Difficulty conceiving or carrying a child affects approximately 20% 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. In this article, we briefly discuss the most common fertility treatments, along with some of the halachic questions that they raise.
In practice, each individual situation requires direct consultation with a halachic authority who has experience in this area and can work in concert with medical professionals sensitive to the halachic needs of their patients.
As of Spring 2020, Yoatzot Halacha Fertility Counselors provide free consultations to help guide couples through their fertility journey.
Artificial insemination, intracervical (ICI) or intrauterine (IUI), may be used to assist sperm that cannot easily reach the egg (ovum). IUI is more effective and thus far more prevalent in clinical settings. In this procedure, washed sperm are inserted directly into the uterus through a catheter.
Artificial insemination can be performed either with the husband’s sperm or with donor sperm. The latter raises more halachic concerns but may be permitted after individual halachic consultation. There is halachic debate as to whether it is preferable to use sperm from a Jewish or non-Jewish donor. A Jewish donor’s sperm should only be used if the identity of the donor is known, thus preventing the prospect that children of the same anonymous donor could unwittingly transgress the prohibition on incest.
When necessary, insemination is generally permitted during niddah. This follows the view that conception during niddah is viewed negatively only when it is accomplished through prohibited relations. There is a range of views on how insemination affects counting the clean days, so a woman should ask an individual question if this situation arises.
Assisted Reproductive Technology (IVF, ICSI, etc.)
In IVF (in vitro fertilization), eggs (ova) removed from the wife are placed in a petri dish with sperm from the husband and allowed to combine. In ICSI (intracytoplasmic sperm injection), a sperm cell is inserted directly into an egg cell. The embryo resulting from either procedure is then implanted into the wife’s uterus. Egg retrieval and embryo transfer are both permitted during niddah.
Assisted reproductive technology may be used for a number of reasons. For male factor infertility, IVF or ICSI may work where IUI does not. IVF may also successfully bypass structural female factors of infertility.
Supervision: To prevent even a slight chance that egg or sperm cells from different patients might be accidentally switched, 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 where requested.
Surplus Embryos: ART procedures often produce surplus embryos that will not be implanted. It is halachically permissible to destroy such embryos or to preserve them for future use. They may not be implanted in other couples.
Semen Collection for Treatment
Procurement of semen for treatment purposes is generally halachically permissible, and not considered hotza’at zera levatalah. For more discussion of methods of collection, see here.
Treatment of male infertility may require testicular surgery. Such procedures need to be discussed in advance with a halachic authority.
In women who rarely or never ovulate, oral anti-estrogens or follicle stimulating hormone injections may be used to induce ovulation. This process is tracked with serial ultrasounds and blood tests. These medications may lead to irregular spotting. Halachic guidance can help women undergoing induction to avoid being niddah at the time of ovulation, or to navigate being niddah at the time of ovulation.
Some of the procedures involved in infertility treatments may entail significant uterine dilation, or lead to uterine bleeding that may make a woman niddah. In scheduling a procedure, it is important to take into account the possibility that it could cause niddah or make it difficult to count the clean days, to minimize extra time in niddah.
Before and after a procedure, a woman should ask as many halachic questions as necessary, ideally to a halachic authority with a good understanding of the medical issues involved.
To receive an accurate halachic ruling, it is also important to clarify details of the procedure with one’s physician, ideally in advance: what instruments are used in a procedure and their size, what if any bleeding can be expected and for how long, and if there was any specific trauma from the procedure.
Egg Donation and Surrogacy
Legal policies on the identity of an egg donor or surrogate vary among different jurisdictions. From the perspective of Jewish law, there is not yet consensus on whether halacha recognizes the carrier of a fetus or the woman whose egg was used as the child’s mother. In practice, when a non-Jewish surrogate or egg donor is used, the baby often undergoes conversion to ensure that he or she is considered Jewish according to all opinions.
Jewish egg donors should not be anonymous, to rule out an unwitting future marriage between halachic siblings. A Jewish surrogate or donor should be unmarried and not closely related to either parent, though some halachic authorities may allow for exceptions to this rule on a case by case basis.