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In the haredi and even Modern Orthodox Jewish communities, male and female infertility has long been a delicate subject reserved for whispered conversations among husbands and wives and clandestine appointments with specialists. But no more.
As having children is the most important personal mission of most observant Jews, and barrenness is still regarded as a serious "blemish," the growing number of diagnostic methods and treatments has come into the open even in this cloistered sector. Two new English-language books on Jews and infertility - one by an Israeli rabbi-and-nurse team and the other by a leading Orthodox fertility specialist in New York - have been published simultaneously.
At 492 and 537 pages, the two books use different styles to present a comprehensive look at everything Jewish couples have to know about infertility, including the halachic view and Jewish traditions, treatments and - if all fails - adoption.
Fertility treatment is a major field - and business - in the Jewish world, and Israel alone has more than two dozen in-vitro fertilization units - far more per capita than any other country. The fact that these two major volumes have been published for a relatively tiny English-speaking audience shows how important the subject is.
One is The Third Key: The Jewish Couple's Guide to Fertility, issued by Feldheim Publishers of Jerusalem (www.feldheim.com) and written by Rabbi Baruch Finkelstein (a Jerusalem community and yeshiva rabbi and a chaplain in the Israel Defense Forces) and his wife Michal Finkelstein, a certified nurse/midwife with more than two decades of experience. They previously collaborated on Be'Sha'ah Tovah: A Jewish Woman's Clinical and Halachic Guide to Pregnancy and Childbirth, also a Feldheim book.
The other is Overcoming Infertility: A Jewish Guide for Jewish Couples, published by Toby Press ( www.toby-press.com) and written by Dr. Richard Grazi, a leading authority on treating infertility within the confines of Jewish law who heads the division of reproductive endocrinology at Maimonides Medical Center in Brooklyn, New York.
THE PAIN of infertility is a heartbreaking, frightening test of faith, the Finkelsteins write, and affects about 15% of all couples. Before the text begins, there are endorsements in Hebrew and English by a variety of leading rabbis from New York and Israel and Orthodox physicians from Jerusalem. Rabbi Yisroel Belsky of Brooklyn gives the authors high praise for their "magnum opus," adding that readers should consult a rabbi after being counselled by fertility experts.
Prof. Avraham Steinberg, an Orthodox rabbi, pediatric neurologist and director of medical ethics at Jerusalem's Shaare Zedek Medical Center, notes that years ago many rabbinical arbiters, including the late sage Rabbi Moshe Feinstein, demanded that matters relating to birth control, for example, be "handled in the most private and modest manner." But today, Steinberg adds, avoiding detailed discussion of these matters is no longer a valid option; modern media have exposed the population to vast amounts of information. Quite often this information is distorted. Under these conditions, writes Steinberg, who also teaches medical ethics at The Hebrew University, "it is of the utmost importance to publicize information that is up-to-date, reliable, and with a strong medical foundation... Given this openness as well as the many public forums on these issues in recent years, I feel it is absolutely essential to clarify and present the halachic perspective in precise terms." He congratulates the Finkelsteins for doing "a great service."
The 24 chapters move between relevant discussions of faith and observance and detailed descriptions of the human reproductive system, what can go wrong, how fertility disorders are diagnosed and how they may be treated. Although both Finkelsteins are the authors, it appears that the rabbi focused on the religious aspects and his wife the nurse on fertility treatments.
Producing semen samples by "self stimulation" or collecting it in a condom during intercourse is openly discussed, but there is still some lingering reluctance to bare all: An anatomical drawing of the male reproductive system is cut off, as if a ritual circumciser had done too enthusiastic a job. The female reproductive system is, however, depicted accurately.
SECULAR JEWS might wonder how so many pages can be filled with the religious aspects of infertility. But there are many. For example, how do couples observe Shabbat and family purity laws while undergoing treatments? Observant Jews who discover they can't have children without medical assistance often have a crisis of faith, as if they are being punished by God.
The authors insist that God ideally wants every Jew to have children, and that most of the Patriarchs and Matriarchs, plus the mothers of the Prophet Samuel and Samson, were initially unable to have children. These pure souls were certainly not being punished. Instead, the Finkelsteins write, God made it difficult for them to conceive so that they would pray fervently.
"We are not bargaining with God. We are not saying, if You do X, then we will do Y... We are developing a relationship with the Almighty, and regardless of the outcome of our prayers we will continue to strengthen our relationship with Him. In our prayers, we should request a child that the parents, the Jewish People, and the Almighty will be proud of." Readers are advised to "never give up praying, even if doctors tell them there is no chance of them having a child."
The Finkelstein book notes, by the way, that a couple has the option of getting a divorce if they cannot have a baby after being married for 10 years, but if they move to Israel, they get another decade "bonus" before having the option of a divorce (and even then it is not mandatory, they write).
Non-believers may dismiss these notions, but since stress is well known to reduce fertility and hamper fertility treatments, trust in God can actually increase the chances for a pregnancy.
Despite the heavy dose of Jewish law, philosophy, inspiration and mysticism, nonobservant Jews who need fertility treatment will be able to get much from the book, as it explains a great deal of technical material - from diagnostic examinations to testicular sperm extraction and IVF - in a lucid way. A helpful appendix presents laboratory values of medical tests, a guide to medications, detailed glossaries of medical and relevant Hebrew terms, a bibliography and thumbnail biographies of rabbis mentioned. There is no index at the end, but there are hundreds of footnotes.
We are told in the very last sentence what the "third key" - for which the book is titled - is. It refers to a Torah commentary maintaining that God holds three keys to the world, with the third being the key to fertility. "Through the pain that you have endured and in the merit of your faith that it is all for the best, let us hope that the salvation of the world will come swiftly in our days. And may we then live to enjoy the fulfillment of God's promise, 'There will be no infertile male or female among you. And we will all be the beneficiaries of God's blessing - the third key."
While complementary medicine techniques purported to help infertile couples are described, the authors urge readers not to fall for "segulas" (objects claimed to have special powers) given away or sold by quacks.
The Finkelsteins offer helpful ways to minimize conflict between husband and wife while undergoing painful treatments. Their book expresses a high degree of compassion and thoughtfulness, and even urges people blessed with children to be careful what they say in the presence of the infertile so as not to cause jealousy or distress.
THE SECOND book, written in a much more academic and less intimate style, speaks in many more voices, as not only Grazi writes chapters but also 11 others, including rabbis, clinical psychologists and physicians from the US and Israel. For 18 years, Grazi treated observant Jews suffering from infertility, so he writes with much experience. Interestingly enough, he - like the Finkelsteins - wrote his first book (12 years ago) on fertility (called Be Fruitful and Multiply: Fertility Therapy and the Jewish Tradition).
Because of rapid changes in medical technology, rabbinical arbiters have to update themselves as couples come for rulings on infertility issues, which are dealt with in Grazi's book in great detail.
One halachic issue is how long a couple must wait before fertility impairment can be evaluated. Rabbi Avrohom Friedlander explains that some authorities insist they wait for a decade, while others say five, two or even less. Friedlander, the rabbi of Maimonides Medical Center, concludes that each couple should consult their own rabbinical arbiter.
Divided into six major parts, the volume discusses infertility from both a rabbinic and historical perspective; the impact of Judaism on the issue; the physical causes of female and male infertility and techniques to diagnose them; therapeutic interventions and their halachic repercussions; special considerations relating to fertility treatment on Shabbat and holidays, rabbinical supervision during therapy, and ethical issues.
The Toby Press volume, which has no rabbinical endorsements but does carry a foreword by the late British chief rabbi Lord Immanuel Jakobovits, also comes with a large "Resources" section that includes an extensive index, glossaries of medical and halachic terms, a list of acronyms (from AI, artificial insemination, to ZIFT, zygote intrafallopian transfer), and information about Israeli and American organizations that can be helpful.
As both cover pretty much the same ground, the interested reader can choose between them, depending on what style he or she prefers, or read them both