Observance of taharat hamishpachah (the laws of family purity) may be responsible for some observant couples experiencing difficulty conceiving children. Some health-care professionals in both the United States and Israel know of this problem and have even given it a name – “Orthodox Infertility.” The problem arises when a woman ovulates before she visits the mikvah (ritual bath).1See Nishmat Avraham (Yoreh Deah 2:116), who notes that women encounter this problem of “Orthodox Infertility” due to one of two distinct causes: either they have very short menstrual cycles, or they bleed for more days than most women (such as bleeding for nine days in a thirty-day cycle). Rav Gidon Weitzman (personal communication) commented that it is important to identify which cause is responsible in each case, as they are treated differently. A couple, generally speaking, is capable of producing a child if they have relations from about two days before the wife’s ovulation until a very brief time after her ovulation. Hence, if a woman cannot visit the mikvah before ovulation, then she will not be able to cohabit with her husband at a time when she can conceive. In this chapter, we summarize how halachic authorities of the past fifty years have grappled with this issue.2Also see Rav Getsel Ellinson and Dr. Mitchell Snyder’s essay in Proceedings of the Association of Orthodox Jewish Scientists (6:157-176), which summarizes this issue’s development until 1980. We also seek to provide some direction for couples who are experiencing this problem.
Background: Seven Clean Days
In order to understand the problem, we must first define the Biblical concepts of nidah and zavah.3For a full introduction to these concepts, see Rav Pinchas Kehati’s commentary to the Mishnah (Arachin 2:1) and Badei Hashulchan (Introduction to 183). Nidah refers to a woman who sees menstrual blood on a day when she expects it to flow (Vayikra 15:19). This flow renders her ritually impure and prohibits relations with her husband for seven days. Even if she continues to see blood all seven days, she may go to the mikvah and purify herself immediately after they end. On the other hand, if a woman sees uterine blood at an unexpected time, then she becomes a zavah. If the bleeding persists for three consecutive days, she must wait until all bleeding ceases. She then counts seven days before she may visit the mikvah (Vayikra 15:25-28). Thus, once a zavah sees blood for three consecutive days, the total time that she remains impure will always last at least three days longer than the seven-day nidah period.
In numerous places in the Gemara (such as Nidah 61a), Rabbi Zeira recounts that Jewish women accepted upon themselves to treat even the slightest drop of blood as if it rendered them zavot. Hence, women wait for all bleeding to stop, and then they count seven “clean” (bloodless) days. The Rambam (Hilchot Issurei Bi’ah 11:1-4) explains that women accepted this stringency - commonly known as chumra deRabbi Zeira - to avoid confusion in distinguishing between expected and unexpected events. Rather than risk transgressing an extremely serious Torah prohibition, Jewish women opted to always wait seven clean days.
The Gemara (Berachot 31a) presents this practice as an example of halachah p’sukah, an undisputed rule. The Ramban (Hilchot Nidah Leramban 1:19) comments:
This stringency that Jewish women have adopted was approved by Chazal, and they accorded it the status of halachah p’sukah in all locales. Therefore, it is never permitted to be lenient about this matter.4The Meiri adopts a similar approach in his commentary to Berachot (31a s.v. Nimtza). The Shach (Yoreh Deah 183:4) also writes, “Chazal always required the counting of the seven clean days.”
Five Additional Days
Following the acceptance of chumra deRabbi Zeira, women could potentially begin counting seven clean days from the first day after they stop seeing blood. However, the Gemara (Nidah 42a) appears to rule that a woman may not count a day towards the required seven clean days if her body releases semen on that day (poletet shichvat zera; see Tosafot, Nidah 33a s.v. Ro’ah). Accordingly, were a couple to have relations shortly before the wife’s menstruation, she would not be able to count clean days until she could be sure that her husband’s semen was no longer in her body.
The majority opinion in the Gemara (Shabbat 86b) asserts that sperm can live inside the woman for three full days. For example, if a couple had relations on Sunday at 12:00 AM, the woman could continue to release live sperm until 12:00 AM Wednesday. In such a situation, the clean days could not commence until Wednesday night even if the woman’s entire menstrual flow started and ceased earlier in the week.
The Terumat Hadeshen (Teshuvot 245) records two additional stringencies that developed during the Middle Ages, which can further delay the start of the seven clean days. Since some couples might have relations just before the onset of menstruation, many Rishonim require all women to wait four days from when they first see blood before they count seven clean days. Even if a particular woman did not cohabit prior to menstruation, they rule that she, too, must wait these four days. The Rama (Yoreh Deah 196:11) codifies their position.
Furthermore, the Terumat Hadeshen adds a fifth day before the clean days may begin. He expresses concern that couples will cohabit immediately after sunset, while thinking that they had relations before sunset. Thus, they will calculate the four days incorrectly. For example, a couple will cohabit Sunday evening and think that it is still late Sunday afternoon. The wife will thus think that she can begin her clean days on Thursday, whereas in reality she had relations on Monday and must thus wait until Friday. In order to avoid confusion, the Terumat Hadeshen requires every woman to wait five days from when bleeding begins, so only the sixth day can count as the first clean day. The Rama (ibid.) accepts this stringency, as well.
In practice, Ashkenazic Jews universally accept the Rama’s ruling and do not begin counting seven clean days until the sixth day after first seeing blood. Rav Ovadia Yosef (Taharat Habayit 2:13:11) permits Sephardic Jews to rely on the Shulchan Aruch and start counting clean days on the fifth day. Nevertheless, Rav Shlomo Levy (in a lecture at Yeshivat Har Etzion) reported that most Sephardic women have traditionally followed the Rama on this issue, and Rav Mordechai Eliyahu (Darchei Taharah p. 138) also rules in accordance with the Rama. Of course, a woman may never begin counting clean days until she stops seeing blood, regardless of how many days have passed.
The Problem
For most women, our present stringencies work out conveniently, as the night of immersion will often correspond to the ideal time for conception. For certain couples, however, ovulation occurs before the night of immersion. After ovulation, sperm cells cannot normally reach the egg, so the window of opportunity for conception has closed. The poskim of the past few decades have addressed which of the aforementioned stringent customs might be waived in order to facilitate immersion before ovulation for these couples.5See Teshuvot Minchat Shlomo (2:70) for Rav Shlomo Zalman Auerbach’s proposed solution, which generated much controversy (see Badei Hashulchan 188:35 and Shiurei Sheivet Halevi 188:3:1).
Response of the Twentieth Century Poskim
Waiving the chumra deRabbi Zeira would enable women who ovulate early to conceive. Without chumra deRabbi Zeira, they could immerse seven days after beginning to see blood, in accordance with the laws of a Biblical nidah. However, virtually all halachic authorities have forbidden this solution. Rav Yosef Dov Soloveitchik (as reported by Rav Aharon Lichtenstein and Rav Yosef Adler), Rav Ovadia Yosef (Taharat Habayit 1:1:6), and Rav Shlomo Zalman Auerbach (Teshuvot Minchat Shlomo 2:70:1:3) all cite the Ramban’s aforementioned comments as proof that we may never waive the requirement for seven clean days, even when it interferes with conception.
One may ask, however, why does the Torah obligation of peru ur’vu (the obligation to have children) not override the rabbinic requirement for seven clean days, in cases where we are certain that the woman is not truly a zavah.6See Gittin 41 regarding the weight of peru ur’vu when it conflicts with a halachic prohibition. Also see Rav Asher Weiss’s and Rav David Lau’s essays in the twenty-third volume of Techumin (pp. 220-222, 231-236) for further discussion of conflicts between peru ur’vu and halachic prohibitions. Rav Moshe Feinstein (Teshuvot Igrot Moshe, Y.D. 1:93) responds that there is no general halachic principle that permits violation of a rabbinic prohibition in order to fulfill a Torah obligation. In fact, the Gemara (Shabbat 130b) teaches that we may not carry a milah knife on Shabbat in an area where the Rabbis forbade carrying, the Biblical mitzvah of circumcision notwithstanding. Similarly, one may not violate the rabbinic prohibition against sprinkling the ashes of a parah adumah (red heifer) on Shabbat, even when this procedure would enable someone who came in contact with a corpse to offer the korban Pesach (Pesachim 92a and Rambam, Hilchot Korban Pesach 6:6).7In Bemidbar 19, the Torah describes the process for purifying someone from the ritual impurity that results from contact with a dead body. This process includes mixing the ashes of a red heifer with other ingredients and sprinkling the mixture on the impure individual. An entire tractate of Mishnah, Masechet Parah, is dedicated to the laws of this process. Rav Moshe thus asserts that in most cases one may not violate a rabbinic prohibition in order to fulfill a Biblical obligation.
Rav Ovadia Yosef (note 6) offers a second approach for why peru ur’vu does not override chumra deRabbi Zeira, based on Tosafot in Gittin (41a s.v. Lisa). He notes that Chazal (Gittin 41) forced the owner of a partially emancipated slave8Someone becomes a partially emancipated slave by being owned by two partners, one of whom frees him. to free him completely, as the slave’s hybrid status would otherwise prevent him from marrying Jews and slaves alike. Tosafot question why the mitzvah of peru ur’vu does not override the prohibition against a partial slave marrying a Jewish woman, thus alleviating the need to free him. They answer that we do not waive this prohibition because an alternative exists to accomplish the goal and violate a less serious prohibition (freeing a Canaanite slave). Rav Ovadia argues that we similarly do not waive the requirement for seven clean days since there are other halachic and medical options that allow the husband to fulfill peru ur’vu without violating it.
Tosafot also point out that women are not obligated in the mitzvah of peru ur’vu (see Yevamot 65b). Accordingly, even if the slave had no other options, we could not permit a Jewish woman to marry him - a sin for her - simply to facilitate his fulfillment of peru ur’vu. Similarly, Rav Ovadia argues, since the woman is not obligated in peru ur’vu, she may not skip counting seven clean days simply to enable her husband to fulfill his mitzvah.
Halachic and Medical Options
Rav Ovadia Yosef (ibid.) and Rav Moshe Feinstein (Teshuvot Igrot Moshe, Even Ha’ezer 2:18) permit artificial insemination using the husband’s sperm, before the wife has immersed in the mikvah.9Regarding the practice of many rabbis to permit this practice only after several years of marriage and unsuccessful attempts at all other methods, see Maharsham (Teshuvot 3:268), Teshuvot Divrei Malkiel (4:107), Teshuvot Tzitz Eliezer (9:51:4:6), Teshuvot Yabia Omer (E.H. 2:1), Teshuvot Yaskil Avdi (E.H. 5:10), Teshuvot Mishpetei Uzziel (2:19), and Nishmat Avraham (3:6-7). Rav Ovadia and Rav Moshe write that the child will not bear the stigma of a ben nidah (child conceived during the nidah period) if it is conceived in this manner.10For the opinions of other authorities regarding this point, see sources cited in Proceedings of the Association of Orthodox Jewish Scientists (6:169 and note 53). The Shulchan Aruch (E.H. 4:13) alludes to the stigma of ben nidah. See Teshuvot Igrot Moshe (E.H. 4:14) and Rav Shimon Eider’s Halachos of Nidah (vol. 1 Chapter 1 note 15), who discuss this stigma and present the position of many contemporary poskim that one should not refrain from marrying someone with fine character traits simply because he or she was conceived during the nidah period. Also see Kehilot Yaakov (Likutim 2:23), Teshuvot Chelkat Yaakov (3:6-7), Teshuvot Minchat Yitzchak (7:107), Teshuvot Sheivet Halevi (4:162), Teshuvot Vehanhagot (1:732-733 and 2:627), and Rav Yehoshua Neuwirth (cited in Nishmat Avraham 5:118). It is important to note that many poskim strongly urge that this process be performed under rabbinical supervision to insure that no tampering or mistakes occur during the process.11Rav Mordechai Eliyahu (reported by Rav Gidon Weitzman) absolutely requires rabbinical supervision for this process.
As an alternative solution to “Orthodox Infertility,” many halachic authorities permit a woman with this problem, subject to certain conditions, to examine herself in the prescribed manner (hefseik taharah) even before five days have passed since the bleeding began.12These authorities include Rav Shlomo Zalman Auerbach (Teshuvot Minchat Shlomo 2:70:1:1), Rav Moshe Feinstein (Teshuvot Igrot Moshe Y.D. 4:17:22), Rav Yosef Dov Soloveitchik (reported by Rav Yosef Adler), and Rav Ovadia Yosef (Taharat Habayit 2:13 note 12). If her examination proves that she has indeed stopped bleeding, then she may immediately begin counting seven days. These authorities believe that the custom to wait five days (or four days for those Sephardic Jews who follow Rav Ovadia Yosef’s view) from the start of the bleeding before beginning to count the seven clean days may be relaxed in order to fulfill the mitzvah of peru ur’vu, as we treat a custom significantly less stringently than a full-fledged rabbinic prohibition.13As we have explained, the five days that a woman waits before a hefseik taharah can be divided into two parts. The first four days, which all Jewish women wait, address the concern that a woman released semen from cohabitation that took place immediately prior to her bleeding. Theoretically, if a woman were to abstain from relations with her husband immediately before she began to bleed, then she should not need to wait these four days. Under normal circumstances, though, our practice nonetheless is to wait these days, as we have already cited from the Terumat Hadeshen. A fifth day, which all Ashkenazic women and many Sephardic women wait, was added to prevent confusion regarding the calculation of four days when a couple cohabited close to sunset. Therefore, in cases where waiting all five days will impede conception, a poseik has two options for helping the woman conceive while violating nothing more than a custom. He may simply waive the fifth day, or he may also advise that the couple abstain from marital relations a certain amount of time before the woman expects to see blood and shorten the four-day period accordingly. In practice, the latter option is difficult to implement, because most women do not stop bleeding quickly enough. Furthermore, Rav Gidon Weitzman reports that Rav Mordechai Eliyahu requires the couple to deliberately abstain from relations for this purpose, but he would not permit a woman experiencing fertility problems to shorten the four-day period if she had coincidentally abstained from relations well before seeing blood. This approach helps solve the problem in those cases where a woman stops bleeding fast enough to permit her to perform an early hefseik taharah.
Another option might be for an especially competent doctor to prescribe medicine that will adjust the wife’s cycle to avoid this problem. Rav Menachem Burstein (in a 2004 lecture at Yeshiva University) mentioned that medications have greatly reduced instances of “Orthodox Infertility.” Care must be taken to insure that this process does not harm her health.
It is important to note that some couples mistakenly believe that the laws of family purity are preventing the wife from conceiving, because the wife believes that she is a nidah when, in fact, she is not. Rav Binyamin Forst (The Laws of Niddah p. 34) explains, “Many women do not suddenly stop staining on the fifth day. It is very common to find a stain on the Hefseik Taharah cloth.” Some women think that every one of these spots is a prohibited stain and thus do not begin the seven clean days when they are in fact permitted to do so. A couple should consult a competent halachic authority regarding this issue, as it might be the reason that the woman is not conceiving.
Home Remedies
Assorted sources have reported varying success in solving this problem with home remedies. Dr. Mordechai Halperin of Jerusalem once stated in a public lecture that he has experienced successful resolution of this problem in some cases simply by instructing the wife to eat breakfast. In fact, I recommended this course of action to a woman who approached me regarding her difficulty conceiving. A few months later, she reported that she conceived soon after she initiated a daily routine of eating a proper breakfast.
Interestingly, the Gemara (Bava Kama 92b) and Shulchan Aruch (Orach Chaim 155:2) urge us to eat breakfast. The Gemara quotes a folk saying, “Sixty people run, but they cannot keep up with one who ate breakfast.” Furthermore, the Gemara (Bava Metzia 107b) states that eighty-three sicknesses are related to malfunctioning of the gall bladder, and eating breakfast can cure all of them. Rav Menachem Burstein (the head of the prestigious Machon Puah in Jerusalem) told me that eating breakfast sometimes solves Orthodox Infertility, because orderly nutritional intake might help bring order to a woman’s cycle.
Other home remedies also exist, and Rav Burstein told me that he has heard reports of limited success with these approaches. These home remedies, however, offer only limited success and have some noteworthy drawbacks. They often take considerable time to take effect, and older couples cannot necessarily afford to wait a year or two in order to see if these remedies will work. Even younger couples, who do not feel the same urgency to conceive immediately, can still experience unhealthy emotional stress in their marriages as their period of infertility continues. Moreover, Dr. Zalman Levine (a noted fertility specialist), Dr. Harry Lieman (a noted fertility specialist) and Dr. David Serur (Associate Prof. of Medicine at Weil-Cornell Medical Center) all pointed out to me that, thus far, no scientific evidence has proven the efficacy of eating breakfast or the other home remedies. Accordingly, it would seem wise to seek out competent medical advice before deciding to attempt home remedies instead of recognized medical procedures.
Conclusion
I have become aware of an urgent need to inform people about this problem and its potential solutions. Rabbis and doctors have told me that appropriate halachic and medical advice can help resolve this problem in almost all cases.
Postscript – Machon Puah
It is very important to bring to the community’s attention a most wonderful resource for Jews throughout the world. Machon Puah in Jerusalem provides halachic guidance to couples who are experiencing difficulties conceiving a child. Currently, their rabbinical staff includes rabbis who speak five languages. Rabbis are available full-time to respond to questions regarding the interface of Halachah and fertility. Moreover, Machon Puah is at the forefront of offering rabbinical supervision of fertility procedures. It is highly worthwhile for rabbis and laymen to consult with Machon Puah in case of need. One may contact them by e-mail at questions@puah.org.il<.