Tucked away in a far corner of Brooklyn, a graceful brick building houses an open secret among the Orthodox: a fertility clinic that sensitively caters to their needs as observant Jews. Earlier this year, its director and founder, Dr. Richard Grazi, reached out to the wider public with the publication of “Overcoming Infertility: A Guide for Jewish Couples” (Toby Press). At 537 pages, the book takes a comprehensive look at diagnosing and treating infertility in accordance with Jewish law and ethics.
Grazi, a leading medical expert on Halacha and infertility, is the director of the Division of Reproductive Endocrinology and Infertility at Maimonides Medical Center, located in the Orthodox Borough Park section of Brooklyn. He published the first book on the topic, “Be Fruitful and Multiply: Fertility Therapy and the Jewish Tradition” (Genese Jerusalem Press), in 1994. Two years later, he opened Genesis Fertility & Reproductive Medicine, an infertility clinic.
Grazi is an energetic man with lively eyes who speaks enthusiastically about his work. An observant Jew, he grew up in the Sephardic community of New York City and attended Brooklyn’s Yeshivah of Flatbush. He informed the Forward that from his earliest days in medical school, he knew he wanted to enter the field of reproductive medicine. “It’s a fantastic field. While you don’t often get to save a person’s life, you do get to save their posterity. In a sense, with each child that is born, you become responsible for all the future generations that emanate from that child. It’s very dramatic and exciting. When things work out, you become forever connected to the couples,” he said, noting that because many of his patients come from his own community, he has the added pleasure of living among “the product of his work.”
While in residency training at the New York University School of Medicine, Grazi spent two months working in London with Robert Winston, a reproductive surgeon who was a pioneer of in vitro fertilization. The fact that he was also an Orthodox Jew made a lasting impression on Grazi. “When my interest matured, I thought what a good thing it would be if a person who has a background in Halacha would bring it together with medical knowledge,” Grazi said, using the Hebrew word for rabbinic law. At Maimonides, Grazi encountered many observant patients who needed his help.
Today, two-thirds of the patients at Genesis are Jewish and half of these are from the Orthodox community. “Having infertility has such a strong spiritual and psychological overlay,” said Grazi, who has six children of his own, ranging in age from 10 to 24. “It is important that observant couples who seek care at Genesis feel what they are doing is aligned with Halacha.” At the time that he started his clinic, he said, “infertility therapy was not on the radar screen of most halachists.”
Until recently, discussing and addressing infertility was virtually taboo in a community that regards having children as one of life’s primary responsibilities. Orthodox couples found themselves doubly alone: ashamed to share their difficulties with friends and relatives, and unable to convey their particular concerns to health professionals. “There was no one to speak to other than in the secular world, and they didn’t understand the issues and the pressure” to have children, Brany Rosen said of the struggles she had faced over a decade ago.
Rosen, an ultra-Orthodox woman from Brooklyn, went on to become director and co-founder of A TIME: A Torah Infertility Medium of Exchange. When she first started her organization in 1993, most newspapers serving the Orthodox community refused to publish her ad. “They told us to change our name,” she said. Yet, A TIME’s growth from a small support group to a 5,000-member organization with chapters throughout America, Canada and Israel is a testament to how much times have changed.
Rabbis and halachists, too, have caught up. Today a number of them are experts in the field of reproductive Halacha, and several essays in “Overcoming Infertility” have been written by rabbis.
Practically every aspect of assisted reproduction raises halachic issues. According to medical protocol, the first order of business in evaluating a couple is to analyze the husband’s semen. Yet, as Dr. Zalman Levine, a rabbi and fertility specialist at the Fertility Institute of New Jersey and New York, noted, “Whenever sperm is involved, there is always the looming issue of onanism.” To accommodate observant couples, Grazi reorders the protocol for evaluation. He tests the woman first, he said, but stops “before anything invasive has to be done, and then I insist on testing the male.” Concern over wasting semen is so great, many rabbis will only permit sperm to be collected after intercourse or in a special condom that contains no spermicide.
Various procedures also raise red flags for the laws of family purity. Many rabbis differ over whether such procedures as artificial insemination can be performed during a woman’s time of “ritual impurity” or niddah . According to Jewish law, a couple cannot have sexual relations from the beginning of the woman’s menstrual cycle until seven days after its end, at which point she visits the mikveh for ritual purification.
In interviews, patients mentioned that Grazi’s sensitivity to Halacha set them at ease. “His staff really knew about the Halacha,” one woman said. “I didn’t have to feel like a freak.” Another woman, who had both her children through in vitro fertilization, agreed, adding, “I could ask Dr. Grazi ‘Am I niddah ?’” after undergoing certain procedures that caused bleeding.
Grazi likes to emphasize, however, that he is not there to take the place of a rabbi. “I will address spiritual issues, but I keep a clear boundary between my role as a doctor and the rabbi’s role as a posek ,” or legal decision-maker. Where such matters are concerned, Grazi works closely with Rabbi Avrohom Friedlander, Jewish chaplain at Maimonides. Other arrangements that Genesis makes to accommodate observant couples include adjusting protocols so that a woman need not come to the clinic for time-sensitive procedures on the Sabbath or on holidays.
“Overcoming Infertility,” which was illustrated by Grazi’s son, Joseph, has three audiences in mind: patients, doctors and rabbis. “Many of the chapters in this book are meant to stand alone, to be shown to physicians who are new to the subject,” Grazi wrote in his introduction. Likewise, he continued, couples may use chapters to familiarize rabbis “with the medical and physical challenges with which they must grapple.”
“People wonder, ‘How does a nice Jewish boy grow up to be a gynecologist?’” Grazi mused. “It’s not so strange. I think this field draws Jewishly committed people because, at a certain level, it is about bringing new lives into the Jewish community to make up for those not present. A lot of my patients are the children and grandchildren of Holocaust survivors, and they understand this point all too well.”
Talia Bloch is a regular contributor to the Forward and to The Jerusalem Report.