Definition of Infertility
Infertility can affect couples who have never had biological children (primary infertility), as well as couples who already have at least one biological childbut are presently having difficulty conceiving (secondary infertility).
Most couples don't conceive immediately. There is about a 20% chance of pregnancy the first month of trying, and an additional 20% chance during each subsequent month, so that there is about an 85% chance of conceiving within six months.
A physician will generally initiate a medical evaluation only if a couple has not conceived after one year of trying, or, if the woman is over 35, after six months. The statistics cited above are based on the general population, which is largely sexually experienced (either due to delaying pregnancy after marriage or due to premarital relations). In the case of a young and sexually inexperienced couple, there is reason to allow a few additional months before beginning a medical evaluation.
Evaluation of Infertility
In order to treat a couple who is having difficulty conceiving a child, it is important to determine the cause of the problem. Evaluation generally begins with a thorough medical history and physical examination of both husband and wife, followed by a series of diagnostic tests.
In the general population, the examination usually begins simultaneously with both the husband and the wife, as the problem may originate with either or both of them. Evaluation of the male factors, however, raises serious halachic problems; therefore, a couple should consult with a rabbi before embarking on a medical evaluation. Often, the rabbis will require that the basic, non-invasive tests be performed on the wife first and that the husband be evaluated only if these tests do not produce a diagnosis. They may also stipulate that a minimum time of marriage without children elapse before permitting such testing.
Two situations, which are often not addressed in the medical literature, need to be taken into consideration when evaluating couples who observe Jewish law. These are effective marital relations and halachic infertility.
When dealing with a young couple married for the first time, it is quite important, before embarking on an extensive medical work-up, to verify that sexual relations are taking place in an effective fashion. Exposure to sex is so prevalent in the general community that physicians often assume that their patients know the basics. However, while sex is a natural behavior, it also needs to be learned. Because of modesty, sex education is usually not included in formal Jewish education. Exposure to sexually explicit popularliterature and media may be limited and is hardly to be recommended. Essential information about anatomy and physiology should be provided to both members of the couple prior to the wedding as part of teaching the laws of family life. Unfortunately, this is not always the case, and in cases of infertility, the possibility of the couple having had relations in a manner that will not lead to pregnancy should be delicately explored.