When Dr. David Barad talks about “the birds and the bees,” his subject matter has more to do with petri dishes and test tubes than romantic embraces.
On any afternoon, Barad, director of reproductive endocrinology at New York’s Montefiore Medical Center, can expect a visit by those among the one in 10 American couples affected by infertility — defined by most experts as the inability to conceive after one year of unprotected intercourse.
Speaking at a recent conference in New York, Barad summed up the typical questions couples ask.
“What can be done? How much does in-vitro fertilization cost? Why does insurance not cover it? What are the risks? Can you make sure we have twins?”
Barad’s audience at the April 14 conference, “Assisted Reproductive Technologies and the Jewish Community,” had come to learn the answers to those questions.
Organized by the American Jewish Congress’ Commission for Women’s Equality, the meeting was cosponsored by representatives of eight national Jewish women’s organizations — Women of Reform Judaism, Na’amat USA, Jewish Women International, Women’s League for Conservative Judaism, Women’s American ORT, UJA-Federation of New York, the Leadership Conference of National Jewish Women’s Groups and the AJCongress — that have traditionally been advocates for Jewish women’s health issues.
Concerns of “family and women combined with religious and ethical aspects are a commonplace on our agenda,” said Ellen Rosenberg, executive director of Women of Reform Judaism.
Now these issues are becoming part of bioethical and religious debates about making babies.
Statistically, Jews are no more prone to infertility than are members of other ethnic or religious groups, but anecdotal evidence indicates that many turn to medical technologies to conceive children.
Highly educated and professionally accomplished, Jewish women tend to marry late in life. The Jewish feminist magazine Lilith has reported that Jewish women, at 15 percent, are twice as likely as non-Jewish Caucasian American women to remain unmarried into their 40s.
Newsweek recently reported that the incidence of infertility is evenly split between men and women, with about 10 to 20 percent of cases remaining “unexplained.” Still, the report says, doctors see “advanced maternal age” as a “formidable enemy of fertility.”
Judaism’s emphasis on children and a theological sense that Jews should play an active role in improving the world also contribute to the pursuit of expensive, time-intensive and emotionally draining cycles of hormone injections, in-vitro fertilizations or artificial inseminations.
Rabbi Aaron Mackler, another conference speaker, attributed some of the Jewish openness to reproductive therapies to “a general sense of valuing medicine, valuing human improvement of the world and valuing children.”
In Israel, which has the most fertility clinics per capita in the world, socialized medicine covers a full range of infertility treatments for all citizens, according to Susan Kahn, the research director of the International Research Institute on Jewish Women at Brandeis University.
Israeli women, regardless of marital status, are entitled to up to seven rounds of in-vitro fertilization treatment until they have two live children, Kahn writes in a recent study, “Rabbis and Reproduction: The Uses of New Reproductive Technologies Among Ultra-Orthodox Jews in Israel.”
Moreover, Israeli fertility specialists lead the field in research and development.
In the United States, reproductive procedures can run into the tens of thousands of dollars, and insurance coverage is rare, making infertility treatment available only to wealthier citizens, and no American federal funds support clinical trials. Thus couples, in essence, pay for their own experiments in which they serve as the test cases.
Lois Waldman, the director of the AJCongress’ commission, said Jewish women’s organizations could play a role in providing updated medical information and evaluations of the more than 300 clinics around the country. They could also help push for legislation to increase insurance coverage for reproductive services in the United States.
Participants at the AJCongress conference also came from nonprofit education, referral and support groups: the Brooklyn-based ATIME, A Torah Infertility Medium of Exchange, and Resolve, a national, secular advocacy organization.
Most participants left the conference ready to highlight the issue on the communal agenda, providing information and referrals in brochures, newsletters, magazines and Web sites, or serving as resource centers for their members.
As the technologies advance, there is an awareness among secular bioethicists and “increasingly among Jews” that there are “real challenges involved,” said Mackler, a professor of theology at Duquesne University in Pittsburgh.
There are real risks as well, including the potential for tremendous financial and emotional costs, the dangers of repeated hormone injections and invasive surgical procedures, and a high rate of multiple births.
When reproductive technologies were first developed, they were embraced by the medical and Jewish religious communities.
Mackler, who has been studying the subject for five years, cites talmudic and medieval sources examining theoretical cases of artificial insemination, and rabbis have been pondering the issues surrounding assisted reproduction for decades before the first “test-tube” baby was born in 1978.
In her study, Kahn notes that “rabbinic debates about reproductive technology began in the 1940s with debates about artificial insemination and continue until today.”
The most widely accepted uses of reproductive technology from the vantage point of halachah, or Jewish law, involve couples using their own genetic materials.
Greater ethical complications arise when donor sperm or eggs are used, spawning complex discussions of adultery and Jewish identity.
To circumvent the biblical admonition against implanting one’s “seed” in a neighbor’s wife, Kahn explains, some Orthodox rabbis advise using in-vitro fertilization since there is no such prohibition against implanting an embryo.
Many rabbis advise using sperm from non-Jewish donors. This method reduces the possibility of the child marrying a close blood relative; it also avoids any risk of adultery, when that is defined as sexual intercourse between a married Jewish woman and a Jewish man.
“Artificial insemination with Jewish donor sperm is entirely prohibited in the ultra-Orthodox world,” writes Kahn, whose book, “Reproducing Jews: A Cultural Account of Assisted Conception in Israel,” is due out later this year.
Using donor eggs presents another set of complex circumstances pertaining to maternity and Jewish identity. Is the mother the ovum donor or the birth mother?
For Mackler, “the more important concern would be that the child will have genetic and biological ties to one parent and not the other.”
“Kavod habriot,” Hebrew for “respect for persons,” is a central tenet in Mackler’s discussion of assisted reproductive technologies. The concept extends not only to considerations of the hoped-for children’s well-being, but also to the potential parents’ emotional and physical health.
Despite Judaism’s bent toward childbearing — “Be fruitful and multiply, God commanded Abraham” — “People should not feel pressured into utilizing any of these technologies,” he said.
The Archive of the Jewish Telegraphic Agency includes articles published from 1923 to 2008. Archive stories reflect the journalistic standards and practices of the time they were published.
