The following questions are common questions about diagnosis and treatment our counselors receive while working with couples.
Answer: The standard answer to that question is that a couple who have been trying to get pregnant for twelve months unsuccessfully should turn to professional help and start testing. The rationale behind this is that the chances of getting pregnant each month are about 20-25%; in addition many women do not ovulate each month, or ovulation may have been missed; therefore twelve months of trying is a good standard.
However, this answer needs to be qualified, in that there are many cases when a Rav would suggest that a couple consult a doctor before 12 months. If there is a known medical history, or exposure to harmful medications, if the couple are older, and if there is some question regarding the timing of ovulation a couple may want to resort to a doctor earlier.
Any couple who has a question may turn to the Puah Institute.
Answer: First of all please understand, fertility problems are very common and some 15 – 20% of all couples experience some fertility problems.
How do we define a fertility problem? The most common definition that has been adopted by fertility associations world wide, is that if a couple have been trying to get pregnant for one year unsuccessfully then they are suffering from infertility. This needs some explaining as to how the number of one year was arrived at.
The biology of conception is extremely complex and requires a meeting between sperm and egg cells at exactly the right time and in the best conditions. The chances of getting pregnant even with optimal conditions is still only about 20% each month. Therefore it is almost a miracle that any of us are born, as it is more likely not to happen than to happen.
Since the chances are around 20% each month, unless a couple has been trying for at least six months we cannot say that they have a problem as they are still within the statistical average. However, this would suggest that six months is sufficient, yet the standard is twelve months. This is because it is not clear that each woman ovulates every month, in fact she may only ovulate every other month; in addition, the timing may not have been perfect each month etc. Since these less than perfect conditions affect the chances of getting pregnant, the standard figure is twelve months of trying.
Of course, this is not a hard and fast rule and many other factors have to be taken into account. For example, since female fertility decreases quite dramatically with age, when the couple got married a little later in life they can and should be encouraged to embark on testing and treatment earlier, and should not wait the twelve months. The same would be true for a couple in which at least one of them has a medical history that may affect their fertility, or if they did not have children in a previous marriage.
On the converse, a young healthy couple with no previous history need not start getting anxious and run to treatment on their first wedding anniversary, especially in a case where we know that there were not optimal conditions for some of that year, e.g. the husband was in the army or was ill etc.
In summary, the standard for determining a fertility problem is a couple who have been trying unsuccessfully to get pregnant for twelve months; however, each case must be examined individually in order to best advise and counsel each specific couple.
Answer: We said in our last article that a couple should try to get pregnant on their own for at least twelve months before turning to a doctor. If a young and otherwise healthy couple asks a Rav should they start treatment before twelve months he may not allow it.
There are occasions when a Rav may suggest that a couple hold off from fertility testing even after twelve months have passed. For example, in a case where there were intimacy issues during those twelve months, the Rav may decided that the couple need to concentrate on this first, before going to a reproductive specialist.
Stress is also a major factor affecting fertility. If the Rav perceives that the major issue for a couple is stress he may suggest that they try to work on that first.
It should be noted that fertility testing itself can increase stress and put an extra strain on a young marriage.
Answer: The problem with male testing is the prohibition against wasting seed, which is a Torah prohibition, according to most opinions and is considered to be a very severe prohibition (see Shulchan Aruch, Ever HaEzer 23:1). However, we cannot ignore the fact that around 40% of fertility problems are male factor. In fact, in the religious Jewish community this percentage may be even higher.
Therefore, it is preferable to perform all non-invasive testing on the wife first, before testing the husband. I suggest that you contact me directly to see exactly which tests I mean.
There are ways to test the husband which are preferable according to the halacha, but again, I can discuss these methods with you directly.
If your husband has a former problem, or has been exposed to radiation or other things that adversely affect male fertility then it may be in order to test him at an earlier stage.