A number of medical techniques exist that help infertile couples have a child. One of these techniques is In Vitro Fertilization (IVF). What is this technique, what does it involve and what are the halachic issues that need to be considered?
Defining In Vitro Fertilization (IVF)
If IUI has been performed several times without success, or in cases where IUI is not an option, either due to age, quality of sperm, or blocked fallopian tubes, the best treatment is in vitro fertilization (IVF). In IVF, the meeting between sperm and egg takes place outside of the body, in the fertility laboratory (“vitro” means glass in Latin, referring to the material of a test tube).
The woman receives hormonal stimulation using shots, and she is monitored the optimum time for her egg retrieval. She then receives a final injection and 36 hours later comes to the clinic for the retrieval. At this time the sperm is also brought to the lab. The sperm sample is obtained through the method already described using the condom. The eggs are then extracted from the woman’s ovary using a long needle inserted through the vagina.
The eggs and sperm are then either left together a Petri dish to fertilize together, or sperm cells are injected into the egg in a process called intracytoplasmic sperm injection (ICSI). The following day the eggs are monitored to see whether they have fertilized; the next day a number of fertilized eggs are implanted in the uterus. Usually, the treatment also includes drugs for the woman to increase the likelihood of successful implantation.
Sometimes the eggs will be left until the fifth day, until a stage of development called the blastocyst and will then be implanted. Two weeks later a pregnancy test is performed to see whether a pregnancy has been achieved.
The entire process requires outside supervision. The outside supervisor is present throughout.
Halachic Considerations: Niddah
The actual egg retrieval does not usually render a woman a niddah as the bleeding comes form the vagina, not the uterus. If there was abnormal bleeding a Rav should be consulted. Implantation should also not make a woman niddah, as the bleeding is usually cervical and not uterine. Again, when in doubt a Rav should be consulted.
Whenever possible, all efforts should be made to administer the hormone treatment prior to the IVF in such a way that the woman will not ovulate before her immersion in the mikveh. If despite all these efforts the ovulation occurs before the mikveh, then there is nevertheless no halachic problem with taking out the eggs; the sperm sample can be retrieved using the same method referred to above.
If the implantation falls before the mikveh, then it is better to delay this treatment and only afterwards to implant the fertilized eggs, as there are opinions that implanting the eggs before the mikveh will make the child a ben niddah. However, many poskim disagree and rule that where it is essential, the eggs can be implanted before the mikveh.
Halachic Considerations: Be fruitful
While the commandment of being “fruitful and multiply” is of foremost importance the question arises as to whether this requirement is fulfilled by having children or by fathering them only in the regular “natural” way, in which case having children born through insemination or in vitro fertilization would not be a fulfilment of this halachic requirement. This question of whether one fulfils their obligation to “be fruitful and multiply” through IUI or IVF has been debated widely by different poskim.
While many poskim do accept that any child born through IUI or IVF fulfils the obligation of having children, Rabbi Yaakov Breisch1ruled that not only does the couple not fulfill their obligation to have children, but the wife is considered childless and even if she were to have several children through IUI or IVF, were the husband to die she would be have to undergo yibbum (levirate marriage) or, more likely, chalitzah2, like any widow of a childless man.
It is clear, though, that most couples do not have children simply to fulfill their halachic obligation, but as they have an existential need to have children, and as previously stated, this is of supreme importance when counselling couples in this area.