[Avodah] [Areivim] Halachic Infertilit

[Chana Luntz]

In the interests of fair disclosure, I had better restate what I
explained on Areivim (although for some reason it does not seem to have
been published), which explains a bit why I know something about the
topic:

I am/was borderline vis a vis this.  After doing numerous measurements
during the year and a half before I conceived my 5 month old daughter,
it became clear that I was ovulating so that what is considered my
fertile period post ovulation finished shortly before I could get to
mikvah (although often we seemed to be talking about nothing more than
around three -six hours).  Luckily, we seem to be pretty fertile in
other ways so that - in that year and a half period, while mostly I
could not get a clean hefsek tahara on my fifth day no matter how I
tried (meaning I started counting on my seventh day), three times in
that year I managed to get a clean hefsek tahara on day five.  The first
time we got as far as the 30 day and a positive pregnancy test before I
lost it. The second time nothing (but that time I ovulated a day earlier
as well) and the third time my daughter was conceived.  But that is
actually an extremely high hit rate - if we had had other problems
besides halachic infertility I doubt I would have had my daughter.
 
RMB writes:

> There are ways of shortening the time until a hefseiq taharah
> as well.

Only if in fact you *can* get a clean hefseiq taharah earlier than the
normal five days (eg on day two or three) and the only reason you are
waiting until four or five is because of the minhag (Rav Moshe has a
psak about this).  It does not apply if your period is long and your
ovulation period is short.

> But if all else fails, there have been pesaqim
> lequlah -- at least before IVF.

The funny thing is, everybody seems to believe there are heterim out
there, until one goes exploring for one, and they seem to vanish into
thin air - and one keeps being referred to the medical system.  I can't
say we explored very hard - basically we (well I) just gave up - it was
getting too stressful as it was (with all the measuring etc - I think it
was the time I ended up in tears because there was queue at the mikvah
which meant I couldn't go in in the first round, putting us back around
an hour that made me say that I am not going to let this dominate
anymore and I gave up).

 Now that a couple can produce a baby without violating minhag yisrael,
as IVF-H involves 
> simpler halachic issues (donation for the purpose of procreation) than

> eliminating 7 neqiim, I do not know if
> those teshuvos are still applied.

In most of these cases one isn't talking about going as far as IVF -
there are apparently hormones that generally make the cycle longer.

In our case I live in England, and as I wrote in my Areivim post:

"when hormones to lengthen the period of ovulation was suggested, I was
extremely sceptical that I could even get hold of such on the NHS.  I
could just imagine a dialogue with a doctor going like this - Woman
presents herself to a doctor and says she wants IVF.  Doctor asks
whether she has problems conceiving and she explains that she doesn't
think so, just that she is a religious Xtian and holds that sex is
sinful, but she wants a child, and hence she wants to have it via IVF.
I think that the NHS would throw her out the door, saying they have
enough people with real infertility problems making claims on the
system.  And while we are not talking about the expense of IVF, from
their perspective this is no different. If  my husband and I are not
prepared to have relations as the time when I am going to conceive, that
is not the NHS's fault, and they are unlikely to want to be able to help
me."

Now, in England you can go to a GP privately (so long as you pay) and
there are apparently frum GPs who will prescribe these things.  BUT, if
I am prescribed something on the NHS and there are complications, I go
back to the NHS.  If am prescribed something by a private GP - and
especially when I *know* that the NHS would not recommend such
prescribing- and from their perspective he is probably a rogue GP (since
he is medicalising unnecessarily) and there are complications - what is
going to happen?  (As I also explained on my Areivim post - in England,
birth control and abortion are allowed as follows:

"The logic that is used here in the UK regarding birth control pills
goes like this:  it is more dangerous for a woman to have an abortion or
proceed through a pregnancy than to use birth control pills - so
therefore since you are not going to be able to prevent relations, then
birth control pills should be prescribed (it is the same logic that is
used to allow an abortion once a woman is pregnant - the risks to the
woman (eg of dying) of going through with a pregnancy is something like
nine times that of an abortion so therefore, although we do not
technically have abortion on demand here in the UK, the two doctors who
have to permit the abortion are reading from the same risk chart, and
hence invariably permit on medical grounds).  Regarding acne - unless
you are killing two birds with one stone, my understanding is that the
doctors are supposed to weigh up the psychological harm to eg a
vulnerable teenage girl with acne verses the risks of these pills.  In a
society where physical appearance is considered very important, and
there have been numbers of suicides as a consequence of teenagers
feeling ugly (or having been teased/bullied to the point where they
believe they are ugly) this is not a totally insignificant concern, but
that the doctor is *supposed* to consider the case of the patient before
him and weigh up these risks."

But the same analysis cannot be applied to prescription of hormones to
lengthen ovulation - and when we approached another doctor (who happens
to be frum) he told us that the procedure on the NHS would have been to
refer us to an NHS infertility clinic where they would have done a
battery of tests (including taking a sample from my husband to determine
fertility) before coming to any conclusions.  And given that we were
pretty sure that was unnecessary, where is your heter there?

I also don't really understand this idea about "donation for the purpose
of procreation" being so easy. It seems to me it is the same analysis as
the shiva nekiim- ie an aseh of procreation being doche a lo taseh -
except that in the case of the shiva nekiim it is at most a safek
d'orisa and in the case of shichat zera it is a vadai d'orisa violation.
In fact the discussions in the gemora around the lo taseh are not
related to the causing of procreation (because of course relations are
permitted in cases where there is clearly no chance of procreation, such
as when the woman is pregnant or too old) but about the place.  The only
case of this sort of thing (Ben Sirach) seems to have been involuntary.
So the heter seems to be a very modern psak based on modern logic.

> 
> But finding a doctor who wants to do away with minhag yisrael
> altogether is just a Haaretzism, and an Areivim discussion if 
> anywhere.
> 

I was assuming that he was only talking about in cases of halachic
infertility - given that the default position today seems to be a
medical one (of course my assumption could be wrong).  And of course
only in a case where the couple wanted a child (I would have thought
that the shiva nekiim could go on performing their function as a form of
birth control in all other cases - which I guess I have tended to assume
was part of the point.  It is known that a woman's cycle shortens as she
gets older - which is why I suspect there are more cases of this than
there used to be, as women are marrying later.  I therefore suspect that
in gemora times it functioned as a natural way of preventing excessive
children at relatively old ages - this is of course just being my
speculation).

> Tir'u baTov!
> -mi

I have to go, so I am only going to respond to a small portion of RIS's
post (maybe more another time) but:

>
RIS writes:

> The seven clean days requirement is based on a SAFEK 
> D'ORAITA. We can no longer distinguish niddah from zivah, 
> because we have lost the mesorah of which precise four shades 
> of red and one of black render a woman niddah d'oraita. 

 This I also don't fully understand.  As I understand it, the way rov
rishonim seems to understand the difference between nida and ziva is due
to the counting system which is reset every month or so.  The problem is
that the counting system is complicated, and it was difficult for women
to account for it on a regular basis.  But I would have thought that
when everybody is looking over her shoulder in a halachic infertility
situation, it could be allowed.

I agree this does not work with the Rambam, as you needed to have kept
count since you first got your period at around 12 or so, and nobody has
done that - but is not the Rambam a daas yachid?

This 
> makes it impossible to pinpoint the halachic onset of 
> bleeding, which means we can no longer keeep an accurate 
> niddah-zivah calendar.

I don't really understand this - because even if you take the most
machmir position regarding onset, if you get long enough then you must
be out of the yamei ziva and into the yamei niddah, and most women -
even with short cycles, do do that.  So the way I understood the safek
d'orisa it was based on general propensity to miscount, not different
colours - how do you get to this different colour understanding (it is
true we have lost the ability to distinguish colours - but I understood
that to mean that any form of red is assur - even though d'orisa there
are some permissible reds) not that this affected the ziva/nida
equation.

> - Ilana

Regards 

Chana