Infertility and the Jewish couple
Experts say others need to understand physical, psychological tolls on those unable to conceive
JUDY WERTHEIMER
Pittsburgh Jewish Chronicle
For many couples, teasing from friends and family about when they plan to start a family is inevitable. The ribbing and nudging often begin under the chuppah (wedding canopy), when the rabbi extols the virtues of being fruitful and multiplying.
But for some couples, each teasing remark is like salt in a fresh wound, as they struggle to bring a child of their own into the world. For many, the word "struggle" doesn't begin to cover the pain of infertility, which is felt on so many different levels.
Infertility is defined as the inability to become pregnant after one year of regular sexual relations without contraception. It also is defined as the inability to carry a baby to live birth. Between 15 and 20 percent of couples of child-bearing age in the United States are infertile.
Rabbi Michael Gold, in his book, "And Hannah Wept: Infertility, Adoption, and the Jewish Couple," suggests that, based on his own observation, the number of Jewish couples experiencing infertility appears to be even higher.
"The reason is simple," writes Gold, the former spiritual leader of a Pittsburgh synagogue. "Jews tend to marry later and postpone having children longer than the general population." Studies have shown that fertility decreases with age.
"Before anyone knew we were having problems, there was constant kidding and joking about starting a family," recalls Laurie L., who asked that her last name not be disclosed. "My father-in-law would end every phone conversation by saying, 'OK, go get off the phone and make me a grandchild.'
"After we told everyone we were having problems, the family was supportive, but we still got a lot of 'just relax,' 'maybe you're trying too hard,' 'take a vacation.' " Laurie adds. "Most everyone experiencing infertility can tell similar stories."
"Unsolicited advice can be a real problem," explains Sherri Leisman, an infertility and adoption counselor with University Women's Health Care in Monroeville, Pa. "People say things and they mean well, but they can often be hurtful." Not only do remarks like "just relax," and "take a vacation" call into question the couple's own ability to choose well and wisely for themselves, they also ignore the fact that people sometimes have blocked fallopian tubes or bad sperm, Leisman points out.
"Infertility is a valid problem," echoes Laurie L. "It's not happening because we're not relaxing. It is a medical problem. I think a lot of people don't understand that, and don't understand how devastating it is."
As time went on, Laurie's and her husband's families began to see that their infertility was a real, ongoing problem, and family members began to make offers of financial support. In just over two years, Laurie and her husband have been through numerous medical procedures and received a variety of fertility drugs administered orally and through daily shots, the effects of which are monitored by countless ultrasounds and blood draws.
The latest procedure was their first attempt at in vitro fertilization, bringing the tab to about $10,000, of which insurance covered nothing. In vitro fertilization (IVF) involves removing a woman's egg cells from her ovaries, fertilizing the eggs with sperm outside the woman's body, and implanting the resulting embryo or embryos back in the woman's uterus.
The Jewish viewpoint
How does Judaism look upon such medical interventions? As with most everything else, there are a range of Jewish opinions, says Rabbi Aaron Mackler, who is also a Pennsylvania college professor.
"In general, Judaism tends to be very open and supportive of medical intervention to combat infertility. The use of hormones and other medical intervention, on the whole, is supported," says Mackler.
Regarding IVF in particular, Mackler says there are some Orthodox thinkers who would suggest that this form of reproduction upsets the natural order of things. And the question becomes more complicated when couples consider using donated sperm or eggs.
"It's more complicated because of the question of who is officially the parent in Jewish law. Some feel it's not appropriate to have other people's genetic material coming into a marriage," explains Mackler.
As reproductive technology continues to evolve, so does the body of literature exploring its relationship to Jewish law and ethics, but by and large, Rabbi Mackler asserts, Judaism is very much pro-children and generally pro-medical intervention. In fact, to suggest that Judaism is pro-children is a bit of an understatement.
"Be fruitful and multiply" is the first commandment in the Torah. And because of the focus on children in much of our religious and communal life, writes Rabbi Gold in his book, "infertility is particularly painful to Jews." Shabbat, Hanukkah, Passover, Sukkot - so many holidays involve special rituals for children; it's often difficult for couples experiencing infertility to participate in these and other life-cycle celebrations.
One veteran of infertility treatments, Naomi Zikmund-Fisher, recalls telling her best friend that she didn't know if she and her husband would be able to attend the naming ceremony of her friend's second child.
"I told her it would depend on what kind of day we were having," explains Zikmund-Fisher. Her friend found that hard to understand, but they continued to talk about it. Ultimately, Naomi and her husband attended, as the child's godparents.
Leisman tells clients to take care of themselves. "It may be difficult to attend a baby shower. You might feel guilty, but if you can't, you can't, and that's OK," she asserts.
Couples seek moral support
While some Jewish rituals may prove difficult, Zikmund-Fisher found one to be especially helpful. As a teacher of b'nai mitzvah classes at Temple Sinai in Squirrel Hill, Pa., she always has encouraged her students not to knock things until they try them. In that same spirit, she decided to try going to the mikvah (ritual bath) and found that it really meant something to her. When each month brought disappointment, she looked at going to the mikvah as a new beginning.
"OK, here's a rebirth, a fresh start; God cares about what's happening to me. Going to the mikvah was really important to me," Zikmund-Fisher explains. "When you're trying to become pregnant, your period really is a death. To go to the mikvah is to wash away a death and start working on a new life."
Zikmund-Fisher is expecting her first child any day.
While she found comfort at the mikvah, her husband, Brian, struggled to make his own way. He resisted traditional sources of support, such as the counselor available to him through their doctor's practice and, he admits, "it was probably the wrong choice."
Part of the difficulty for men in dealing with this is that it's something men typically don't talk about. "Conversations are almost exclusively among women. Naomi had lots of people to talk to, but it's not something guys talk about," explains Brian. "I talked almost exclusively to Naomi, and it wasn't fair to her because she had her own issues to deal with." But that communication between the two of them, says Brian, is what enabled their marriage to survive the strain that infertility can cause.
"It's such a strain for so long, watching friends get pregnant," he says. "When you find someone who has gone through this or who you can talk to about it, it can be very important."
Indeed, people struggling with infertility speak a common language of pain and perseverance, of daily shots and so many blood draws each week that they begin to feel like human pin cushions, of tears shed and hormones run amok on the drug of the month, of time missed at work, and of the insensitive things blurted out by even the best-intentioned friends and family members. Less often heard are stories of what friends and family do right.
Naomi Zikmund-Fisher recalls that one of the best things someone did for her was a gesture by her rabbi. Zikmund-Fisher had gone to services on Shabbat at a particularly bad time and ended up in tears. The rabbi, Jamie Gibson of Temple Sinai in Pittsburgh, offered to call her at home, and when he called, he offered to bring chocolate.
"He came over with a huge grocery bag full of chocolate, ice cream, Pop Tarts, all kinds of goodies. We shmoozed about nothing for two hours, and it was so important. We didn't even talk about (infertility). It just made me feel really good," she says, "because he sent the message 'You're worth spending time with; you have value as a person in your own right.' "
Turning to prayer
Some couples find solace in prayer or inward thought when conception is difficult. Naomi Zikmund-Fisher wrote the following prayer to say before going in the mikvah the night before she began the procedure that ultimately resulted in her pregnancy:
"Shechina my God, God of all generations, I stand before you today as did my mothers, Sarah, Rebecca, Rachel, Leah, Hannah and Michal, to ask for your help in my quest for a child. As each of their journeys took a different path, so, too, I am mindful that my journey has many possible endings.
"I stand before you not to ask for a baby, but to ask for the strength to face all that lies before me with grace, dignity, and courage. Help me to remember that your covenant at Sinai bound those who were there with those who had not yet come to be, and to be mindful of the participation of both myself and the child I seek in that covenant relationship with you. Help me to accept the comfort and support of my family and friends as I walk this road, and keep alive in me the spirit of hope. Amen."
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