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Fertility, halachah mix at counseling service

Rabbi Menachem Burstein, director of the Puah Institute in Jerusalem, counsels a religious couple dealing with infertility.  (Puah Institute)

Rabbi Menachem Burstein, director of the Puah Institute in Jerusalem, counsels a religious couple dealing with infertility. (Puah Institute)

JERUSALEM, Sept. 29 (JTA) — Prayer books and fertility pamphlets are scattered across the coffee table in the waiting room of the Puah Institute, a center that helps couples seeking to undergo fertility treatments in a way that accords with Jewish law. Named for the Hebrew midwife Puah, who defied Pharaoh’s orders to kill Jewish male newborns, the center receives about 150 calls and e-mails a day from childless couples. “The goal is halachic advice and medical advice,” says Rabbi Gideon Weitzman, head of Puah’s English- speaking section. Weitzman is one of 10 rabbis at the institute, all Orthodox, offering services not only in Hebrew and English but also in Spanish, French and Yiddish. “The first mitzvah in the Torah is to have children. That’s always going to be at our forefront — that we want to have Jewish families,” he said. “There’s a great desire on the part of the religious establishment to feel the pain of couples. The Torah spoke of our foremothers and forefathers as being infertile. That leads to a tremendous amount of being lenient where possible.” Most couples that turn to Puah for its free counseling services are religiously observant. They often come with questions about Judaism’s approach to modern fertility technology, from in-vitro fertilization, or IVF, to egg donation. Many inquire about how the laws of family purity can be coordinated with treatment and how procedures can be supervised according to halachah, or Jewish law. Many of the religious couples’ concerns are no different than those of non-religious couples, who also sometimes turn to Puah for advice, Weitzman said. “A lot of the issues are similar, such as the feelings of hopelessness and the lack of control over one’s life,” said the British-born Weitzman, who comes from a family of scientists. Like the other rabbis on Puah’s staff, he has been trained extensively in the medical aspects of fertility treatment by medical experts. Puah’s counseling often addresses family tensions that can arise from infertility. The pressure to have children can be overwhelming in any society, but is especially intense in the religious community, where large families are the norm and family life is a crucial part of the community. The rabbis also provide practical advice about the nature of available treatments and can suggest which specialists might be the best match for a particular couple. They sometimes even serve as sex therapists. “There is a tremendous amount of stress on the family, and he really helped us in dealing with that stress and creating a game plan for ourselves,” said one Orthodox woman who was counseled by Weitzman and eventually gave birth to twins. She asked that her name not be used in order to maintain her privacy. The woman and her husband went to Puah to make sure their fertility treatment plans were sanctioned by halachah, but ended up getting much more. “I feel it helped me on every level, medically and with emotional advice and counseling,” she said. According to the institute’s estimates, Puah is involved in about 1,500 births a year — not bad for an organization that started in the living room of its founder, Rabbi Menachem Burstein, in 1990. Burstein had been asked by one of Israel’s chief rabbis at the time to research the issue of fertility treatments and what might be possible under halachah. Puah now has a four-story office in Jerusalem and a staff of about 70 people in Israel, the United States, France and Australia. The organization gets by on donations, mostly from contributors in Israel. Burstein, an outgoing man with a long salt-and-pepper beard, was born in Uruguay. His office, like many of the other offices in the center, has photos of babies whose parents used Puah’s services. Burstein is quick to speak of some of his more challenging cases, including a bride-to-be who found out shortly before her wedding day that she did not have a womb. Realizing the engagement might be broken off, the rabbi called a wealthy relative of the young woman the family told him of and asked him to provide enough money to cover the cost of two pregnancies by a surrogate mother. The relative complied and the recently married couple is planning to use a surrogate mother to begin their family. “I’m happy I have been able to find a synthesis between halachah and the practical world,” Burstein said. Aside from counseling, Puah also provides individual halachic supervision of treatments. The main concern some rabbis initially had about treatments such as IVF was whether a mistake might happen in the lab in which sperm and eggs were misplaced or embryos switched or tampered with. Aside from the personal ramifications, this would call into question the child’s future status for marriage or inheritance. Among the rabbis who opposed IVF for that reason was the late Lubavitcher rebbe, Menachem Mendel Schneerson. Schneerson later changed his mind because of Puah’s effectiveness in reducing error. To prevent the chance of human error, Puah has trained about 50 women in Israel and others who work in overseas fertility clinics to oversee the lab work. In the case of an IVF procedure, the women lock the petri dish containing the embryo into a specially constructed sterilized stainless steel box that can be locked and then put in an incubator. Later, if embryos are frozen, Puah has created a locked crypto-preservation vat. A sealed canister is put into the vat which, in turn, can also be locked. The special devices are on display in Puah’s offices, along with magnified photos of the conception process. Supervision costs are subsidized by the institute, so that supervision costs only about $80 for IVF treatments. Supervision also is conducted in Puah’s locations in the United States, France and Australia. On the top floor of the institute, Rabbi Aryeh Noyek, who directs Puah’s supervision department, is fielding calls at a desk piled high with folders. He said doctors are pleased to have Puah supervisors in the lab because it helps put their patients at ease — which can translate into higher success rates for the treatment. Egg donation is not currently allowed in Israel, so patients who decide on that procedure must travel abroad, usually to Eastern Europe. Puah offers supervision there and also arranges visas, hotels, flights and kosher food for their clients, some of whom have never left Israel before. Since egg donation isn’t covered by Israeli health funds, clients must pay for the procedure themselves. Still, the $6,000 to $7,000 that egg donation costs in Eastern Europe is far less than the $25,000 or so it can cost in the United States. For those who balk at the idea of rabbis delving into issues of fertility, Weitzman points out the Torah acknowledges infertility among both women and men. The Talmud, he says, even deals with semen analysis. In the tractate Tevamot it describes how in some particular cases, men’s ability to ejaculate was tested. “It is very modern — light years ahead of any theology or philosophy of 2,000 years ago,” he said. “The Torah is very advanced in its thinking.”