Judaism and Science

Guest Essay by Prof. William D. Petok

The Bible and Fertility

The Biblical imperative is clear. “Be fruitful and multiply; fill the earth and tame it . . . .” (Gen. 1:28.) And God gives no description of how Adam and Eve are to do this. Again, after the flood, the same message comes from on high: “God then blessed Noah and his sons, saying to them, ‘Be fruitful and multiply, and fill the earth.’”(Gen. 9:1.) At least seven more times the commandment is given. This must be important!

Later in the text we are introduced to the problem of infertility. Sarah struggles and suggests that Abraham use the first known surrogate, Hagar, her handmaiden. After Ishmael is born Sarah conceives at the ripe age of 90. Tension between the two women increases and Hagar and Ishmael are cast out.

Infertility skips Isaac and Rebecca but plagues the next generation of the Matriarchs. “When Rachel saw that she was not bearing [children] to Jacob, Rachel came to envy her sister. She said to Jacob, “Let me have children; otherwise I am a dead woman.’” (Gen. 30:1.)

And finally, Elkahnah’s wife is stricken. Unfortunately, Elkhanah misses an opportunity to connect with his wife when he says “Am I not more to you than ten sons?” (1 Sam. 1:8.) Then, “In her deep anguish Hannah prayed to the Lord, weeping bitterly. And she made a vow, saying, ‘Lord Almighty, if you will only look on your servant’s misery and remember me, and not forget Your servant, but give her a son, then I will give him to the Lord for all the days of his life.’” (1 Sam. 1:10-11.) Miraculously, as in earlier texts, she conceives, and a son is born.

Modern Fertility Strategies

Today, we are less likely to rely on divine intervention for fertility problems. Reproductive medicine has developed an array of strategies for both men and women who are unable to create children “the old-fashioned way.” The most complex of these are considered Assisted Reproductive Technology (ART) and include In Vitro Fertilization (IVF) in which eggs and sperm join without other manipulation in a petri dish, Intrauterine Insemination (IUI), in which sperm is introduced to the uterus via a catheter, Intracytoplasmic Sperm Injection (ICSI), in which a single sperm is injected into a single egg under the microscope, the use of donor sperm or eggs, and the use of a gestational carrier when a woman’s is unable to carry a pregnancy to term for medical reasons. More recently, pre-implantation genetic testing (PGT) allows the determination of genetic problems with an embryo before it is transferred to a uterus. The process involves removing several cells in order to test them. Finally, egg freezing allows a woman to freeze her eggs for later use or donation at a later time.

As an added benefit of these technologies, same sex couples who wish to have children to whom they have a genetic connection can employ one or more of the above methods and build their families.

When Judaism Meets Reproductive Science

What does Judaism, the religion that brought us “Be fruitful and multiply,” have to say about these methods which did not exist when the biblical authors created the texts above? Many religions approach the problem of infertility with some amount of overlap. Judaism says that procreation is a religious duty, that infertility is imposed by God and may be seen as a punishment for wrongdoing. In fact, all the major religions take the view that infertility is a punitive response from the deity. As with most religions, Judaism has denominations ranging from the most orthodox to the most liberal. And the range of opinions on what is acceptable is significant. Generally, the more strictly one adheres to Jewish law, the more restrictive are the options.

Judaism in its most conservative forms is fairly flexible when it comes to ART. IVF is acceptable, particularly when the sperm and egg come from the individuals who will carry to term and raise the infant. IUI is acceptable if the sperm comes from the husband of the woman who will carry the pregnancy.

Egg donation

There are rabbis who will reject the use of donor eggs while others allow it with the husband’s consent. A major concern, if the donor is Jewish, would be the “provenance” of the egg for future marriage of the child. Regardless of faith, it’s a bad idea to marry a half sibling. The genetic consequences could be problematic. In the most religious circles, a gentile donor is preferred, the assumption being that the child will only marry a Jew, thus removing concerns about gene lines and consanguinity. Many authorities would favor a full conversion to insure the Jewish heritage of the child.

Sperm Donation

The use of donor sperm from a Jewish donor is not allowed because it constitutes an adulterous relationship, at least metaphorically, because the donor creates a child with a woman who is not his wife. The child would then be considered a mamzer or bastard.

For men with male factor infertility, this option is removed. A non-Jewish donor, on the other hand, changes the equation. The child can’t unknowingly marry a half-sibling because in “proper” marriage arrangements there is only a Jewish option. If a donor is Jewish, accurate records must be kept to insure that the donor’s subsequent children are not potential marriage mates.

Seed Spilling

The issue of IUI, IVF, and ICSI are complicated by how the sperm and egg “get together.” Since these procedures all take place without intercourse, “spilling of seed,” or masturbation, is required. The original text from Genesis (38:9) and then again in Leviticus presents questions about emission of semen and raises similar questions about ritual purity. Jews who follow a strict interpretation of text will then have a problem with how sperm are obtained for the procedures above. Typically, a man provides a specimen for use by masturbating into a collection cup. But this violates the prohibition of spilling seed. In order to avoid the prohibition, special collection condoms have been created so the couple can have intercourse and the “seed is not spilt.” In the most observant situations, there is a small hole at the top of the condom, so it is “possible” for seed to escape into the vagina and it won’t be “wasted.” From a medical/scientific point of view these machinations are less than desirable, but acceptable.

Surrogacy

Some Jewish denominations allow surrogacy via gestational carrier. This a distinctly different form of surrogacy than the one Abraham employed. Today that would be referred to as “traditional surrogacy” in which the carrier is inseminated with the father’s sperm, carries the child to birth and the turns the infant over to the parents who will raise it. This practice is used far less today than 25 years ago because of advances in IVF which allow creation of a fetus outside the womb and subsequent transfer to a carrier. In the best case, the carrier would be an unmarried woman. However, some Halachic authorities raise the question of maternal identity. Is the carrier, who’s only contribution to the birth is her womb, a mother? It is possible to find Halachic authorities who make the case both for and against gestational surrogacy. Liberal Judaism, which has accepted patrilineal descent, finds gestational surrogacy acceptable.

Most gestational surrogacy arrangements today involve a woman who is done creating her own family. As with any pregnancy, one risk is future infertility due to complications of gestation or birth. Another reason for this guideline is that a woman who has her own children is more likely to turn over a child she has carried for someone else. Many carriers comment that they loved being pregnant and look forward to the process especially because they will be able to sleep through the night after the delivery!

Anonymity

While egg and sperm donors were initially required to be anonymous for reasons that don’t make sense today, there is a strong movement to create donor sibling registries. This allows donor conceived children to find their half-siblings, “diblings” in some circles, and obtain ongoing medical information about their donor which may impact them in the future. When donor sperm and later donor egg procedures became possible, no one could have predicted the impact of technology on reproduction. Today, with genetic testing from organizations such as 23andMe and Ancestry.com, it is almost impossible for a donor to remain anonymous. In the not too distant future, children who are not told about their donor conception could easily discover the “truth” when they take biology in middle school and bring home the DNA swab kit to learn about their own genetic makeup.

Egg Freezing

Egg freezing, a process in which a woman’s ovaries are stimulated in a controlled fashion to produce more eggs than are normal for one cycle, is gaining acceptance in the Orthodox community. The procedure allows eggs to be retrieved by needle aspiration while the woman is sedated. They are subsequently frozen and stored in cryopreservation tanks for later use. For an unmarried woman in her late 30’s, this is a significant development as it allows her to preserve some measure of fertility until she finds a mate. It is also significant for a woman who has a medical condition that requires treatment that can render her infertile, such as some treatments for cancer and other diseases. As striking a development as it sounds, it is an imperfect process. Not all frozen eggs will thaw properly and not all of those that do thaw will fertilize. Finally, not all those that fertilize will develop into embryos that can be transferred.

Genetic Testing

Preimplantation genetic testing (PGT) was developed to diagnose genetically transmittable disorders. The process involves removing a single cell from a day 3 embryo and studying the genetic makeup of that cell. While the process is taking place, the embryo is frozen for later use. At day 3, the eight cells that make up the embryo are undifferentiated. Removing one will not affect the subsequent development of the embryo. The information obtained can prevent the transfer of embryos with Tay-Sachs, Down’s syndrome, and other disorders. It could also be used for sex determination, something that Halachic and non-Halachic authorities consider frivolous.

Additional Resources

This brief overview of Judaism’s approach to ART is by no means exhaustive. The reader who wants a deeper dive into both the Jewish approach and the broader field of ART is referred to several books and websites listed below.

Grazi, Richard V. Overcoming Infertility: A guide for Jewish couples (Toby Press, 2005). An edited collection by an experienced reproductive endocrinologist with contributions from rabbinic and medical experts.

Finkelstein, Baruch and Finkelstein, Michal. (The Third Key: the Jewish couple’s guide to Fertility (Feldheim Publishers, 2005). Contains halachic explanations of ART and what is and is not permissible for the most observant.

Cardin, Nina Beth. Tears of Sorrow, Seeds of Hope. Jewish Lights Publishing, 1999. Written by a Reform rabbi, this book, subtitled “A Jewish Companion for Infertility and Pregnancy Loss,” contains spiritual resources for those coping with infertility and pregnancy loss.

Jewish Fertility Foundation. https://www.jewishfertilityfoundation.org.  Headquartered in Atlanta, this organization provides financial assistance, educational awareness and emotional support to Jewish people who have medical fertility challenges.

Uprooted. https://weareuprooted.org.  A Boston based organization that offers advocacy and ritual creation. Uprooted educates Jewish leaders in assisting families with fertility challenges and provides national communal support to those struggling to grow their families.

Puah. https://www.puahfertility.org. Headquartered in Israel and providing services in the United States, this organization describes itself as “fertility, medicine and halacha.” In addition to information and events, it offers lab supervision to insure rabbinic requirements that Jewish parentage is established.

A Time. https://www.atime.org.  Headquartered in Brooklyn, this organization is focused on religiously observant Jews dealing with infertility and family building challenges.

RESOLVE. https://resolve.org/ The national patient advocacy organization. RESOLVE provides free support groups in more than 200 communities and is the leading patient advocacy voice.

The Society for Assisted Reproductive Technology. https://www.sart.org.  SART provides unbiased information and sets standards for in vitro fertilization (IVF). Member clinics provide data on success rates which are validated and available online. The website contains a wealth of patient friendly information in print and video form.

The American Society for Reproductive Medicine. https://www.asrm.org.  ASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. Its patient information page, https://www.reproductivefacts.org, contains significant information about the medical aspects of infertility and its treatment

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William D. Petok, PhD, is a Clinical Associate Professor of Obstetrics and Gynecology at Thomas Jefferson University/Sidney Kimmel Medical College, Philadelphia, PA.

The views expressed by Prof. Petok are his own and not necessarily those of the Blogmaster. They are published in order to promote this blog’s mission to provide information and foster discussion about matters of faith and science. The Blogmaster thanks Prof. Petok for his contribution to this forum.