Difficulty in conception affects approximately twenty percent of all couples at some time in their lives. Fortunately, there have been significant advances in the treatment of infertility in recent years. Medical intervention for the purpose of achieving pregnancy is halachically permitted and even encouraged when needed. Some common infertility treatments are discussed briefly here.
Ovulation problems can be treated with medications that induce ovulation. Female factors that are structural can often be treated with surgery or bypassed by performing artificial reproductive techniques such as in vitro fertilization (IVF). In IVF eggs (ova) removed from the wife and sperm from the husband are allowed to combine in a petri dish. The resulting embryo is then implanted into the wife's uterus.
For male factors, intrauterine insemination (IUI) is used to assist sperm that cannot easily reach the area needed for conception to take place. In this procedure, washed sperm is inserted directly into the uterus through a catheter. If IUI does not work, IVF is used. At times, insertion of the contents of the sperm directly into the egg (ICSI), can be performed.
Many of the required procedures raise serious halachic issues. Below is a brief presentation of some of the questions that arise. In practice, each individual situation requires direct consultation with a rabbinic authority who is experienced in this area, working together with a physician who is sensitive to the religious needs of his or her patients.
Obtaining sperm for purposes of treatment
Procurement of sperm for treatment purposes is generally permitted. Couples should work together with their rabbi and physician to choose a method of procurement that will be both halachically and medically acceptable.
Artificial insemination (both vaginal and intrauterine) is permitted with the husband's sperm. Whether to permit this during niddah is a matter of rabbinic debate, and a specific question should be asked.
However, artificial insemination by a donor is a matter of serious halachic debate and is prohibited by many authorities. The husband does not fulfill his mitzvah of p'ru ur'vu if donor sperm is used. With a Jewish donor, there is also the prospect that children of the same anonymous donor could meet and marry, unwittingly transgressing the prohibition on incest.
Assisted Reproductive Technology (IVF, ICSI, etc.)
To prevent even a slight chance that egg or sperm cells from different patients might be accidentally switched (mix ups have occasionally occurred), some rabbis require additional halachic supervision for procedures such as IVF. Some fertility laboratories have their own supervision (see Halachic Supervision for Assisted Reproductive Technology). Machon Puah can arrange this service world-wide for those that do not.
ART procedures often produce surplus embryos that will not be implanted. It is halachically permissible to destroy such embryos. They may not be implanted in other couples.
Some of the procedures involved in infertility treatments may involve significant uterine dilation, or cause bleeding that makes you niddah. In these situations, it is important to ask as many halachic questions as necessary, ideally to a rabbi with a good understanding of the procedures involved. It is equally important that your physician be aware of the halachic implications of your treatment and work with you in scheduling procedures to minimize extra time in niddah.
Treatment of male infertility may require testicular surgery. Such procedures can raise serious halachic concerns and need to be discussed in advance with your rabbi. Most situations can be handled by a rabbi with understanding of the medical procedures, working in concert with a physician sensitive to the halachic needs of his or her patient.
Egg Donation and Surrogacy
The use of donor eggs or a surrogate mother raises the question of who is halachically considered the child's mother. There is not yet halachic consensus on this question, which is important for deciding whether to use a Jewish or non-Jewish surrogate or donor. With a non-Jew, the child might require conversion. On the other hand, with a Jewish donor there is concern about the possibility of future marriage between halachic siblings. If a Jewish surrogate or donor is used, she should be unmarried and not closely related to either parent.