Definition of Infertility
Infertility can affect couples who have never had biological children, as well as couples who already have at least one biological child, but are presently having difficulty conceiving (in what is called 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, roughly an 85% chance of conceiving within six months.
A physician will generally initiate a medical evaluation of fertility only if a couple has not conceived after one year of trying, or after six months if the woman is over 35 or there is a specific reason for concern. Medical evaluation is also warranted when a woman experiences repeat miscarriages, see more here.
In the case of a young and sexually inexperienced couple, there is reason to allow a few additional months before beginning a medical evaluation, since the statistics above are based on the general population.
Since a number of different hormonal, structural, mechanical or sexual factors can contribute to infertility, and since treatments for infertility vary depending upon its causes, it is important to begin with a thorough evaluation.
Evaluation generally starts with a comprehensive 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 difficulty may originate with either or both of them.
Evaluation of the male factors through semen analysis, however, may raise the halachic issue of hotza’at zera levatalah, spilling seed. Therefore, halachic consensus has been for the wife to undergo basic, non-invasive tests first and for the husband to undergo evaluation only afterwards, if the tests on the wife do not produce a diagnosis. In recent years, as understanding of male factor infertility has increased, some rabbis have reconsidered this position. Our site’s rabbinic supervisor, Rav Yehuda Henkin, now permits semen analysis at the same time as the woman’s initial testing.
In fertility evaluations of couples who observe Jewish law, special consideration should be given to the efficacy of marital relations and to the timing of ovulation relative to mikveh immersion.
The decision to pursue fertility evaluation, and the evaluation process itself, can be challenging. Yoatzot Halacha Fertility Counselors can be an important resource for halachic guidance and support through the process. Learn more here about other organizations working to help couples with fertility challenges.
Effective Marital Relations
Before embarking on an extensive medical work-up, it is important for a sexually inexperienced couple to verify that their sexual relations are effective.
While engaging in sexual relations is a natural behavior, it also needs to be learned. Because of our community’s emphasis on modesty, sex education is often not included in school curricula, and exposure to information on these topics is limited.
The essentials of anatomy and physiology should be provided to both the bride and groom prior to the wedding as part of their study of the laws of niddah. Since this unfortunately does not always occur, a couple who are having difficulty conceiving may want to confirm that they are having relations in a manner that can lead to pregnancy. In the Resources and Links section of our site, we list a number of resources to educate couples on having effective and satisfying relations.
Updated June 2020.