We don’t often think that religion and fertility are connected, but for some patients undergoing fertility treatments consideration of the attitudes that their religion has towards assisted conception can be significant. The post below focuses on judaism and fertility and is an extract from the paper “Religious attitudes to gamete donation”.
‘Be fruitful and multiply and fill the earth’ (Genesis 1:28) was the first commandment given to Adam after he was created. Similarly ‘He did not create the world to be desolate but rather inhabited’ (Isaiah 45:18) is a further basis for the importance of fertility for orthodox Jews. Rachel, the matriarch, declared to Jacob,’ Give me children, otherwise I am dead’ (Genesis 30:1). Indeed, these may account for the very liberal laws regarding infertility treatment in Israel,
Unlike secular Jews, orthodox Jews have some limitations regarding reproduction. Orthodox women are not allowed to have sexual contact with their husbands during menstruation and for seven days after the bleeding stops, after which they take the ritual bath and become ‘clean’ again. For the majority of women, this strictly kept law is not a problem but for those with a short cycle in whom ovulation occurs before the ritual bath, pregnancy is obviously out of the question. The only way round this situation is to delay ovulation which has been done using estrogens, clomifene and even GnRH agonists. The irony is that this law was designed to encourage fertility and ‘save’ the sperm until the fertile window.
Artificial insemination with donor sperm is generally frowned upon. Although not regarded as adultery, it is generally discour- aged. Egg donation is generally rejected outright although it is condoned by some if the husband consents. It is the question of who is the mother according to Jewish law which has created a fascinating philosophical discussion, as yet unanswered.
Interpretation of biblical writings and Jewish law into 21stcentury reproductive technology is attempting to keep up with the pace of progress. An account of these interpretations is made all the more complicated by the fact that the Jewish religion today, in addition to orthodox Judaism, has Conservative, Reform and Liberal branches. Furthermore, the state of Israel has laws which bind its, mainly Jewish, population. The following is an attempt to relate to the diversity of opinion on donor gametes within the Jewish religion.
When the husband’s sperm and the wife’s eggs are used, there is general rabbinical agreement that in-vitro fertilization (IVF) is permissible in accordance with Jewish law (halacha).
There are some caveats involved in this agreement. The procurement of a sperm sample is problematical as’ spilling of seed in vain’ is prohibited. This is usually overcome as a sperm sample for the purposes of IVF is regarded as pro-creative and not wasted. Sampling semen for a laboratory examination is, however, inadmissible for the strictly orthodox. As this examination is such an essential part of the initial infertility investigations, semen may be obtained from the vagina or from a condom with a pin-pricked hole in it, both following normal sexual intercourse.
An almost obsessive demand for the establishment of paternity and lineage, assumed for a baby conceived naturally but not assumed in the IVF laboratory by orthodox Jewish couples, presents a problem. Despite the fact that the vast majority of IVF centres are meticulous in their identification of the sperm, eggs and embryos, strictly orthodox couples demand the presence of a trained observer in the laboratory to oversee the procedures and ensure that they are performed according to the halacha.
In orthodox Judaism, artificial insemination with the husband’s sperm is permissible if the wife cannot become pregnant in any other way. Regarding the use of donor sperm however, opinion is much more divided and it is generally frowned upon. Artificial
insemination by a donor is not thought of as adultery as no sexual relations are involved but is, nevertheless, unacceptable by the vast majority of rabbinical authorities.
The Conservative movement in Judaism, mainly based in the USA, have a slightly more liberal view on AID. They allow donor insemination while stipulating that the use of anonymous donors is strongly discouraged. Most Conservative rabbis prefer that non- Jewish donor sperm be used to prevent ‘adultery’ between a Jewish man and a Jewish woman and to prevent future genetic incest among the offspring of anonymous donors.
Reform Judaism has generally approved artificial insemination by a sperm donor. In all streams of Judaism, the sperm donor is regarded as the father so that the child would not, by Jewish law, be considered the child of the infertile husband.
It is interesting to note that in Jewish orthodox circles, a male (sperm) factor is easily the most prevalent cause of infertility. For infertile couples in these circles, it is surely very good news that the use of intra-cytoplasmic sperm injection (ICSI), an IVF procedure involving direct injection of a single sperm into the egg, is now producing such good results. The need to use donor sperm to resolve severe male infertility is consequently diminishing since the advent of ICSI.
In the orthodox Jewish community, the attitude on whether to permit egg donation is deeply divided. Some rabbis reject this procedure unequivocally while others condone the use of donor eggs if the recipient has her husband’s consent.
The fascinating question of who is the mother in the case of egg donation, the genetic (donor) or gestational/birth (recipient) mother, has unique relevance in the Jewish religion. The determination of who is a Jew depends on whether the mother is Jewish.
If both the genetic and gestational mother are Jewish then, although the question of who is the real mother is debatable, the Jewish identity is not in doubt. However, many infertile Jewish women receive eggs from non-Jewish donors. In this situation even the wisdom of Solomon would probably have a problem deciding whether the baby is regarded as Jewish or not. Other religions do not have the same problem whereas traditional Judaism places great emphasis of the religious status of the baby at birth. This also has an impact in adult life for orthodox Jews as, for example, having a bar-mitzvah or permission to marry.
It is, therefore, not surprising that the debate of who is regarded as the mother following egg donation has generated a good deal of heat, if not light. There are rabbis who consider that the genetic mother is the true mother and if the eggs have been donated by a non-Jewish woman, the more stringent of these contend that the baby should be ‘converted’ to Judaism. Others regard the gestational mother as the true mother and this is also the view of the Conservative stream. For the Reform Jews, this is not a problem as if either the mother or the father is Jewish then the child is regarded as Jewish. Finally, Israeli law categorically states that the gestational mother is the mother of a child born following egg donation for all intents and purposes.
From the wide divergence of opinion expressed within the Jewish religion, it seems clear that the scriptures cannot provide all the answers to the moral and ethical problems posed by the rapid advances in assisted reproductive technology. The opinions are necessarily based on interpretations of the written word which, for all the wisdom therein, could not possibly have anticipated the ‘science fiction’ age in which we live today. The fact that fertility is at the forefront of Jewish philosophy will ensure the continuation of the debates and will continue to provide a source of fascination for those inside and outside this religion.