Fertilizing the Halakha

Jerusalem's Puah Institute offers advice on the latest fertility treatment in tune with religious law. Ha'aretz meets its Anglo counselor Rabbi Gideon Weitzman.

What can the Torah tell us about sperm donation? What do the chief rabbis say about Intra-Uterine Insemination (IUI) or egg donation? What steps must be taken for In-Vitro Fertilization (IVF) to be accepted under halakha (Jewish law)?

"No one else is really talking much about these things," says Rabbi Gideon Weitzman of the topics he spends much of his week discussing. Indeed, experts in the field of fertility treatment and halakha are hard to come by and the issues are complex and extremely sensitive. But Weitzman, head of the English-speaking section of the Puah Institute in Jerusalem - the only non-clinical organization in the world which deals with fertility and halakha - is very used to discussing "these things."

As one of eight rabbis at the institute who provides counseling to infertile - mostly religious - couples, British-born Weitzman says constant developments within fertility medicine mean the need for expert guidance is growing.

Between them, the institute's rabbis provide support and guidance to more than 100 couples a day, sometimes face-to-face and often on the telephone.

Weitzman says the counseling service, which is free, offers a supportive, listening ear and helps couples work out a "game plan" - a program of fertility treatment they can pursue, which is both acceptable according to halakha and reflects the couple's particular medical histories.

Sometimes he refers couples to particular doctors or hospitals (usually non-private) which specialize in the treatment they are seeking or he suggests medical procedures which may have been bypassed, such as an HSG (an X-ray of the uterus) or in-depth sperm analysis. Weitzman can also act as a liaison between the couple and their rabbi or doctor. Conflict is rare, he says, because "we all have the same goal - we all want the couple have a baby."

On occasions, Weitzman has informed rabbis of precedents they were unaware of, worked with couples who were "on their way to IVF" when in fact sexual dysfunction was the cause of infertility, and he has reexplained medical procedures to couples that had misunderstood first time around. Weitzman says he sometimes cautions couples before they embark on certain treatments - and he takes care never to give false hopes.

The couples who seek help at the institute range from anxious newlyweds, who have failed to become pregnant after a year, to those depressed and exhausted after several rounds of IVF. Weitzman says the desire or "even existential need" of some people to have children can not be underestimated.

He believes the fact that the Puah Institute's staff are not doctors - and the center does not provide clinical treatment - frees them up to spend more time "on the people, not the process," something doctors often lack the time to do.

The Puah Institute was founded 12 years ago by Rabbi Menachem Burstein, a world renowned halakhic authority on issues of medicine and science, following a request by then Sephardi Chief Rabbi Mordechai Eliyahu.

Developments in fertility medicine had opened up the options for many childless couples, yet the treatments raised halakhic questions, which - left unanswered - deterred many religious couples from embarking on them.

As fertility treatments are not clearly written about in the Torah, says Weitzman, rabbis require detailed medical information to inform their halakhic decisions. The institute helps provide this through lectures, seminars, tours of fertility units and regular meetings with rabbinical authorities. As new developments are continual, Weitzman says, the flow of information is ongoing, sometimes even on a day-to-day basis.

This year, the institute - which is funded largely by private donations - organized its first annual conference for rabbis and rabbinical students. The topics of contraception and egg donation were discussed from the ethical, medical and halakhic perspectives and both medical experts in the fertility field and prominent halakhic figures attended. A second conference, slated for January 2002, will focus on testing during pregnancy and male fertility.

Through contact with the institute, rabbis can receive up-to-date information on what is medically available and consider the halakhic ramifications and precendents. Weitzman says sperm donation, egg donation and surrogacy are the most problematic fertility treatments available from the halakhic standpoint, yet all have been employed by religious couples with approval of some religious authorities.

The halakhic problems, he says, relate to questions of parenthood, "changing the natural order" and the definition of adultery. A conclusive decision acceptable to all rabbinical authorities has not yet been reached.

Sperm donation to a single woman is something Weitzman has found the large majority of (Orthodox) rabbis to be against. Yet with IVF, many of the halakhic concerns have been resolved. Fears resulting from a series of high profile mix-ups in laboratories (e.g. embryos implanted in the wrong woman) have been quelled by the institute's solution of providing halakhic supervision in the laboratories (see box).

The institute staff also provide halakhic consultation to medical professionals, with the goal of improving the services hospitals offer to their religious patients.

Weitzman says that many non-religious couples also seek guidance at the institute. He welcomes this - and has also counseled several Christian and Muslim couples - although when advising Jews, he says that, as a rabbi, he will not "advise something against the halakha." But nor will he make any religious demands of the institute's clients.

As to whether he would counsel an unmarried or gay couple or individual, Weitzman says would depend on "what exactly they were asking." There is no official policy, he says, and "no one gets turned away" from the institute. He says, in his two and half years at the center, no lesbian couples have ever come to him for advice.

With a small Puah Institute office in New York, Weitzman sometimes lectures and provides counseling to religious American couples while in the United States. He says the costs involved in fertility treatments there make advising couples more problematic. He says he "feels terrible" sending people to embark on treatments which costs $30,000 and this makes him appreciate the situation in Israel, where almost unlimited fertility treatment to enable two children is provided at minimal cost.

It is the level of government subsidy for fertility treatment in Israel that has enabled Puah to grow, says Weitzman, as well as the enabling the births of numerous children that would otherwise have been unthinkable, including children born during the 11th round of IVF.

The Puah stamp of approval

Until recently some rabbis refused to view In-Vitro Fertilization (IVF) as acceptable under Jewish law. One of the major concerns in determining whether IVF should be permissible centered on the possibility of mistakes and mix-ups occuring in the laboratory as a result of human error, which could endanger the halakhic (as well as genetic) connection between the parents and their child.

In the United States, a white couple gave birth after IVF to a black baby following a laboratory mix-up. This and other high profile cases of errors deterred rabbis from granting their approval to IVF and other treatments which involved storing sperm or eggs.

The Puah Institute provided a solution to satisfy these rabbis: The institute sends specially trained supervisors to oversee procedures in laboratories - similar to kashrut inspectors who supervise the preparation of food - to guarantee mistakes are not made. Rabbi Gideon Weitzman reports that, since the supervisors began operating about five years ago, 19 mistakes have been prevented - the large majority of them in Israel.

The supervisors - mainly ultra-Orthodox women, because it is mostly women who work in laboratories and receive treatment - are accepted by all rabbinical authorities, a factor Weitzman regards as the Puah Institute's biggest achievement.

Without this consensus, he says, children might grow up to be considered by some as Jewish only according to Agudat Yisrael's rabbinical court or another rabbinical authority.

Today, this supervision is automatic in three hospitals in Israel (Bikur Holim in Jerusalem, Hasharon Hospital in Petah Tikva and the Rebecca Sieff Hospital in Safed) and can be arranged in a large number of other Israeli hospitals, plus selected hospitals in the United States and one in Paris. The cost in Israel is heavily subsidized by the institute and the couple pays about NIS 100 each day the supervision is required (usually one day for IUI and a few days for IVF).

Weitzman says supervision should soon also be available in Britain. "If we need a halakhic hekhsher (kosher stamp) on food," he asks, "how much more important is it for children?" (Charlotte Hall)

The Puah Institute, 19 Azriel St., Givat Shaul, Jerusalem, (02) 6515050. English e-mail enquiries to: machonpuah@hotmail.com