Abstract: The treatment of infertility caused by Jewish law involves an interplay of halacha and medicine. Halachic consultation to assure that the wife is not unnecessarily prolonging her niddah status should be the first step. Rabbinically approved shortening of the five day minimum may assist women with short duration of menses. Medications that delay ovulation will work in most cases. If this intervention does not lead to conception, standard artificial or intrauterine insemination may be used but requires prior rabbinic consultation.

Discussion: The treatment of infertility caused by Jewish law should include halachic consultation. As outlined under diagnosis, it is important to assure that the wife is in fact niddah for as long as she has related. In stubborn cases of infertility, the rabbi may allow the couple to shorten somewhat the five day minimum normally required before beginning the seven clean days. This dispensation is only helpful, however, for those women who have halachically relevant bleeding of shorter duration than five days.

The next step is to attempt delay of ovulation. Common regimens include:

1. Clomiphene citrate, which tends to delay ovulation [1]
2. Estrogen [2]

If ovulation cannot be delayed, medical insemination prior to mikveh use may be permitted. The procurement of a semen sample raises a number of halachic issues. Because of the importance of procreation in Jewish law, a solution is generally found. However, different rabbinic authorities allow divergent approaches. Therefore, halachic authority needs to be consulted prior to undergoing this procedure.

In addition to standard artificial insemination, intrauterine insemination and in vitro fertilization could also be used. However, one would certainly first try standard artificial insemination as it is less costly (cost is also a halachic consideration) and involves less potentially dangerous medical intervention for the wife, the avoidance of which is also a halachic consideration.

Implications for Patient Care: Involving the couple's halachic authority is an important component of treating infertility caused by Jewish law.

Halachic interventions to allow the woman to immerse earlier should be explored prior to medical manipulation of the cycle.

If medicinal intervention is needed but does not lead to pregnancy, artificial insemination may be approved but needs prior rabbinic consultation.

Medical References

[1] Speroff L, Glass RH, Kase NG. Induction of ovulation in Clinical Gynecologic Endocrinology and Infertility. 6th ed. Philadelphia: Lippincott, Williams & Wilkins, 1999:1101.

[2] Dahan MH, Goldstein J, Ratts V, Odem R. Programming ovulation using estrogen for patients to time intercourse. Obstet Gynecol 2005 May;105(5 Pt 2):1209-10.

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