Shmirat halashon

Someone asked if I want to join a shmirat halashon group that was started on Friday. A woman started the learning in the zechut for a refuah for her husband who was diagnosed with cancer.

I shrugged and said, "Sure, why not?" and became one of 5700 women who joined in less than a week. Whatsapp has a limit of 250 people per group so they had started multiple groups and by the time I joined they were up to more than 20 groups!

I may have exaggerated the pie chart a little.

I know that learning two halachot a day may not eliminate all the LH from daily life but even if this makes a dent it's already a win. It's a true challenge for me because I love juicy gossip. Not so much sharing it, but more knowing insider info on people and happenings.

In the zechut of this learning may this woman's husband have a complete recovery and may we merit to have healthy babies.

Fourth DE shot down. One more before a lining check.

Superfluous fluff: what holds you back?

Last night my husband asked if I ever feel like Judaism holds me back and it sparked an interesting conversation. The question was rather does the fact that we choose to be orthodox and follow halacha make me feel constrained in any way? To answer the question, not really except in one aspect. More on that soon.

For some background, he was learning about the mitzvah of p'ru urvu, literally translated as be fruitful and multiply, referring to the commandment to have children. In order to fulfill this mitzvah, one must have at least one boy and one girl. Anything else doesn't fulfill the mitzvah regardless of how many children or grandchildren one has.

Logically, if one has a genetic mutation that may cause a child to have a fatal disease, one would think that they are exempt from this mitzvah, right? He couldn't find any rav that says that in source. No one will come out and say you're exempt. You have to make the decision whether you want that mitzvah point regardless of how disabled or how slim the chances for survival are for said child.

In our case, we know we have a 50% chance at having a severely disabled child. While we are both normal, healthy adults, our child could come out with significant, possibly fatal defects. There is a spectrum and the disability could be very minor or very awful which would result in the necessity of multiple surgeries and endless stays in the NICU. I can't do that. At a certain point it becomes less about me and my mitzvah and more about this tiny baby coming into the world for a lifetime of pain ahead.

There's no way to know in advance which point on the spectrum the child will land, and it could be different for each child. Back when we were engaged and just learning of all this, we had decided that we would do everything in our power not to get pregnant with a disabled child but that if we did get pregnant naturally, there would be no abortion. Birth control may be a gray area in Judaism, but abortion is nearly black and white. Even if it wasn't, I knew that it's against my own personal belief. I wouldn't be able to handle it mentally and emotionally knowing I was purposely aborting my babies, potentially over and over depending on how many times it took to get pregnant with a healthy baby.

So it bothered my husband that no matter what we do, we may not complete this mitzvah of p'ru urvu and he felt like he can't win. I shared that in my view, we can't win 'em all. They say it takes a village, and in this case I think it can be meant literally. There are 613 mitzvot and we as a tribe can fulfill them all, but there's no way that one person can individually. For example, I said, "I can't be king and you can't be niddah." That's just how the cookie crumbles! Another example I gave was that we have so many friends with only one gender kids - all boys or all girls. They also didn't get the mitzvah point for p'ru urvu because technically they're still missing a gender. It doesn't make their kids any less special or miraculous. At the end of the day they all get married and have their own kids. Everyone fulfills their part and together we get to the 613.

I'm a lot less strict regarding halacha than he is and a lot more laid back about technicalities, so maybe that's why I never feel restricted. There is one thing I feel restricted and that's Survivor. It's my absolute favorite show and I would LOVE to be a contestant on it. But there are too many parts of it that I'm limited by Judaism: Shabbat, tzniut, kashrut, negiah... the list goes on! I would be so good at the strategy and manipulation, I could do puzzles and challenges, make fire, build shelter, find idols, and I would be great at the social aspect of it. But I can't go into a challenge not being able to eat a bug because it's not kosher, or not being able to cast a vote at tribal council because it's Friday night and I'm not supposed to write on Shabbat :) The thought of trying to explain all these limitations to Jeff Probst is hilarious to me. It's a very silly restriction and not really a restriction because I can obviously do without. In short, I don't really feel restricted at all. But I digress.....

I don't care so much about the technicalities of p'ru urvu, possibly because it's not even my mitzvah; it's his responsibility. Even so, I want a baby because I want a child. I understand that he will become a smartass one day and talk back and have tantrums and be expensive and exhausting. I know. I can only imagine how hard it would be, but I also know that the reason I want it can't be described in words.

I was telling my husband I want it all: the bris, the pidyon, the celebration, the parties, etc etc etc. He said not to get our expectations too high because what if there isn't a pidyon and what if we're so disappointed. I said that after all the years of waiting and treatment and then the 9 mos of pregnancy living with heightened anxiety and then surviving the stress of labor, if we are ever zoche to have a healthy baby in our arms, none of that will matter anymore and there is just no way we could be disappointed. I can dream big and hope for the best but we both know that the healthy baby is the important part; everything else is fluff.

IYH soon by us.

Endometrial Receptivity Assay and Halacha

In prep for the ERA biopsy, we looked into whether this procedure would create an issue with regard to halacha.

Because of the nature of the procedure being time sensitive, it is by design scheduled during tahor days. Fertility treatment is already a game of "Red-Light, Green-Light, 1-2-3" with regard to niddah. Beside for the hormones messing with mind and body affecting interest, there's also the tangible issue of hormone-inducing spotting every so often. Taharat hamishpacha is a challenging mitzvah even in the best of times, and even more so when tahor weeks become shorter and shorter.

So I asked whether the procedure itself would render me niddah. Uterine bleeding will almost always result from an endometrial biopsy. Since this bleeding is caused by injury, the opinion of the posek on yoatzot.org, Ravi Henkin, is that it does not render a woman niddah. In addition, for all procedures that enter the uterus, the size of the instrument that enters is also relevant. As long as the catheter used for the endometrial biopsy is smaller than 19mm, the instruments entry into the uterus would not itself make one niddah.

I was told that the bleeding may go on for about a week, and for that time can be attributed to the procedure, but by that point I will have stopped all meds and will be expecting an actual period.

For anyone interested, this website is a great source of information. I love the Yoatzot.org website and appreciate that they are available to answer these questions.

Halacha and IVF

Fertility treatment comes with many questions and decisions. For those who care to follow Jewish law, there's the added element of making sure everything about the treatment follows halacha. In general, my husband and I feel confident enough in our education to make informed decisions with regard to halacha. There are times, however, that either we don't agree on an outcome or we've reached a point where we recognize that it's beyond our knowledge. At that point we ask the Rabbi for some halachic guidance.

 

In this particular case, we had two questions related to IVF that we couldn't agree on* and wanted the Rabbi's input. The two questions were: 

1. Do we need to have supervision for the embryos as is suggested by some?
2. Are we allowed to violate Shabbat for IVF treatment, specifically for the egg retrieval surgery and for shots and monitoring? 

The idea behind having a certified supervisor (aka mashgiach), according to some, is that in order to establish lineage without any doubt, some claim there needs to be a third party supervisor to watch over the eggs/embryos from the time of the egg retrieval until they are put back in at the transfer to ensure that there was no mixing up of the sperm, eggs, or embryos at any point. I was very uncomfortable with the idea of having a "supervisor" having access to the embryos. The clinic we use not only has a professional lab with trained embryologists, but they also have so many checks and balances specifically to avoid this very issue. Forget Jewish lineage issues, they are scared of malpractice lawsuits! It's in their best interests to keep everyone's reproductive material clearly labeled and not mixed up.

 

Before sharing what the Rabbi told us, let me clarify each of our positions. I didn't think there was even a question. I don't see the need for halachic supervision - I trust the clinic and mistakes can happen even with an added random person there watching (would they even know if a mistake was made?). I didn't think it was necessary. Not only is it an added cost but in my opinion it's entirely superfluous and possibly hazardous. With regard to Shabbat, I didn't think there was a question there either. Everything about the treatment is time sensitive so if the egg retrieval needs to happen on Shabbat it's not ideal but it's still going to happen. I'm not going to bust a cycle because of timing, there's just too much at stake! To make things interesting, my husband did not entirely agree with me. He found conflicting texts regarding the halachic supervision and didn't know who believe. In addition, it didn't sit right with him to violate the laws of Shabbat for something that is not technically life threatening.

 

For the sake of shalom bayit, we agreed to look into it. Specifically, I agreed to bend just enough to hear more information. I was vehemently against having a halachic supervisor or postponing for Shabbat. While I was confident in my position, I didn't want to have issues in the future (someone second guessing my child's heritage?) and I was willing to admit that there's a very small chance I was wrong and didn't want to deal with the repercussions for our future kids if that was the case. Mainly because we had the time (this conversation was sparked shortly after our last failed cycle so there was plenty of time to wait for the new year and new insurance to kick in), we agreed to look into it so we can have more information. I contacted an organization in New York to ask questions about the halachic supervision. They were unable to answer any of my questions. In fact, they were surprised I even had questions - they were ready to take my credit card. I was very unhappy with the conversations I had with multiple people there. This organization inspired zero confidence and I was completely turned off by them. Then I took a step back and made an appointment with the Rabbi - let's see if this was even necessary.

 

The meeting with the Rabbi was brief. I shared our questions and the Rabbi asked two follow up questions: where our treatment will be taking place and whether we already have children. His answer to our first question was that no halachic supervision is necessary. The reasoning he gave was that it was a trusted clinic with advanced technology which makes an added person unnecessary. He said that halachic supervision is something that is done in Israel but many poskim have ruled that it is not necessary in the USA.

As for the second question about Shabbat, the answer was simply that if it was possible to work it out that the retrieval will be on any other day then that is preferable. If it absolutely has to be on Shabbat, then it's preferable to stay nearby and walk to the clinic or have a non-Jew drive us there/back so that we ourselves are not violating any of the Shabbat prohibitions. Long story short, it is permissible to have treatment on Shabbat. When I asked the part about it not being pikuach nefesh, the Rabbi said that there is leniency with regard to laws that are derabanan vs those that are d'orita, especially since we don't have children yet and this is to fulfill the mitzvah of p'ru u'rvu. In other words, we can have things done on our behalf as long as we're not violating Shabbat ourselves. With regard to shots and monitoring, it was the same idea: preferable to work around Shabbat if possible, and if it needs to be on Shabbat that it's preferable to have someone else do it for you.

 

Both my husband and I are satisfied with these answers. I'm also happy with the outcome - not only did we look into it but basically nothing is different. Actually, one thing was different: the Rabbi gave us a blessing that the treatment should be successful :)

 

*For the record, our first two cycles did not have supervision and luckily the ERs did not end up on Shabbat. Once we got the second negative beta we did more research and came across the supervision issue which is what sparked the conversations.

Updates

It's only been ten days since the last post but I'm happy to report that there are a few new things that have happened since (progress!): 

• Timeline - I started my CD1 and reported it to my nurse who was able to  give me a timeline for our treatment.  It looks like my baseline is scheduled for 2/9 with an estimated ER on 2/26. It would have worked out a lot better schedule-wise if the ER was during President's Day weekend, but I'm happy to get a date and get started. 
• Insurance - My new benefits have been verified at the clinic - yay!  Finally. It took 3 weeks for that info to come in. Now that it's in, they can submit for authorization for an IVF cycle which may take another two weeks. Still... progress!  
• Medication - Since my benefits were verified I was able to go ahead and schedule a delivery for the fertility medication. We had to work around the epic Blizzard 2016 and the delivery came today.
• Halachic all-clear - We were able to schedule an appointment with the Rabbi which I will elaborate more on in another post. We had specific questions which we needed answered before a cycle started and today we got our answers. This was an ongoing conversation my husband and I have discussed almost daily and finally having a resolution puts the issue to rest and gives peace of mind. 

Even though the current schedule puts a transfer later than I wanted, I'm still glad we're moving forward. I'm praying for a successful cycle with embryos to transfer and not a repeat of disastrous IVF #2 where none of the embryos were viable. Late is still better than nothing, so I'll take it, and if it works the extra 6 weeks won't matter in the long run.