Fertility Treatment or Testing on Shabbat

Information Sheet: Diagnosis & Treatment on Shabbat

What treatments are permitted on Shabbat? What tests can be done on Shabbat? Is there a difference between the way treatment should performed on Shabbat as opposed to any other day?

There is some discussion among the Rabbis as to the halachic status of couples experiencing fertility issues. Some rabbis are of the opinion that such couples are considered slightly ill, since they are not actually suffering from a specific medical condition. However, most Rabbis do consider them to be ill, even though their lives are not in danger.

It is essential to note that a sick person suffering from a non-life threatening condition is 

• permitted to take medicine
• permitted to transgress certain rabbinic prohibitions for the purpose of treatment
• permitted on Shabbat to ask a non-Jew to perform certain types of work for him for the purpose of treatment

In light of this most authorities will permit certain tests and treatments on the Sabbath or festivals.

Monitoring Ovulation

There are three basic methods to test ovulation

1. Basal Body Temperature (BBT): Normally one is prohibited from measuring their temperature on Shabbat as it falls in the category of "measuring". Measuring for the purpose of mitzvah is permitted. In this case, measuring BBT to achieve pregnancy is part of the mitzvah of procreation. It is therefore permitted on Shabbat (only when using a non-digital thermometer).
2. Home Ovulation Testing Kit: The urinalysis strips used in this test change color to indicate ovulation. Normally one is prohibited from coloring on Shabbat as it falls in the category of "dyeing". Since the strip is immediately discarded, this type of coloring is a rabbinic prohibition. It is therefore permitted, as noted above.
3. Blood Test and Ultrasound (US): The drawing of blood on Shabbat is a Torah prohibition. US involves the use of electricity, which is also prohibited on Shabbat. Since there are permissible methods of achieving the desired information, this method is not permitted on Shabbat.
4. Other Tests: Most other types of evaluation testing are not time specific. Whenever testing can be performed during the week it is prohibited on Shabbat.

Ovulation Induction

• Clomiphene Citrate: Taking medication is normally prohibited on Shabbat. As stated above one who is ill can take medication to treat their illness, in this case fertility. As such clomiphene citrate or other such fertility medications can be taken on Shabbat. One should be careful not to tear the letters on the wrapping on Shabbat and it is advisable to prepare the tablets before Shabbat when possible.
• Injections: There are several halachic issues involved with administering injections on Shabbat.
  • Taking medication on Shabbat: Permitted. Same explanation as clomiphene citrate.
  • Drawing blood: As noted above, drawing blood on Shabbat is prohibited by the Torah. At the present all injections for ovulation induction are intramuscular or subcutaneous and do not require the drawing of blood. Therefore this Torah prohibition does not apply.
  • Assembling the needle: This falls into the category of building a vessel and is prohibited on Shabbat. Therefore when possible the needle should be attached to the vial before Shabbat. One should be careful not to compromise the sterile environment that is essential for treatment. In cases where this is impossible a non-Jew can be asked to assemble the needle or it can be done in an unusual way. Please consult your Rabbi or a Puah counselor in such a case.
  • Sterilizing the injection site: One may not use cotton wool dipped in alcohol to clean the site of the injection, which is included in the prohibition of "squeezing". One should use a pre-prepared alcohol swab of synthetic material, or pour alcohol directly onto the skin and then wipe off the excess with cotton.

In light of the above, it is preferable not to administer injections unless this is absolutely necessary on Shabbat. When possible they should be administered before and after Shabbat. If this is impossible, it is preferable for a non-Jew to give the injection. In a case where no other possibility exists, the injections may be given by a Jew on Shabbat as described above.
 
Chorionic gonadotropin (hCG) injections need to be given at a particular time. In the case where the injection must be given on Shabbat. As above, it is preferable that this should be done by a non-Jew, but when this is impossible even a Jew may do so as described above.

Receiving an injection on Yom Kippur appears to be permitted and is not considered in the category of eating.

Intrauterine Insemination (IUI)

Sperm preparation for intrauterine insemination involves a number of actions that are forbidden on Shabbat such as the use of electricity and the separation of the sperm. It is preferable not to undergo such treatment on Shabbat. Therefore, when embarking on treatment the couple must inform their doctor that he must schedule their treatment such that it will not fall on Shabbat.

However, since an IUI must be performed to coincide with ovulation this cannot always be avoided. In such a case the couple must consult their Rabbi or a Puah counselor.  

All fertility treatments involving processing eggs, sperm or embryos require close rabbinic supervision. The supervisor must be available to come to the laboratory on Shabbat. In places where the clinic is not near a residential Jewish area, this may create extremely grave, and even insurmountable, difficulties.

In-Vitro Fertilization (IVF)

The halachic issues and solutions regarding IVF are similar to those of IUI. IVF involves days that the couple need to be in the clinic and days when the medical staff work on the embryos but the couple need not be in attendance. While all efforts should be made to avoid a retrieval or implantation on Shabbat, it is permissible for a non-Jew to check embryos on Shabbat.

The couple must inform the doctor of these limitations and urge him not to schedule a Thursday, Friday or Shabbat retrieval. When retrieval does fall on Shabbat the couple must consult their Rabbi or a Puah counselor.

When egg transfers fall on Shabbat it can often be pushed off until after Shabbat, or brought forward to a Friday.

Supervision is required for an IVF and this may present problems if the procedure falls on the weekend, since the supervisor must be in attendance throughout the procedure.

Traveling to the Hospital or Clinic on the Sabbath

In the rare cases, such as in a case of ovarian hyperstimulation, where delaying treatment is potentially life-threatening, a woman may travel to the hospital by car on the Sabbath.  However, with regard to all other types of fertility treatment that may be permitted on the Sabbath, many authorities do not permit traveling by car.  In such cases the couple should stay within walking distance of the hospital or clinic over the Shabbat.
Some rabbis hold that it is permitted for a non-Jew to drive a woman to hospital on the Sabbath in order to undergo fertility treatment. It is preferable to make this arrangement with the non-Jew before the Sabbath and the non-Jew should open and close the door of the car if this causes the light to turn on and off.

Festivals

The laws of Shabbat are applicable to all the festivals. One should bear this in mind when scheduling treatment and avoid the times in the year when the festivals occur wherever possible.

Summary

• Couples facing fertility issues are considered by the halachah as ill
• They are permitted to undergo testing and treatment on Shabbat if it is necessary and does not contradict a Torah prohibition
• Halachic considerations are:
  • Ovulation testing
  • Ovulation Induction
  • IUI
  • IVF