When a young Orthodox Jewish girl opens the chapter of dating, she first focuses on finding ‘Mr. Right,’ as does every young woman. But, as time goes by, the question of ‘when will I find Mr. Right?’ starts to morph into ‘will I ever be a mother? The pressure of the biological clock adds to the already present social and societal pressures for finding Mr. Right. Meanwhile, as the search for Mr. Right continues, fertility slowly starts to decline.
In Orthodox Jewish circles, early marriages and large families are the norm. Girls and boys are raised in separate schools and avoid mixing with the opposite gender until the time arrives to officially begin dating. Dating commences early, soon after high school (18 yrs/old for women and early 20’s for men). Dating is oriented towards marriage, as family is the foundation of the Orthodox Jewish way of life. Unfortunately, at present, single religious women are going through a crisis of sorts as there are significantly more single women than single men. This imbalance leaves many young women single late into their 30’s and 40’s, a problem the orthodox community is grappling with and trying to solve, although it is unclear how it started in the first place. Dating in the mid 30’s to late 40’s leaves women and any potential partner they meet unsure of whether to ignore or address potential fertility issues that may occur with the ‘older’ single woman. Does one bring it up while dating? Is it timely and appropriate to deal with while dating or should the focus be more on the relationship, and fertility left in the hands of God?
Women often ponder these questions about their fertility. It is established that after the age of 35, the average woman begins experiencing a progressive decline in her chances of achieving a healthy pregnancy. This stems from a quantitative and qualitative decline in the available supply of eggs - the ovarian reserve - which can become precipitous after this age. However, actually addressing the issue may also bring forth multiple questions. One such question is, should a woman electively freeze her eggs to preserve her fertility? In addition to the logistical, emotional and financial issues, an Orthodox Jewish woman may need to face ethical and religious dilemmas.
One dilemma is with the actual surgical procedure. The surgical egg retrieval process involved in egg freezing is invasive for a woman; for an observant Jewess this can be emotionally invasive, because eggs are removed though the vagina, an obvious problem for women who are typically celibate until marriage. Furthermore, undergoing an elective surgical procedure under general anesthesia, which is part of elective egg freezing, poses two potential problems in Jewish Law: 1) issues of ‘self endangerment,’ meaning putting oneself in a situation that can potentially bring harm to oneself, and 2) issues of ‘self injury,’ meaning causing bleeding/harm to one’s body. There is a generally accepted opinion cited in the Talmud (the collection of Jewish law and tradition commonly referred to as rabbinic law) that one may rely on God to protect a person from the risks inherent in generally accepted practices. If one believes that egg freezing has minimal risk and that this risk is assumed for the sake of fertility preservation, a rabbi may conclude that undergoing the procedure does not fall under the category of ‘self endangerment,’ as God protects us from common risks. Regarding the subject of ‘self injury,’ the surgical procedure egg retrieval does cause bleeding. However, Jewish law expounds on this. Many rabbinical authorities allow egg freezing, as the process can help remove oneself from the psychological pain of fertility decline, and, as such, prevent injury to oneself. Furthermore, the egg retrieval process is not a self inflicted or degrading pain, and is therefore permissible. There are, of course, counter-arguments, and other religious authorities feel that egg freezing falls into the aforementioned category of prohibitions and is therefore proscribed.
In attempt to prioritize egg freezing as a back-up and not an insurance, preliminary testing must take place. The pre-oocyte cryopreservation testing requires the usual initial fertility work-up: AMH testing, basal FSH testing, and transvaginal ultrasound, all of which are a part of the initial work-up that may reveal several other factors about a woman’s health and fertility. Factors such as diminished ovarian reserve or endometriosis, which inhibit fertility, would be additional elements of concern. Ideally, a woman should freeze her eggs when her ovarian reserve is highest and fertility potential strongest – i.e. in her 20's. Many rabbis who recommend egg freezing suggest doing so between the ages of 32 and 35 years old; 35 being considered the late end, or to freeze earlier if there are known fertility issues. It is also recommended that a woman have the procedure done under the auspices of a rabbi, as doing so would dissuade her from eventually having her eggs fertilized using a sperm donor, an issue which is highly controversial in orthodox circles.
The Jewish tradition involves a continuous analysis of precedent law to adjust ancient tradition to the challenges of modern day life. Orthodox Jewish authorities continuously dialogue to analyze new situations that arise, including those that impact the lineage of the Jewish people. Many Orthodox Jewish community leaders along with ASRM (American Society for Reproductive Medicine) see the benefits of elective egg freezing at a certain point in a woman’s life, but emphasize that this must not be misconstrued as a guaranteed “insurance” against future infertility.
'Kate Silverman' is a pseudonym used to protect the privacy of the author, an IVF Coordinator at GENESIS Fertility and Reproductive Medicine in Brooklyn, NY.