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The Unique Challenges of Infertility in the Orthodox Jewish Community

For Orthodox couples facing infertility, the struggle to adhere to Jewish law and tradition presents a special set of challenges on the path to parenthood.

October 27th, 2023 | 6 min. read

By Ilana Ressler, MD, FACOG

Rebecca* is a wife, a mother, and a practicing Orthodox Jew. She is also among the 11 percent of women in the United States who have experienced infertility. 

In this article:

Meet Rebecca & Jacob

The trajectory of infertility looks different for every couple. For Rebecca and her husband Jacob*, whose family now includes three young children, their journey included a paradox familiar to those within the Orthodox community. 

While they had the advantage of a closely knit, built-in support network near their home in New York, infertility remains a taboo topic within the community. Those struggling to grow their families tend to keep their struggle as private as possible.

For Rebecca and her husband, finding support meant forging a different path through the maze of infertility.

*Names have been changed at the couple’s request.

The Root of Rebecca's Infertility

The maze began, she said, with a common, but complex, endocrine condition.

Polycystic ovary syndrome (PCOS) is a disorder affecting menstrual cycles and other reproductive hormones that often leads to fertility issues.

When she was diagnosed with PCOS as a teenager, Rebecca’s doctor at the time gave her a prescription for metformin, which is often considered for use in combating insulin resistance, a condition common in PCOS patients. 

Family Building in the Orthodox Community

A few years later, Rebecca married. From the beginning, she and her husband Jacob struggled to conceive.

This can be especially difficult to conceal within an Orthodox Jewish community, where couples are expected to marry and conceive at a relatively young age (the average age of one’s first marriage is 22-24 among Orthodox Jews, and 29-31 among the general U.S. population). 

Even within the U.S. Jewish population, the differences in family demographics are stark. A 2021 Pew survey revealed Orthodox Jews are five years younger, on average, when they give birth to their first child (23.6 compared to 28.6 among non-Orthodox Jews).

On Concealing the Struggle to Conceive 

Rebecca and her husband, Jacob, waited three long years to become parents. That was considered "late" within their community.

Couples who must wait longer, Rebecca said, “don’t so much keep it private, as the rumors are so strong― either marriage problems, illness, or infertility ― you’d have to say something. I know a few people who waited way longer than I did, but they did not keep it private.”

Not wanting to arouse suspicion, Rebecca hid her struggle to conceive, telling only one close friend and one cousin, who had experienced infertility herself. 

Finding Culturally Competent Care

Rebecca and Jacob ended up using a nonprofit support services agency, Refuah Helpline, to locate a reproductive endocrinologist within the Orthodox community who could prescribe a treatment regimen that conformed with written and oral Jewish laws.

After becoming patients at Illume Fertility, they were relatively fortunate in their first attempt to conceive. A timed intercourse cycle resulted in a successful, healthy pregnancy.

As a practicing member of the Orthodox community myself, I was able to provide specialized, culturally-competent care to the couple, pairing my medical expertise with a unique knowledge of Orthodox tradition and law.

This provided Rebecca and Jacob with an additional layer of comfort and support throughout the process, knowing that there was a deep understanding of their unique needs and respect for their religious background.

On Adding to Their Family

A year and a half later, wanting to conceive again, Rebecca and Jacob returned for assistance. This time, they were unable to conceive through timed intercourse.

Here too, their struggle was pronounced because of the cultural expectations around family building within the Orthodox community. Most Orthodox couples have at least three children, and families with 10 or more children are not uncommon. 

After undergoing intrauterine insemination (IUI) treatment, Rebecca ultimately conceived again and gave birth to twins.

The struggle was worth it, she said, and she appreciates the rare degree of specialized support and understanding she received from her team at Illume Fertility on her journey to motherhood.

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Religious Law & Fertility Treatment

For Orthodox couples who need the assistance of fertility treatment to conceive, navigating the relationship between religious law and medicine can be challenging.

“Our scholars have to interpret the law that exists, match it with the medical law that exists, then match it with a solution,” Jacob said. “It’s complicated, but from a lawyer’s perspective, sometimes you can find a middle way, a loophole, to make things work.” 

Are there restrictions for Orthodox couples?

Certain common fertility-related procedures are not always an option for Orthodox couples. Something as simple as semen analysis, for example, may be prohibited or require special permission from a rabbi in order to comply with Jewish law.

Fertility treatments like IUI and IVF also require a independent religious observer (mashgicha) from within the Orthodox community to be present in the fertility clinic’s lab during certain procedures or stages of the process, to make sure the chain of custody while handling a specimen is not broken.

"A lot of issues can come up with Jewish law," Rebecca said. "Some people unfortunately never end up having kids because their rabbi didn’t allow certain things." The key, she says, is finding a rabbi who understands your personal situation: "If it’s just a Jewish law issue, there’s a way to work around it - and I was fortunate to find a good rabbi."

Growing Families While Respecting Tradition

With families being so highly valued in the Orthodox Jewish community, those who struggle to conceive on their own often feel isolated and unsure of where to turn for help.

Thanks to specialized resources like Refuah Helpline and other community-based support services, couples who need assistance to expand their families are often able to connect with fertility specialists who not only respect their culture and traditions, but identify as members of the community themselves.

In addition to finding a knowledgeable rabbi who can help you navigate fertility treatment, working with a fertility specialist who understands and respects the intricacies of Jewish rituals and traditions can make all the difference when trying to build a family. 

Here at Illume Fertility, we are proud to work closely with Orthodox Jewish patients, rabbis, and observers to help make family-building dreams come true. In addition to having other Jewish physicians like myself on staff, our entire team is dedicated to ensuring adherence to Jewish law throughout each patient's journey to pregnancy.

Ilana Ressler, MD, FACOG

Dr. Ilana Ressler is a board-certified OB/GYN and reproductive endocrinologist who joined the Illume Fertility team in 2017. Dr. Ressler has a special interest in treating patients with PCOS and advocating for ovarian and breast cancer awareness in the Jewish community through her advocacy work.

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