Infertility, IVF, Embryonic Stem Cells, Ovary Transplantation, and Judaism

The Jewish views on IVF and modern reproductive technology issues are therefore readily deducible. According to the Talmud, the soul does not enter the embryo until 40 days after conception. Furthermore, we all have an obligation to have offspring and to “be fruitful and multiply.” IVF is absolutely obligatory when it is medically indicated in order for a couple to have children. It is not just allowable, but it is obligatory. Preimplantation genetic diagnosis (PGD) represents no moral or ethical risk, because the soul has not yet entered the embryo. Selective reduction of a multiple pregnancy is acceptable if its goal is to enhance the possibility of life. Embryo research to promote life is, therefore, acceptable. Not only is therapeutic cloning acceptable but it is an obligation to do any research which can enhance and promote life-saving treatment such as stem cell and cellular replacement therapy. In orthodox Judaism, which is otherwise a “right to life” and anti-abortion religion, the early embryo does not yet have a soul and so is not yet a person. Nonetheless it cannot be just discarded for no reason, because it is a step toward the commandment “be fruitful and multiply.” But it would not be considered murder to utilize an early embryo for research that might eventually save lives.

Commandments in Conflict

The Talmud specifically forbids “cutting the sperm ducts” [9, 10]. But yet the Torah insists “be fruitful and multiply.” So if we are not allowed to cut the sperm ducts, and yet we are obligated to do whatever we can to have children, what about “MESA” and what about “TESE (i.e., microsurgical sperm retrieval procedures)?” These are procedures that allow us to retrieve sperm from men who are otherwise sterile, in order to perform IVF and give them children. Modern Talmud scholars, universally respected orthodox Rabbinical minds, have weighed this conflict and decided that the first commandment “to be fruitful and multiply” takes priority over the commandment not to “cut the sperm ducts.” Therefore, MESA and TESE are fully allowable and, in fact, mandatory (Rabbi Y.S. Eliyashiv and Rabbi Dovid Morgenstern, 2009, oral decision, Personal communication).

Such a decision, based on a clear conflict between two commandments is referred to as a “leniency.” In other words, the rabbis are not really happy about the prospect of an apparent violation of a Torah commandment, but it is understood that God’s intention in the commandment to avoid cutting the sperm ducts was meant to be a corollary of “be fruitful and multiply,” and not to be a prohibition against doing whatever you can to “be fruitful and multiply.” Nonetheless, because it is just a “leniency,” once the couple has had a boy and a girl, they are not allowed to have any further sperm retrieval procedures which would “cut the sperm ducts.” For this reason it is important that the first such procedure on any orthodox Jewish couple retrieves and safely freezes all the sperm they will ever need for as many future babies as they might wish to have.

Controversial Issues Such as Donor Gametes

Most rabbinic authorities forbid either egg or sperm donation (Rabbi Y.S. Eliyashiv and Rabbi Dovid Morgenstern, 2009, oral decision, Personal communication). The reason is that Jews are commanded “to build a wall” around the sacred marital bond. Women cannot even touch via handshake another man. The same is true of course for men, who cannot even shake the hand of another woman, unless it is his wife or blood relative. Also men and women must dress modestly so as not to invite any sort of flirtatious breach of that marital firewall. However, what if the only way to fulfill the first commandment, “be fruitful and multiply” is donor gametes?

The great legal orthodox Jewish minds are very cautious on this issue. Many orthodox Jews assume that donor gametes are not allowable and do not even think to engage in detailed, syllogistic scrutiny of this issue. Therefore, most rabbinic authorities generally do not allow either donor sperm or donor eggs. There is no clear injunction in the Torah against donor sperm or donor eggs, and there is a clear imperative to “be fruitful and multiply.” In fact, the imperative to “be fruitful and multiply” is so strong that prior to modern reproductive technology, divorce (which is generally shunned among orthodox Jews) would be allowed if the couple were infertile, just to allow them the chance to try via a different marital partner to have children.

One way for the couple who needs donor gametes to solve this issue is to search “for the right rabbi” who will go through the details of this complex issue with them privately and perhaps favorably. The issue is complicated and complex, and one of the greatest conflicts in all of orthodox Judaism arose out of this issue. The most respected orthodox Jewish mind of the twentieth century was Rabbi Moshe Feinstein (1975, oral decision, Personal communication). Unfortunately he passed away, but his views (however, radical seeming) were generally regarded by orthodox Jews, no matter what their hesitation, as the correct guidelines. His knowledge and his reasoning were considered to be vaster than any other rabbi in the later twentieth century. He never had a chance to make a ruling on donor eggs, but he felt the use of donor sperm was a private matter for the couple to decide, and in certain situations it would be recommended in order to fulfill the first commandment as well as to keep the marriage together. Despite his favorable opinion, there is a universal sentiment among most orthodox rabbis against any use of donor gametes. When you press the rabbinic students on why there is this almost universal disagreement on this one issue with the otherwise unassailable Rabbi Moshe Feinstein, they answer that sperm donation is just going too far. Despite his great logic, and despite Judaism’s emphasis on rationality, most of the great rabbis today simply do not accept Rabbi Feinstein’s favorable ruling on gamete donation.

Ovary (and Testicle) Transplantation

Ovary (and testicle) transplantation solves this dilemma of gamete donation for orthodox Jews and is very helpful for physicians to understand when counseling patients with ovarian failure who cannot have egg donation for religious reasons. Ovary transplantation is currently an important tool for orthodox rabbis’ in helping women with premature ovarian failure as well as for cancer patients who are candidates for fertility preservation. Our work in this arena began with a series of discordant identical twins (one had no eggs at all and the other had two normal ovaries and was quite fertile), we transplanted ovarian tissue from the fertile twin to the sterile twin, and in all cases normal reproductive function ensued, with all natural conception and pregnancy following. So far frozen ovarian tissue has performed as well as fresh. Freezing ovarian tissue in cancer patients who will otherwise be rendered sterile from their treatment is the current technology at the center of our effort to preserve the fertility of young women so that they can have biological children. Transplanting this tissue back to the same woman does not seem to raise any objections within Judaism. But what about transplanting tissue from one woman to another who is in ovarian failure in lieu of egg donation?

The most severe orthodox rabbis fully approve of this approach to gamete donation (Oral Decision – Eliyashiv and Morgenstern, 2009, Personal communication). Although egg donation is not allowed, ovary tissue donation is allowed. Neither the rabbis nor the patients are fooled into thinking that the DNA of the child comes from anyone but the donor. There is no delusion on that point. They know full well that from a genetic point of view, this is no different from egg donation. However, from a spiritual perspective, the egg is being ovulated within the body of the intended mother and that makes all the difference. The DNA is not the major issue with gamete donation, but rather the possible intrusion past the safety firewall that orthodox Jews must build around the sanctity of the marriage. So as long as the ovulation is taking place inside the wife’s body, ovarian tissue transplantation is consistent with the severest Jewish law, even if the DNA is not hers. The soul of the baby does not enter until approximately 6 weeks of fetal life, and therefore is in a sense independent of the DNA.