of niddah, women cannot immerse in the mikvah until at least 12 days (11 days according to Sephardic opinions)  from the onset of menstruation.

On average, a woman will therefore immerse (depending on the duration of bleeding) anywhere from the 12th day of her cycle to the 14th day of her cycle. Most women will ovulate after immersion, an optimum time for fertility. Women who have an average 14 day cycle and bleed for a full 7 days will ovulate on the day of immersion, a situation which is considered to be borderline and may result in infertility.

Short Cycle

Short cycle infertility is defined as a case where even a woman with the shortest duration of bleeding cannot immerse in the mikveh prior to ovulation. Women whose cycles are 25 days or less will not immerse until at least the 12th day after the onset of monthly bleeding. Since ovulation generally occurs 14 days before the onset of monthly bleeding, we can calculate that ovulation in such cycles will occur on or prior to the 11th day of the monthly cycle. Such women cannot immerse prior to ovulation, which results in infertility.

Women whose cycles are 26 days are considered to be borderline cases; some may ovulate prior to immersion while others may ovulate after immersion, depending on the duration of her bleeding period.

Long Bleeding

Long bleeding is defined as a case in which either the duration of menstrual bleeding or occurrences of irregular bleeding lead to an inability to immerse in the mikveh prior to ovulation.

Any instance where the duration of bleeding combined with the mandatory minimum 7 day waiting period after the cessation of period leads to immersion after ovulation. For instance, a woman with a 27 day cycle will ovulate on day 13 of her cycle. If her period lasts for 7 days, she will immerse no earlier than day 14.

Please note that a monthly period lasting for longer than 7 days may require medical attention. A physician should be consulted.

Solutions

The above calculations are explanatory in nature and should not be relied upon to calculate the date of ovulation. There are methods to determine the exact date of ovulation which should be used to determine if religious infertility is indeed the case. If it is determined that a woman is indeed suffering from religious infertility there are methods within halacha to address the situation.

The following solutions are not general in nature. Each case must be evaluated and treated on an individual basis in consultation with a Rabbi or Puah Rabbinic Counselor.

  • Short Cycle Solutions: Short cycles can be caused by excess stress or dietary issues. In such cases, dietary changes (eating 3 healthy well balanced meals each day), relaxation techniques and/or moderate exercise may result in the extension of the cycle to normal levels. If these solutions are not effective, there are natural remedies as well as pharmacological remedies that may be prescribed. This should only be done in consultation with a fertility professional and/or Puah Rabbinical Counselor.
  • Long Bleeding Solutions: Many cases of long bleeding are the result of unnecessary stringency in the observance of the laws of niddah. The responsibility in this area is placed on the woman herself and the natural inclination when in doubt is to err on the side of caution. As such, there are women who postpone their immersion date in error and can actually halachically immerse earlier than they think. If there is any question as to the determination of a stain or spot halachically, a Rabbi should be consulted for a definitive halachic ruling.

    Not every case, however, can be solved through halachic leniency. In particular, the seven blood-free days cannot begin before bleeding has stopped, as confirmed by a hefsek taharah. Therefore, a woman with early ovulation whose menses last at least five days may require medical intervention in order to conceive.

    There are a number of medical treatments that can delay ovulation. One common treatment is clomiphene citrate (Clomid, Serephene, or Ikaclomin). This drug is normally used in fertility treatment to induce ovulation, but it is helpful in this case, because it has the side effect of delaying ovulation. Another approach is to use estrogen at the beginning of the cycle to delay ovulation by a few days. Other hormonal manipulation can delay ovulation as well. All these medications require a prescription, and must be used under the supervision of a physician.

    If the standard medical treatments fail or are unsuitable, there are other possible ways to intervene, but these should be developed by a medical team working together with a rabbi experienced in fertility.

    There are also natural remedies that may be employed to shorten the duration of a menstrual cycle. For example, in some cases, drinking the juice of one lemon each day of menstruation has been shown to be effective in shortening the duration of a period.

Reference:

http://www.jewishfertility.org/halachic-infertility.php

http://www.yoatzot.org/womens-health-and-halacha/?id=584

 

What fertility treatments are permitted on Shabbat?

What fertility treatments are permitted on Shabbat?

Diagnosis & Treatment on Shabbat

What treatments are permitted on Shabbat? What tests can be done on Shabbat? Is there a difference between the way treatment should be performed on Shabbat as opposed to any other day?
There is some discussion among the Rabbis as to the halachic status of couples experiencing fertility issues. Some rabbis are of the opinion that such couples are considered slightly ill since they are not actually suffering from a specific medical condition. However, most Rabbis do consider them to be ill, even though their lives are not in danger.

It is essential to note that a sick person suffering from a non-life threatening condition is:

  • permitted to take medicine
  • permitted to transgress certain rabbinic prohibitions for the purpose of treatment
  • permitted on Shabat to ask a non-Jew to perform certain types of work for him for the purpose of treatment
  • In light of this most authorities will permit certain tests and treatments on the Sabbath or festivals.

Monitoring Ovulation

There are three basic methods to test ovulation

  1. Basal Body Temperature (BBT): Normally one is prohibited from measuring their temperature on Shabbat as it falls into the category of “measuring”. Measuring for the purpose of the mitzvah is permitted. In this case, measuring BBT to achieve pregnancy is part of the mitzvah of procreation. It is therefore permitted on Shabbat (only when using a non-digital thermometer).
  2. Home Ovulation Testing Kit: The urinalysis strips used in this test change color to indicate ovulation. Normally one is prohibited from coloring on Shabbat as it falls into the category of “dying”. Since the strip is immediately discarded, this type of coloring is a rabbinic prohibition. It is therefore permitted, as noted above.
  3. Blood Test and Ultrasound (BW/US): The drawing of blood on Shabbat is a Torah prohibition. US involves the use of electricity, which is also prohibited on Shabbat. Since there are permissible methods of achieving the desired information, this method is not permitted on Shabbat.
  4. Other Tests: Most other types of evaluation testing are not time specific. Whenever testing can be performed during the week it is prohibited on Shabbat.

Ovulation Induction

Clomiphene Citrate (CC): Taking medication is normally prohibited on Shabbat. As stated above one who is ill can take medication to treat their illness, in this case, fertility. As such CC or other such fertility medications can be taken on Shabbat. One should be careful not to tear the letters on the wrapping on Shabbat and it is advisable to prepare the tablets before Shabbat when possible.
Injections: There are several halachic issues involved with administering injections on Shabbat. As noted above, drawing blood on Shabbat is prohibited by the Torah. At the present, all injections for ovulation induction are intramuscular or subcutaneous and do not require the drawing of blood. Therefore this Torah prohibition does not apply.
Assembling the needle: This falls into the category of building a vessel and is prohibited on Shabbat. Therefore when possible the needle should be attached to the vial before Shabbat. One should be careful not to compromise the sterile environment that is essential for treatment. In cases where this is impossible, a non-Jew can be asked to assemble the needle or it can be done in an unusual way. Please consult your Rabbi in such a case.
Sterilizing the injection site: One may not use cotton wool dipped in alcohol to clean the site of the injection, which is included in the prohibition of “squeezing”. One should use a pre-prepared alcohol swab of synthetic material, or pour alcohol directly onto the skin and then wipe off the excess with cotton.
In light of the above, it is preferable not to administer injections unless this is absolutely necessary on Shabbat. When possible they should be administered before and after Shabbat. If this is impossible, it is preferable for a non-Jew to give the injection. In a case where no other possibility exists, the injections may be given by a Jew on Shabbat as described above.

Chorionic gonadotropin (hCG) injections need to be given at a particular time. In the case where the injection must be given on Shabbat. As above, it is preferable that this should be done by a non-Jew, but when this is impossible even a Jew may do so as described above.

Receiving an injection on Yom Kippur appears to be permitted and is not considered in the category of eating.

Intrauterine Insemination (IUI)

Sperm preparation for intrauterine insemination involves a number of actions that are forbidden on Shabbat such as the use of electricity and the separation of the sperm. It is preferable not to undergo such treatment on Shabbat. Therefore, when embarking on treatment the couple must inform their doctor that he must schedule their treatment such that it will not fall on Shabbat. However, since an IUI must be performed to coincide with ovulation this cannot always be avoided. In such a case the couple must consult their Rabbi.

All fertility treatments involving processing eggs, sperm or embryos require close rabbinic supervision. The supervisor must be available to come to the laboratory on Shabbat. In places where the clinic is not near a residential Jewish area, this may create extremely grave, and even insurmountable, difficulties.

In-Vitro Fertilization (IVF)

The halachic issues and solutions regarding IVF are similar to those of IUI. IVF involves days that the couple needs to be in the clinic and days when the medical staff work on the embryos but the couple need not be in attendance. While all efforts should be made to avoid a retrieval or implantation on Shabbat, it is permissible for a non-Jew to check embryos on Shabbat.

The couple must inform the doctor of these limitations and urge him not to schedule a Thursday, Friday or Shabbat retrieval. When retrieval does fall on Shabbat the couple must consult their Rabbi.

When egg transfers fall on Shabbat it can often be pushed off until after Shabbat, or brought forward to a Friday.

Supervision is required for an IVF and this may present problems if the procedure falls on the weekend, since the supervisor must be in attendance throughout the procedure.

Traveling to the Hospital or Clinic on the Sabbath

In the rare cases, such as in a case of ovarian hyperstimulation, where delaying treatment is potentially life-threatening, a woman may travel to the hospital by car on the Sabbath. However, with regard to all other types of fertility treatment that may be permitted on the Sabbath, many authorities do not permit traveling by car. In such cases, the couple should stay within walking distance of the hospital or clinic over the Shabbat.
Some rabbis hold that it is permitted for a non-Jew to drive a woman to the hospital on the Sabbath in order to undergo fertility treatment. It is preferable to make this arrangement with the non-Jew before the Sabbath and the non-Jew should open and close the door of the car if this causes the light to turn on and off.

Yom Tovim/Festivals

The laws of Shabbat are applicable to all the festivals. One should bear this in mind when scheduling treatment and avoid the times in the year when the festivals occur wherever possible.

Summary
Couples facing fertility issues are considered by the Halachah as ill
They are permitted to undergo testing and treatment on Shabbat if it is necessary and does not contradict a Torah prohibition

References: http://www.jewishfertility.org/diagnosis-treatment-shabbat.php