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According to Rosen, over the past 20 years the secular and religious worlds alike have undergone a transformational shift with regard to infertility. Most doctors in the New York area are now sensitive to the laws of Jewish ritual purity. Grazi has been practicing in the frum world for 25 years. He quickly learned not to advise women to visit the mikveh early. “That is just a nonstarter,” he said. “I know where my patients and my rabbis are coming from.”
At the same time, childlessness is now openly acknowledged in Orthodox communities. Headquartered in a rose-colored office in Boro Park, Brany’s A.T.I.M.E. services some 8,000 couples struggling to get pregnant in the United States, England and Israel. Another fertility support group, Bonei Olam, is located less than a mile away. Rosen said that a key talking point in lifting the infertility taboo was to remind her clients and their families that Sarah, the Hebrew bible’s most important matriarch, was infertile for much of her life.
A.T.I.M.E. also trains rabbis in the latest reproductive technologies so that they can make informed recommendations to infertile couples about which treatments square with Halacha.
Grazi said that he typically addresses halachic infertility by directing a patient to wear an adhesive patch that delivers estradiol, the natural female sex hormone, just as she begins menstruating. This patch is meant to delay her ovulation until after she goes to the mikveh. If the patch is working but the woman is still having trouble getting pregnant, then Grazi will add one of several medications to stimulate egg development — a potent one-two punch for toppling halachic infertility.
But in the instances that the patch doesn’t delay a woman’s ovulation, Grazi will take more drastic measures, prescribing a medication called Lupron, which mutes the body’s egg development and ovulation. Then, Grazi will place a woman on a regimen of injectable natural hormones, managing her cycle so that her fertility peaks when she is allowed to have sex with her husband.
For halachically infertile couples with an aversion to using hormones, there are other options. One simple fix is to artificially inseminate the woman with her husband’s sperm before she goes to the mikveh. Since the woman is not allowed to have sex with her husband at the time that she is ovulating, insemination will bring his sperm in contact with her egg without the couple actually touching. Rabbis, however, disagree as to whether this is allowed under halachic law. Some Modern Orthodox rabbis are more lenient in their approach to insemination. But other rabbis, particularly those in ultra-Orthodox communities believe that insemination during niddah can cause spiritual harm to the child.
Obtaining a sperm sample also complicates the matter. The Torah admonishes men not to “spill” their “seed” through masturbation, and many rabbis are reluctant to waive this ruling for fertility treatments. To get around this, some Orthodox men don a special medical grade polyurethane condom when they have sex, in order to secure a sample. Because the use of prophylactics is otherwise strictly prohibited, some couples poke a small hole in the condom as a symbolic gesture that the sperm is not actually going to waste.