Tuesday, September 22, 2009

This is why Halachic Supervision is a must

In yesterday's edition of the Today Show on NBC TV, there was a feature concerning IVF and a lab error. A couple had been implanted with the wrong embryos and the wife was carrying someone else's child, a child she will have to give up after it is born.

Although it is impossible to totally eliminate human error from the process, halachic supervision is required because of errors such as these. Halachic supervision reduces the risk of human error to levels near zero. An independent pair of eyes is crucial to the process.

To see the full story click here Today Show Embryo Error

Wednesday, July 22, 2009

From Torah Tidbits:Supervision & Male Fertility Preservation

Supervision & Male Fertility Preservation  In the early days of the development of modern scientific fertility treatments, poskim, concerned about the potential for laboratory errors leading to the use of the wrong genetic materials, ruled that such treatments were impermissible. Several highly publicized cases of IVF babies being implanted into the wrong female confirmed their fears.
The onset of halachically supervised fertility treatments dramatically changed the halachic realities. Such supervision requires the presence of a third party supervisor whose job it is to prevent any potential mistakes of human error and ensure that any children born of such methods are the genetic products of the intended parents.
Supervision is not limited to IVF, appropriate supervision is halachically essential for all forms of fertility treatments in which genetic material is processed outside the body for eventual use in the birth of a child. This includes male fertility preservation, our topic of the past few weeks.
In the example we have discussed, a male cancer patient facing potential infertility as a result of his upcoming medical treatments, the need for supervision is paramount, in order to ensure that his frozen sperm sample is "certified" as belonging to him, allowing it to be used for fertilization procedures with his wife. Unfortunately, in the frantic rush to (a) make sure that the patient's sperm is preserved prior to beginning critically needed medical treatment on a timely basis and (b) preserve multiple samples of material for preservation, supervision sometimes gets overlooked.
I recently met with representatives of large organization that works with families who have children with cancer. As part of their services, they regularly refer young men for fertility preservation and through no fault of their own had never even considered the necessity of supervision in such cases. After explaining the process and halachic need for such supervision to them, they immediately changed their protocols and now recommend supervision to all their client families. Not only does supervision ensure that the process if overseen according to halacha, in this case there is an additional benefit.
The young terminally ill patients we are discussing are often frightened and concerned. They may never have ever been to a hospital before becoming ill, and are suddenly subjected to a battery of tests and treatments and told that their treatment may affect their fertility. Having someone meet them at the clinic to assist them, guide them and comfort them, to know that there is someone looking out for them in the lab and be assured that at least this part of the procedure is in good religious hands is a huge reassurance for them and a wonderful aid for their eventual recovery. 
NEXT: Female Fertility Preservation

Monday, June 1, 2009

From Torah Tidbits

Sacrificing One to Save Another  Last week we started discussing the case of the woman who is pregnant with a multi-fetal pregnancy and we are concerned that she will not be able to carry the pregnancy and may lose all of the unborn children. In this case the doctors suggest that she reduce some of the embryos in order to save the others.
The question is whether this is permitted by the halacha?
Rav Zilberstein quoted the section of Talmud that we are not allowed to sacrifice the life of one Jew by giving him over to the gentiles who will kill him, even if they will then kill all of the others. However we mentioned the case of Yonah where the sailors do "kill" Yonah in order to save themselves and they are not punished for this.
There are opinions (such as the Tiferet L'Moshe quoted in the Pitchei T'shuva) that if the gentiles will kill everyone then they are permitted to draw lots and to give over the person who was picked by the lottery to save the others. He brings Yonah as an example that this is permitted.
Many disagree with this, and Rav Zilberstein quotes from the Sefer Chasidim that they cannot draw lots to "sacrifice" one of them as was done in the case of Yonah.  However in another place the Sefer Chasidim writes "if people were in a ship and a great storm came against them to drown them, but all the other ships are sailing safely, then we know that there must be someone on their ship who is liable and they are permitted to draw lots and throw him into the sea." As happened to Yonah. These two quotes seem to contradict each other, however, a close reading reveals that they are dealing with different scenarios. In the second case all of the other ships pass safely and so the indication from heaven is that there must be a person on this specific ship who is the cause. The Midrash does say that in the case of Yonah the sailors saw that all the other ships passed by safely, and only the ship that Yonah sailed on was threatened by the storm. So here we see that there are cases in which we can permit killing one person to save others. However this still seems to be only in very specific cases where there is a Divine indication that this is what should be done. More on this next week.  The Puah Institute for Fertility and Gynecology in Accordance with Halacha is based in Jerusalem and helps couples from all over the world who are experiencing fertility problems. Puah offers free counseling in five languages, halachic supervision, and educational programs. Puah has offices in New York, Los Angeles and Paris. To contact the Puah Institute please call 1-800-071111 in Israel or in the US 718-336-0603. website: www.puahonline.org

Monday, May 25, 2009

Reducing Stress

One of the most annoying things that every woman who has experienced infertility has heard is "just relax and it will happen." Unfortunately, it is not that easy for most women who are experiencing infertility.

However, it has been proven that "stress" does inhibit fertility. Being stressed can inhibit or delay ovulation.  In men, it can reduce sperm counts.

Going through fertility treatments is one of the most stressful things you can go through: early morning appointments for blood tests and ultrasounds, injecting yourself or being injected with drugs everyday.  There is stress along the way worrying if everything is going as it should.  Add to this the financial strain of paying for the treatments and the difficulties of being late to work. And then the worst of all is the 2 week wait when you wait to find out if it worked for if it was all for nothing and you will have to return to square one and start all over again!

Reducing stress is one way to increase your odds of success. 

Some suggestions for reducing stress:

  1. Alternative healers.  Do acupuncture, shiatsu, reflexology.  Whatever you can fit into your schedule without it being more stressful (ie whatever you can schedule conveniently and isn't too big of a stain financially).
  2. Listen to meditative music.  In particular if you are doing an IUI or IVF, take along some music to listen to before/after procedures. 
  3. Listen to (or watch) something funny.  There's nothing like a good laugh to make you feel better.    
  4. Treat yourself when you need to.  


What do you do to reduce your stress levels?

Can you suggest any great meditative music?

Can you suggest any funny podcasts?

Thursday, May 14, 2009

Is a Fetus Alive? (part 2)

Is a Fetus Alive? (part 2) 
 Last week we discussed the position of Rabbi Waldenberg as recorded in his responsa, Tzitz Eliezer, that the unborn child is not considered to be alive in the eyes of the halacha. He based this opinion on the understanding of the Rambam, and particularly the relation between the words of the Rambam and those of the Mishna. 
But another halachic giant held the exact opposite; Rabbi Moshe Feinstein stated that the Rambam was clearly of the opinion that the unborn child is considered to be alive. Therefore, Rabbi Feinstein wrote, the Rambam had to employ the concept of the rodef in order to permit terminating a pregnancy, even when the mother's life is in danger. Since the fetus is alive and the mother is alive and we can only save one and not the other, it is forbidden to kill one person even in order to save another. However if one is a rodef then he must be killed to save the other. Therefore, Rabbi Feinstein held that it is forbidden to terminate a pregnancy under any circumstances, even if the child is ill and even if he will not be able to live afterwards. He was of the opinion that the pregnancy should continue and the child be born even if he will die soon afterwards.  Rabbi Feinstein writes that he felt a need to be strict in light of the large numbers of unwarranted abortions and that we need to take a stand and stop this wherever possible. He writes that he was shocked to see the opinion of Rabbi Waldenberg who allowed the termination of a pregnancy and he felt that one should not rely on this lenient opinion.  There is still, though, a question that remains. How come the unborn child is a rodef before he is born but not after he is born, when he still endangers the mother? Rabbi Feinstein answers that while we may not have a good answer to this it still does not compromise our halachic position since we see that none of the classic commentators on the Rambam disagree or even comment. We can therefore assume that the Rambam had an answer to this question, even if we do not know what it is. [Note that Rambam's word is K'RODEIF, like a Rodeif. Not a real one, but we will consider it so. - Ed.] He does offer one possible answer; that the unborn child is alive and has a soul but not a complete soul, and when we have to decide between saving the mother or saving the fetus, we save her. However when he is born they are on the same halachic level and so we are incapable of deciding who to save and must let nature take its course.  So we see that two halachic authorities of the same generation gave complete opposite psak based on the same Rambam. One allows the termination in certain cases and one does not allow it under any circumstance.  In such a case a person needs to seek specific halachic guidance.   
The Puah Institute for Fertility and Gynecology in Accordance with Halacha is based in Jerusalem and helps couples from all over the world who are experiencing fertility problems. Puah offers free counseling in five languages, halachic supervision, and educational programs. Puah has offices in New York, Los Angeles and Paris. To contact the Puah Institute please call 1-800-071111 in Israel or in the US 718-336-0603. website: www.puahonline.org 

Wednesday, May 13, 2009

The Puah Institute left a meaningful impression at the Israel Fertility Association (IFA)

Puah at the Israel Fertility Association conference
May 11, 2009

The Puah Institute left a meaningful impression at the Israel Fertility Association (IFA) annual conference that took place 11-12 of May at the Dan Panorama Hotel in Tel Aviv.

Rabbi Udi Rath of the Puah institute with Dr. Idit Ben-Yair of the Shifra Institute gave an oral presentation at the general forum about a new PCT introduced by the Puah Institute. A PCT is the first test of male infertility that is done by taking a swab from the woman shortly after intercourse. There is absolutely no halachic issue with this test since it is done on the woman.  The problem in the past with the PCT test it is not often a good indication of whether there is an issue with the sperm.  There are many couples who have a poor PCT who go on to have a good SA (sperm analysis), and there are many couples with a good PCT who go on to have male factor infertility.

Dr. Ben-Yair showed a strong correlation between the results of a regular sperm test (that is Halachicly problematic) and the new PCT in providing a good first picture of the male factor condition.

The presentation was marked as outstanding and was one of four candidates for the annual award of the IFA.

In addition Puah counselors presented three medical Halachic posters at the conference. The posters dealt with: egg donation, ovariectomies of BRCA carriers and cryopreservation of ovarian tissue and oocytes – all of which drew attention from medical crowd.

Saturday, May 9, 2009

Is a Fetus Alive?

Last week we saw the words of the Rambam, that the reason that the Mishna permits terminating a pregnancy when the mother's life is in danger is due to the law of rodef, the pursuer. If this is the case, then why does the Mishna forbid killing the half born child to save the mother, surely he is still considered a pursuer the entire time that the mother's life is in danger? The answer to this query on the Rambam can provide an answer as to the halachic status of the embryo; is he considered alive or not? 
Rabbi Eliezer Waldenberg tz"l, the late halachic giant of Jerusalem, the posek for Sha'arei Zedek Hospital and one of the experts in halacha and medicine, was asked whether one can terminate the pregnancy of a fetus who is suffering from a serious congenital condition. In this case the mother was not in any immediate danger and so the case was not analogous with that of the Mishna. Rabbi Waldenberg allowed a termination to be performed based on the Mishna and on his understanding of the Rambam. He claimed that the Rambam was of the opinion that the unborn fetus is not considered alive since he does not have independent life; but once he is born he is considered a full life. The question then remains as to why did the Rambam employ the principle of the rodef? Rabbi Waldenberg answers, quoting a response of the Nodeh Biyhuda, that even though the fetus is not seen in the eyes of the halacha as being alive, still it has the halachic category of a treifa, a living being that does not have independent life. While it is less severe to kill a treifa than killing a person, still it is not permitted. However, since the fetus is endangering the mother and is a rodef, it is permitted to terminate the pregnancy. This would be the same if the fetus was suffering from a serious condition that would be very difficult to treat, in certain cases this would be grounds to terminate the pregnancy. One question remains, how come the fetus is only a rodef until he is born? Rabbi Waldenberg answers that the Rambam did not mean he is a rodef only that this situation is similar to the case of the rodef. He is like a rodef but not really a rodef and thus not all the laws of rodef are applicable. This is not a simple answer since the Rambam brings in this case in the first chapter of the laws of murder where he discusses the laws of rodef and brings this as a prime example. If it is only similar to a rodef then why does he bring this as the example? Also Rabbi Waldenberg understands that the word rodef in the Rambam is a noun, where there is evidence that it may be a verb which changes the understanding of the sentence. Still, Rabbi Waldenberg holds that the unborn fetus is not considered alive. Next week, the other side of the dispute...  

Sunday, May 3, 2009

Saving a Life or Stopping a Pursuer? (From Torah Tidbits)

Saving a Life or Stopping a Pursuer?  Last week we saw the Mishna that states that before the child is born we can abort him in order to save the mother's life, but once he is born or even the majority of the body is out of the mother then we cannot touch him since we do not push off one soul before another. This suggests that the unborn fetus is not considered alive and only receives the soul at birth. It is clear from the Mishna that the reason that before birth we do all that we can to save the mother's life but after birth we cannot interfere is that before birth he has no soul and only receives that afterwards. 
However, the Rambam brings this Mishna in his discussion of the laws of the rodef, the pursuer. It is a mitzva to stop the pursuer and not to be overly merciful. "Therefore" the Rambam writes (Hilchot Rotze'ach 1:9) "the Rabbis taught that when a woman is in danger during childbirth it is permitted to cut up the fetus either by hand or by a drug since he is like a pursuer to kill her. But if his head came out then we cannot touch him since we do not push off one soul for another and this is the nature of the world." The Rambam adds to the issue another element, namely that of the pursuer, and it is for this reason that we are allowed to kill the fetus. This does not appear in the Mishna and this addition changes both the understanding of the Mishna and the dynamic of the question. Since it now appears that were the fetus not a pursuer it would be forbidden to touch him and thus the Rambam appears to be of the opinion that the fetus is considered alive and only when he is a pursuer can he be killed. But according to this, the child is a pursuer for the entire time that he endangers the mother. Why then does the Rambam permit killing him prior to his birth but forbid it when the birth has reached a critical point, namely that of the head emerging? If the child is a rodef before the birth since he could kill the mother, then he should remain so even after until any danger has passed. These questions are not only academic but hold the key to understanding the halachic status of the unborn child. 


Short Film competition

Everyone who goes through infertility has a story. It is really encouraging for couples going through IF to read success stories. There's an inspiring story for everyone. The longer you go through IF though, the harder it is to find a story that inspires you because you are not going to be inspired by someone who went through way less than you did.

So, calling everyone out there who has a success story(the longer the journey, the better the story IMHO).....you can "win" with your success story.

The contest is sponsored by Fertility Lifelines and Resolve. Do it for your fellow IF sisters because as every IF'er knows $500 or $1000 doesn't go every far when you are paying for treatments.


Sunday, April 26, 2009

HIV Fertility Clinic Opens In Jerusalem, Israel - Viral Disease Carriers Can Have Disease-free Children

The first of its kind in Israel, a new clinic at Hadassah Ein Kerem Hospital in Jerusalem will allow persons who are carriers of viral diseases (Hepatitis C, HIV) to have healthy children using an innovative treatment: washing the sperm.

Dedicated and opened this morning, the new clinic will make it possible for Israeli HIV carriers to bring healthy children into the world. The clinic uses a washing technique that excludes the HIV RNA and allows the doctors to separate the sperm affected by the disease from those unaffected. The 'healthy sperm' are then used to fertilize the wife's egg in regular IUI/IVF procedures., Prof Shlomo Maayan, Head of the Department for Aids Medicine at Hadassah Ein Kerem Hospital, said "In the past there were such attempts in Israel but no practical steps were carried out".

The new procedure gives hope for the 5,000 HIV carriers in Israel. "One of the conditions for participating in the project" explains Prof. Maayan "is that the husband continues to take the [medical] cocktail treatment. The amount of virus in his blood and semen has to be close to zero. Only when we are sure that we have succeeded in cleaning the sperm completely, will we fertilize the wife's egg".

The launching of this project was made possible through the cooperation between Hadassah Ein Kerem's clinic for HIV research, Dr. Philip Halfon, the director of a similar center in Marseille, France, and the Puah Institute for Fertility and Gynecology according to Jewish Law. Benjamin David, the Puah Institute counselor who coordinated the project, explains "When we became aware of this procedure we set out searching for a hospital here in Israel that we could set up such a clinic. God allowed us to play matchmaker in this effort"

"Within the religious world the number of HIV carriers is close to negligible.", said Rabbi Menachem Burstein, Dean of Puah Institute, "Nonetheless we saw an opportunity to help the broad community. To date through this method 200 healthy babies have been born to couples treated by Dr. Halfon's clinic in France. Our hope is that this new center will provide solutions to this problem in Israel as well."

About the Puah Institute

The Puah Institute is an independent non-profit providing medical and religious counseling to infertile couples.

The Puah Institute, established in 1990, provides free medical counseling to couples and works to bridge the gap between religious law and fertility medicine. Puah has offices in Jerusalem, Paris, New York & Los Angeles.

Puah Staff, Nissan Shtrauchler & Dani Adino-Ababa for Yediot Acharonot (Israel)

Sunday, March 22, 2009

Fertility Treatments and the Economy, a View from the US

Last week we discussed how economics can affect fertility and we
saw how a powerful lobby of Puah and several secular groups was
able to keep fertility treatments offered by the Kupot Cholim.

This week I wanted to look at another connection between money
and children, but this time presenting the situation as it
stands today in America. Unlike Israel, most Americans' health
insurance does not cover fertility treatments and the cost of
these treatments can be staggering. Treatments can be over
$20,000 and even much more, all with no guarantee of success,
so couples can spend their entire life savings in order to have
one child.

In recent years, some American citizens have sought ways of
lessening these costs and one common way is fertility tourism
where couples travel overseas to places where treatment is
cheaper in order to cut costs. There is quite debate raging
as to whether this is recommended or not, but for Jewish
couples the option of coming and doing treatment in Israel
is attractive. Indeed, in a recent New York Times article,
Puah was mentioned as being one of the organizations that
has been involved in cases of fertility tourism.

While fertility treatment is not free for couples who do not
hold Israeli citizenship and who pay Kupat Cholim, even done
privately, it is much cheaper than the equivalent treatment
performed elsewhere.

While we believe that often the best is for a couple to
undergo treatment in a place where they are surrounded by
family, friends and a support system, in a place where
they know the system and feel comfortable, still we have
helped many couples come to Israel and have treatments done

This is not for everybody, but the couples who have been
through this and have become pregnant are delighted. They
received top class care and for a fraction of the cost
that it would have been in the US or other places.

At a recent conference, a friend of mine who runs a clinic
in the US that deals with high end treatments, admitted to
me that business has been slowing down; as the economy
nosedives we may see this more and more. In such circumstances,
the options of doing treatment in Israel becomes a more sought
after option and the Puah Institute is proud to provide couples
who seek this option guidance, help and halachic supervision.

Let us hope and pray that no one will need such treatment,
but if they do, then we pray that finances will not be an
insurmountable obstacle.

The Puah Institute for Fertility and Gynecology in Accordance
with Halacha is based in Jerusalem and helps couples from all
over the world who are experiencing fertility problems. Puah
offers free counseling in five languages, halachic supervision,
and educational programs. Puah has offices in New York,
Los Angeles and Paris. To contact the Puah Institute please call
1-800-071111 in Israel or in the US 718-336-0603.
Visit our website: www.puahonline.org

Wednesday, March 18, 2009

Don't Give Up

Yosef and Yehudit had great dreams and hopes for their future together. They were both idealistic and wanted to build a special home in a special place for the Jewish people and so they moved to a yishuv in Gush Katif in order to join the unique community there.
They were so happy and this only increased when Yehudit became pregnant and gave birth to a baby girl. All seemed well and the couple were delighted when Yehudit became pregnant soon afterwards with a boy. 
When the boy was born he also looked healthy, but it did not take too long for the dream to burst. The doctors noticed that Yosef and Yehudit's son did not react to stimuli in the normal way. They ran a battery of tests and it was discovered that he was suffering from a very serious medical condition that affected his reactions and his learning abilities. 
Yosef and Yehudit were concerned and they decided to look into the condition deeper, they had themselves checked and found that they were both carriers of a serious genetic mutation. They quickly realized that this may have affected their daughter as well, who was then also tested and was found to have a somewhat milder form of the condition. As she got older her symptoms became more pronounced and Yosef and Yehudit found their home now filled with two children with serious learning disabilities and special needs. 
In the midst of all this, the Israeli government made the decision to withdraw unilaterally from Gush Katif and within a few months they were homeless and remain so until today.
The Puah Institute has accompanied this couple since they discovered their son's condition and the Rabbi who dealt with them has spoken to them numerous times and guided them through all of their personal trials. 
Yosef and Yehudit underwent a treatment to try and have a healthy child, but after having great expectations, the treatment was not successful and even suggested that they would need more invasive treatment. The couple were distraught and again the Rabbi at Puah was called upon to give them hope and not allow them to give up.
They underwent two more treatments until they were successful - a couple of weeks ago they celebrated the birth of their healthy baby boy together with many of their old friends from the yishuv and, of course, the Rabbi from the Puah Institute. 

Fertility Treatments and the Economic Crisis

Once, in an interview for a Californian newspaper, I was asked whether, in light of the difficult security situation in Israel, people were undergoing less fertility treatments. I answered an unequivocal no, that maybe the opposite is the case, that a worthy answer to war and terror is to have more children. In fact, sometimes we find couples who lost a child who come to have another child feeling that this is their best response to their loss.
However, the present economic crisis has added a dimension to fertility treatments around the world and I would like to discuss this over the next couple of weeks.
We will speak about the situation abroad next week, but I would like to concentrate on Israel in this column.
The current law in Israel is that the Kupat Cholim (the Israeli equivalent of an HMO) is required to pay for most fertility treatments until the couple have two children. While there are other countries in Europe that offer some insurance coverage for fertility treatments, Israel's is still a unique situation. When we compare this with the US where couples can pay thousands of dollars for treatments and can expect to pay tens of thousands of dollars in order to achieve a healthy child, it is truly remarkable.
In addition, this has catapulted Israel to the forefront of fertility treatments; doctors have a tremendous amount of experience with difficult cases and unusual circumstances not often seen in other places around the world.
This law that offered fertility treatment through the Kupat Cholim has been in effect since there has been a Health Ministry and was passed in 1995. However, recently there was talk of changing this law and making fertility treatments available only through private clinics, or at least severely limiting the accessibility of treatments. 
This would have changed the dynamic of fertility treatments in Israel and would have prevented thousands of couples from ever holding their own children, ever dressing them up for Purim, ever shepping nachas at their Bar or Bat Mitzva. Several secular fertility support groups mobilized in order to explain to the politicians the importance of not changing the law and of encouraging demographic growth. The Puah Institute joined with them to form a strong alliance that cut across party and religious lines and it may have been this incredible unity that was able to keep the law as it remains to this day.   The Puah Institute for Fertility and Gynecology in Accordance with Halacha is based in Jerusalem and helps couples from all over the world who are experiencing fertility problems. Puah offers free counseling in five languages, halachic supervision, and educational programs. Puah has offices in New York, Los Angeles and Paris. To contact the Puah Institute please call 1-800-071111 in Israel or in the US 718-336-0603.                
Visit our website: www.puahonline.org