A Jewish couple who gave up hope on having a child rolled into Chabad of Nepal. What happened next will deeply move you.
Mrs. Chani Lifshitz, her husband, and children, are Shluchim of the Rebbe in Kathmandu, Nepal. The following was published onChabad.org and translated by Esther Rabi:
For several days, Limor sits, silent and thoughtful, in the Chabad House. Once in awhile, she asks about this or that, but most of the time she sits, mute, observing the joyous youths around her with a bleak countenance.
Her husband Amir sits at her side, frowning and serious. We never hear him speak.
Everything was so good at first, the whole world awash in the colors of their hopes and dreams. And then their troubles began. They looked with yearning at the families around them. Why did everyone else have a baby, but not them?
“It wasn’t for lack of trying,” she explains. “There wasn’t a specialist that we didn’t consult. There wasn’t a treatment that we didn’t try. Everyone said the same thing: It’s not going to happen.”
Before abandoning their sinking marriage, they decided to make one last effort. They stopped the injections and the treatments and dismally loaded their backpacks “to clear our heads and to get as far away as possible,” she says.
“First, to Nepal, and then afterwards, to India and maybe also China. If travel wouldn’t help us recover what had been destroyed, then there was no hope.”
The tears fall as she cries out that even this didn’t help! She buries her head in my shoulder, sobbing.
“Limor. I want you to come with me to immerse,” I tell her, putting my hand on her hand. My stomach is churning. To immerse? Where did I get such an idea just now? She leaps back, away from my touch.
“To immerse? Like, in a mikvah? Why should I all of a sudden want to immerse in a mikvah?” She rises from the couch. “I already immersed in a mikvah before our wedding. That was enough for me. No, thank you!”
“But you don’t understand! Come with me to immerse. Perhaps this will help you have a child!”
She looks at me, angry and disappointed. “How can you say such a thing? For 10 years, I’ve been going from doctor to doctor, and not one of them could help me have a child. You know me for a minute-and-a-half, and you think you can help me?” The pain in her hazel eyes pierces my soul. She strides hastily to the door.
A moment before she can grab the doorknob, I catch her hand. I look deep into her eyes and ask her to listen to me for just one more moment.
“We don’t have a mikvah here, Limor,” I explain. “We immerse in the river. It’s an hour-and-a-half ride, and then it takes another hour to climb the mountain to get to a freezing river! We break the ice! Literally!”
Tears roll down my cheeks. “I want you to come with me to immerse,” I plead. “I want you to help me break the ice, and in this merit, may G‑d bless you with a child!”
Her cold hands slowly warm in mine. The look in her eyes softens. “Where have you come from, Chani?” she murmurs. “How have you gotten to me? Enough. We’ve already given up. And … and … what about Amir? He’s not at all religious. We don’t believe in those things. What am I going to tell him?”
I calm her, tell her not to worry. My husband Chezki will talk to Amir.
Her inner turmoil slowly subsides. The sun shining through the window streaks her face. “Come, Chani,” she tells me. “Let’s go to the river.”
I tell her now is not the time. First, I want to be sure that she understands the magnitude and sanctity of the mikvah, as well as the requisite laws.
She comes to my home for the next couple of weeks. We sit and talk about what purity means. We talk about the power of the Jewish woman, and her own power. Limor’s eyes are still. She barely touches the coffee or the cinnamon buns I set out for her.
Her husband, Amir, was opposed at first, but when the day comes for her to immerse, he comes to our house to wait for her return. Limor follows him in, wearing a white dress, with such a light in her eyes! A light that I’m sure Amir himself hasn’t seen for a very long time.
A sputtering motorcycle rickshaw takes us to the bus station. We’re on our way to the village where “our” river is. The windows of our old bus have no panes, and a stubborn wind whips our faces. The road twists and turns.
Several times we find ourselves hanging over deep gorges, with only a step between us and oblivion. Each time that happens, I sneak a fearful glance at Limor, but she’s beaming. None of this disturbs her.
I’ve accompanied tens of women who were initially wary of immersion up the steep grade I’m climbing now with Limor. Their hearts melt when they hear stories of righteous women breaking the ice to immerse in the river. This natural feminine experience is enchanting. It’s just them and their Creator, while the mountains surrounding them whisper their prayers.
It’s pitch-dark when we get there, but I know every rock and could walk here with my eyes shut. Limor’s face shines like the moon. We hardly need the miner’s flashlight that I wear on my head.
“Come, Limor,” I say before we reach the river. “Come, sit with me for just a moment. There’s a song I love to sing before immersing. Listen to the words.”
The babbling waters of the river sing with us. The birds are silent. “May this hour be a time of mercy, a time in which Your heavenly will accompanies us.” Limor sings after me, word for word. Her head rests on my shoulder. We hold hands. “A time of mercy, a time in which Your heavenly will accompanies us … ”
I take an axe from my pack and go to break the ice on the river. Limor shivers, not just from cold. A soft cry escapes her as she enters the water. “It’s freeeeeezing!” Her cries rise straight to G‑d’s throne. When she steps out of the river, the stars descend to meet her.
I honor the pure, silent moment, and neither of us sully it with speech. I just hug her and pray. We sit on the steep path. Two women in the center of creation.
The next day, she sets off with Amir to India, and from there to China. We lose touch. I try every which way to find out what has become of her, but can’t. She is just … gone.
Until, 10 months later, the phone rings. Limor is on the line. At first, all I can hear is crying.
Then she tells me they experienced a miracle yesterday. They had a baby girl. They are calling her Nesyah (“miracle of G‑d”).
It’s been eight years. Eight years of my husband and I trying to start a family. If you had told me eight years ago that this would become the hardest journey of my life, I would not have believed you. If you had told me 20 years ago that I would have this much trouble getting pregnant, I would have laughed. Well, I now believe you and that laughter has turned into a lot of tears.
It all started six months before we even made the decision to start trying. I was diagnosed with severe dysplasia and had lesions on my cervix which needed to be removed. At the time, I was planning our wedding, so my doctor suggested we should wait, enjoy our special day and arrange to have the procedure done after. The wedding was flawless and absolutely magical, we had a wonderful honeymoon in Cabo San Lucas and when we returned, the date for the procedure was confirmed.
The procedure I had to do was called a LEEP, which stands for loop electrosurgical excision procedure that uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. The procedure went well and life went on… until a month after.
If I remember correctly, it was October 30, 2006. My period was a few days late and of course I started thinking all kinds of thoughts, one being “could I be pregnant?” Then, after an hour or two, I went to the bathroom and low and behold, my period had started. So, I put on a pad and that was that, until 30 minutes later, when I had to change my pad. Then 30 minutes after that, I had to change it again. This will get a little graphic, but I went through about half a dozen pads in an hour — it was like I got shot. Todd, my husband and his twin brother Shawn drove me to the health clinic and after about 45 minutes, they could do nothing and I was just full of blood. That’s when I was rushed to the emergency room. It’s a night I will never forget.
On the ambulance ride down I was in a lot of pain, so the paramedics gave me some valium. I have to tell you, I don’t understand the purpose of valium. You still feel the pain, you’re just so drugged up that it doesn’t matter. When I arrived in the hospital, I was placed on a bed and was put in a small waiting room. While I was waiting, the blood kept coming out and I was still in a lot of pain. Finally, a blood clot the size of a grapefruit came out! I know this is quite graphic, but this is all true.
I was seen by a couple of doctors and after analyzing my situation, they came to the conclusion that when I had my LEEP done, my doctor cauterized my cervix closed. Yup, that’s right, my cervix was closed and so when I had my period, the blood had no where to go but in to my uterus.
Now March 2007 rolls around and I just finished my three month waiting period after stopping the Pill. Excited and nervous all at the same time, but Todd and I decided it was time to start a family. And so the quiet nightmare began. We were either having chemical pregnancies or weren’t getting pregnant at all. Then I started to develop cysts and from there it basically went downhill.
In November 2007, something else started to happen. Our friends around us started getting pregnant. The first two or three I could handle, but after several, I didn’t think I would have the emotional strength to be happy for my friends — but I was, because I had to be.
After months of trying, failing, doctor appointments, ultrasounds, diet changes, acupuncture, and so on and so on, I found out I had endometriosis. Endometriosis is a disorder in which tissue that normally lines the uterus grows outside the uterus. Dealing with endometriosis is not easy, it’s actually pretty miserable.
We continued to try all throughout 2008 and 2009. Then we moved to Brazil for Todd’s business in January 2010. We sort of continued trying, but not with the same intensity back in the U.S., because we had a whole new set of issues to deal with due to living in a foreign country.
Upon returning from Brazil in January 2014, me at the ripe old age of 40 and Todd 39, in a way exhausted from the four years in Brazil, we were hoping to get back on our pregnancy journey. Of course this came with finding out that at least four other friends were pregnant, almost 20 friends in total over the course of these eight years. However, it was different this time, because those four friends had struggled to get pregnant and were trying IUI (Interuterine Insemination) or IVF (Invitro Fertilization) with a fair amount of failure.
In July 2014, I finally had laparoscopic surgery to confirm my endometriosis and to clean it out! I thought the day would never come. My doctor even told me it was a mess in there, I can only imagine.
This past January 2015 was our first official IUI session. It failed, but that’s OK, because we finally have a chance to give this pregnancy thing a seriously good try. I’m hoping it’s not too late, but I feel we are in a really good place to finally make this happen.
I’m sharing the details of my story, because I am one of millions of women that have fertility issues. It is a horribly devastating feeling to not be able to reproduce. I’m a pretty tough cookie, but this has taken Todd and I to hell and back many times. But we’re not giving up, if anything we’re just getting started.
What I want to know is, why aren’t more women sharing their stories of infertility. There have been a few exceptions like Celine Dion, Giuliana Rancic and Sarah Jessica Parker, but on the whole, not much. When I hear that Susan Sarandon gave birth at 45, or Halle Berry is pregnant at 47, or Geena Davis had twins at 48, my question is, how? Is it taboo to talk about this? Do these women not share their story because they’re embarrassed? Or do they want to give the illusion that it “just” happened? For eight years, I’ve been hoping to hear more stories about infertility from women of all walks of life and I feel I’ve been let down. Yes, the friends that have become pregnant after their struggles of infertility are a blessing in my life, because it gives me hope, but I want to hear more stories. I want to feel I connect with a community of women and couples that know what it means to be reproductively challenged, but they are few and far between.
The face of infertility is me, it could be you, it could be your friend, it could be your coworker. It could be a woman in her early thirties, late thirties or early forties. When we first started trying I was 33; now I’m 41. Yes, it’s more common that a woman in her forties will have fertility issues, but 33 is quite young and it comes as a shock to know you have fertility issues.
If you have fertility issues, know that you’re not alone. Don’t be ashamed of it, talk about it, share your story and when you become pregnant, we will celebrate with you and it will all give us hope that maybe one day soon, we’ll be pregnant too.
This one is for your partner, family and significant other. One of the lovely ladies in the PCOS Diet Support community recently asked me to write an explanation of PCOS for our partners and significant others. Something that makes PCOS easy to understand.
I was diagnosed after being married for 3 years and my hubby has been amazingly supportive. I’ve written this article with him in mind (even though he knows most of it anyway).
WHAT IS PCOS?
I have PCOS or Polycystic Ovarian Syndrome. I know that you think of it as “woman issues” but it’s important that you know what is happening with me and my body because it affects both of us and I’m really going to need your help in coming to terms with it, living with it and getting it under control.
So, I do have “woman issues”. Basically I don’t ovulate every month, which means that my cycle is very irregular. I also might have some cysts on my ovaries. The biggest thing, though, is that I don’t process carbohydrates properly and my body is over sensitive to insulin. This means that I produce too much insulin for the carbs that I eat. The insulin also makes my ovaries release too much testosterone (all women produce testosterone – I just have too much of it).
PCOS is pretty common. Every 1 in 10 women have it so I’m not abnormal or alone in it.
The symptoms of PCOS are pretty rough for me to deal with and can make me feel unattractive. I sometimes struggle with my weight. It’s not for lack of trying, I promise! All of that insulin quickly stores my carbs as fat and makes it difficult for me to lose it.
I have hair where I really don’t want hair and I may lose some of my hair on my head. I also may have bad skin (think teenage boy acne). It’s that darn testosterone.
One of the hardest things about PCOS is that having babies might be a struggle. It’s not impossible by any means but might take longer than we’d like.
WHAT I NEED TO DO FOR ME
PCOS is not a death sentence and I’ve made a decision that although I have PCOS, it doesn’t have me. There are things that I can do to manage my PCOS and help with my symptoms.
The biggest thing I can do for me is to lead a healthy lifestyle, keep active and eat properly. This will make my symptoms easier to manage (exercise and diet are huge in dealing with the insulin which will help with the testosterone). The way I eat is not necessarily aimed at me losing weight (although it will help) but on getting healthy. So we can change the way we eat and get healthy together. There are also some supplements that I take regularly which have been really helpful in managing my symptoms.
I can get help from my doctor or endocrinologist (hormone doctor) and there are medications I can take.
If we’re not ready to think about a family, I can also take birth control, which will keep my symptoms in check for a while. As soon as I come off the pill, though, my symptoms will come back so birth control is a temporary fix and can have unpleasant side effects.
If we do decide to have a family and we’re struggling to, we can go to see a reproductive endocrinologist to look into fertility treatments. They’ll want to check you out too and treat both of us if need be.
WHAT I NEED YOU TO DO
The biggest thing I need from you is your love and support. There are times when living with PCOS is going to make me angry, depressed and feel unattractive. Please just love me through it.
I’m going to do everything I know to do to eat properly and exercise. Please help me by eating healthy too and being active with me. Let’s go for lots of long walks, take up mountain biking or ballroom dancing. If you do have treats (which you’re totally entitled to), please hide them from me so that I’m not tempted by them. Also, please share with them with me once in a blue moon because I also deserve a treat every now and then.
Bearing in mind what I said about feeling unattractive, when I’m having an “ugly” day (and they do happen), please remind me how beautiful I am. Encourage me to get my hair done, have a pedicure or a massage. Sometimes I get so caught up in the daily grind of work, keeping a home and our family, looking after my health, that I forget to take some time just for me. I need you to help me do that.
THANK YOU, SERIOUSLY!
It sounds a bit trite but thank you so much for taking the time to read this. It shows me that you want to understand what I am going through and want to support me and that means the world to me. Thank you for loving me in spite of my many faults (PCOS included) and thank you for choosing to walk this road with me. Having PCOS is not easy but with you by my side, it makes it a little more manageable!
When a person is born or a person dies the Jewish community rallies with meals, support, and love. When a person is experiencing infertility the community is silent – and those suffering feel they have to be silent.
This is a strange omission, especially considering that the history of the Jewish people is replete with tales of infertility – Sarah, Rebecca, and Rachel all have difficulty conceiving and pray for children.
After being married a little while we soon realized that having a baby was not something that would happen easily for us. Rather than feeling like a part of the community, we began to feel isolated. Friends from the past would say things such as, “We’d love to hang out with you, but then who would our kids play with?”
The road to having children can feel endless and lonely. Watching friends and family have babies while they examine your never growing belly can lead to an intense sadness that only those experiencing infertility can relate to. At an engagement party, someone once came over to us and said “you never change,” pointing to Rachel’s stomach.
After almost three years of many doctor visits, no pregnancies, and thinking it probably wouldn’t happen for us, we did finally get pregnant, only to first have a chemical pregnancy, followed by an ectopic pregnancy. When suffering from pregnancy loss, people are quiet and suffer in silence. There is very little in the way of a support network. Mentioning pregnancy loss or infertility can lead to weird looks rather than sympathetic responses. People aren’t sure how to respond. There are no meals delivered to people suffering from miscarriages, no time for mourning, no time off from work, and people are expected to attend synagogue the week of a miscarriage with smiles on their faces. After all, no one knows the internal struggle that’s going on.
If the topics of pregnancy loss and infertility were less taboo in the Jewish community, people could get the support they need. Dealing with infertility involves a long process of seeing doctors, nightly injections, and early-morning appointments. Many times husbands may not be able to attend the appointments, and wives are left going by themselves. The process may involve missing days of work, additional hormones wreaking havoc on your body, and expensive procedures and medication. For many, adoption may seem like the only answer, but that’s also a difficult, long, lonely road, with expenses that add up quickly.
Ultimately, in-vitro fertilization did work for us and helped us start our family, but many others are not as lucky. Infertility is a lonely experience that changes a person. We will never be the people we were when we first got married. While we knew having a child might be difficult for us, we didn’t realize how long the process would be and the toll it would take on us as individuals, our relationship to each other, and relationships with our friends. At one point after being invited to a friend’s child’s birthday party, we had to leave a little early, and our friend told us, “Don’t worry, it was really only meant for mothers and children anyway.”
The experience of infertility shook our confidence in the Jewish community and some of the friendships we had previously formed. It removed the (possibly naïve) optimism we had when we first got married. After being in the dating scene a little while, getting married seemed like the answer to everything. We would finally be able to fit in and catch up with a community that centers on marriage and children. But rather than fitting in we began to feel more and more isolated. It got to the point that we were jealous of our pregnant pet guinea pig. Our confidence in our community and ourselves was (and still is) shaken.
While the experience of pregnancy loss or infertility will never be easy, perhaps if the topic of infertility were less taboo in the Jewish community, more people would speak up about their struggles and more support could be offered. How can we make the topic less taboo? For starters, synagogues can have lectures to raise awareness of the issue, communities can ensure they include and invite all members for Shabbat meals, especially those who do not fit in as well. Perhaps meal conversations can have less discussion about people’s children, or instead schedule Friday night meals in such a way that kids can be put to bed before the meal or before dessert and the adults can hang out together afterwards. More community events can be offered for people with infertility to interact with each other so that they don’t feel so alone. Synagogues could also organize meals for women who experience pregnancy loss, and communities could organize rides or company for women going to doctors’ visits alone. While there are some support organizations out there, there are few (if any?) Modern Orthodox organizations that help people connect with like-minded couples experiencing infertility.
The more the Jewish community speaks about topics such as infertility and pregnancy loss, the more those suffering from it will feel comfortable reaching out to their community for support and discussing what they are going through. A cultural change like this may not happen overnight, but perhaps future family and friends who suffer will have more support to make the process a little less unbearable. Let’s not allow those in our community to suffer alone and in silence.
If we could fall in love online, then just maybe, we could make a baby in a dish.
That’s what I told myself after three years of agonized infertility. Nothing could soothe the ache of so much failed babymaking, except perhaps the strength I felt in my marriage. I would never have found Ken anywhere but cyberspace — he’s a physicist, I’m a writer — so maybe our DNA also needed technology to meet. We would be a modern family in every way. With my 40th birthday looming, we both agreed: it was time for a reproductive hack.
The move into medical measures felt like a capitulation. I’d always preferred “natural” interventions, like acupuncture. Wheatgrass. Prayer. Denial. We’d planned to make a baby Paleo-style, and I’d birth it that way, too. I distrusted doctors, with their needles, wands and scalpels. I had a reality-based aversion to the high expense and low odds of fertility treatment, in particular IVF. I also harbored irrational biases. “I’m not a bread machine,” I’d say to Ken. “I don’t want a bunch of doctors dumping ingredients into me to force up a loaf.”
“I get it,” Ken would say, though he longed for children, too.
Then one day it struck me: my objections to IVF echoed my once-upon-a-time resistance to online dating. In my single days, meeting someone via the Internet had seemed so… unnatural. Wasn’t I supposed to find a mate at a party, the bar, the office? Not that I went to any of those places. Still, the notion held sway, as forceful as the idea that babies can be made with only two people, through one instinctual act. Naturally.
Nevertheless, my courtship with Ken had launched server-to-server, distinctly high-tech. Our relationship quickly went analogue, and two years later we merged our networks forever. At our wedding, we should have toasted those unknown armies of coders who brought us together. Cheers to DARPA, for inventing the Internet. Database programmers, bless you for the digital yenta that is JDate. It took legions to engineer the most natural love I’d ever known.
It turns out courage from one life success can be mortgaged into strength for the next risky step. Ultimately, that’s how I relented to IVF. The doctor said it would be our best chance. In a weird way, IVF felt like fate, too — I’ve noticed the things I rail against almost have more power to emerge, as if mere mentioning, and certainly ranting, tempts fate. If fate exists, it has a sense of irony. For example, I’d always scoffed at huge, double strollers — but I’ll get to that in a minute.
After we paid the fertility clinic in a virtual transaction, our drugs and needles shipped overnight. We picked them up at a UPS store — thank you, commercial pilots, and bless you, drivers of boxy brown trucks; you were our storks. We unpacked our hormones into the refrigerator — thank you, inventors of ice. Then began nightly shots, which Ken prepared over a complex spreadsheet — thanks, Excel, for keeping track — and at last there’d be tears, jokes, injections. I would never claim IVF was romantic, nor was it ideal, but the intimacy of endurance, together, was sometimes profound.
Weeks later, at the fertility clinic, minutes away from the final “transfer,” we still did not know how many viable embryos we’d have, and whether to put in two. We knew we were open to twins, but also afraid of all that could go wrong.
“I guess I’m going to make a major life decision with my pants off,” I said to Ken, “on ten milligrams of Valium.”
“I’m sure that’s how a lot of people get pregnant,” he said back.
At last our doctor whirled in with pictures of our 5-day-old blastocysts, two white blobs, one big, one small. Thank you, clinic incubator, for the awesome daycare.
“I recommend transferring both,” our doctor said.
Ken and I quickly agreed. The conversation took 10 seconds. With IVF, there was still the random element, a moment where desire trumped reasoning and our middle-aged selves embraced a teenage attitude to chance — perhaps in line with nature’s plan after all.
Then the small, sterile room filled with people — Ken, the nurse, our doctor and two techs. The mood was upbeat. We were trying to make a baby, no matter how clinical, no matter the crowd.
Except we didn’t make a child, we made two. Twins. During the grueling pregnancy that followed, I often thought of our twins as the product of IVF, not nature. The only respite I had from the angst and discomfort of my high-risk gestation was glimpsing the babies on the frequent ultrasounds — thank you for that, inventors of sonography. Seeing my sons on a screen, I’d feel stunned with excitement, with tenderness.
Pregnancy complications required a C-section at 36 weeks. By then I’d forgotten about birthing at home in bed while Ken grilled root vegetables for the midwife. I would have an unnatural end to an unnatural pregnancy.
I grasp all reasons why C-sections are both common and condemned, but my twins were breech and transverse, and my particular gestational complication was associated with stillbirth. Death, too, is a natural process, one that as parents we wanted to cheat. In that light, the science of a surgery, the option of a C-section, is nothing short of sacred.
On the scheduled day, at the hospital, my twins were born a minute apart in a crowded room, just as they’d been conceived. A team of waiting protectors surrounded them — two surgeons, two pediatricians, three nurses, an anesthesiologist, Ken, and of course, me — exhausted, thrilled, scared, and relieved.
When I finally held my sons, I basked in a love so primal, so organic, that the world fell away. Then the world fell away for real, as morphine knocked me out. Thanks, big pharma, for that needed break.
It still startles me that people make babies with sex. Privately. Intimately. Easily. I feel like I spent a year at Reproductive Burning Man: with masses of people, piles of drugs, and anticipation of a final, cathartic event. Though people say technologies like IVF unnaturally control things, the opposite is true. It opens you to whole new levels of randomness, hazard, surprise and wonder. I speak lightheartedly of things that often cause anguish because I was lucky — lucky in the outcomes, but also, as I see it, lucky to live in a time when technology tempers fate.
From JDate to IVF to C-section, science let us script the command line of nature. Without it, I might be solitary still. This family we built, with tons of support, is the grace of technology. Two years later, I no longer think of my sons as a product of IVF. I think of them as a gift from God.
Many of our young men and women of marriageable age assume that when a couple decides it is time to start a family, it is simple to conceive and bring a healthy baby into the world. In fairness, they have good reason for making that assumption. Growing up they often hear “mazel tov”s and see birth announcements, they attend brises and baby namings and they witness the growing families around them. Children are a central focus of Jewish life and living, and our young people understandably assume that having them is fairly easy and straightforward.
But they are wrong. What they don’t hear about, because we don’t talk about it, are those suffering and struggling in silence and privacy, desperate to bring a baby into the world and eager to become a mother and father for the first time, or once again. There are more than seven million people of childbearing age in the United States currently struggling with infertility. Up to twenty percent of those who do become pregnant experience a miscarriage. Eighty percent of those miscarriages occur within the first trimester, when the couple is unlikely to have told anyone they were expecting and before the woman begins to show.
Infertility and the pain associated with it are unfortunately nothing new. The Gemara (Yevamos 64a) teaches that our matriarchs and patriarchs struggled with barrenness. The Seforno on our parsha points out that Yitzchak was forty when he got married and the Torah says he was sixty when Yaakov and Esav were born. Together, Yitchak and Rivkah suffered with infertility for twenty long years, praying, longing, and waiting to see the fulfillment of God’s promise to build a nation.
Rachel, too, knew the pain of childlessness. She screamed out in pain, “im ayin, meisa anochi, if I don’t have a child I am already dead,” from which the Gemara (Nedarim 64b) teaches that to live without children is to experience a form of death.
Resolve, the National Infertility Association, writes on its website:
Infertility can feel like a death, like a prolonged mourning process as dreams die and hopes are dashed… The pain is similar to the grief over losing a loved one, but it is unique because it is a recurring grief. When a loved one dies, he isn’t coming back. There is no hope that he will come back from the dead. You must work through the stages of grief, accept that you will never see this person again, and move on with your life.
The grief of infertility is not so cut and dry. Infertile people grieve the loss of the baby that they may never know. They grieve the loss of that baby who would have had mommy’s nose and daddy’s eyes. But, each month, there is the hope that maybe that baby will be conceived after all. No matter how hard they try to prepare themselves for bad news, they still hope that this month will be different. Then, the bad news comes again, and the grief washes over the infertile couple anew. This process happens month after month, year after year. It is like having a deep cut that keeps getting opened right when it starts to heal.
This week, I met with three women whom I don’t know and who themselves only know each other from attending an infertility support group in Boynton Beach. They came with difficult and complex halachic questions about IVF, surrogacy, the use of gestational hosts, and Jewish status. I explained to them that I am far from an expert in these areas, but I am absolutely committed to researching their questions and helping them in every way that I can.
We then got into a discussion of the challenges of struggling with infertility and the acute pain, financial hardship, and intense loneliness that they have each felt. The women shared the often-prohibitive cost of treatments, with one of them having spent over half a million dollars and the others depleting their savings to cover bills totaling a quarter of a million dollars. Two of the women have babies as a result and I pray that the third will have her dreams of being a mother realized in the near future.
A common theme of the agony they described was the loneliness of going through this hardship without the explicit knowledge, awareness, support, love, or assistance of others. Those with infertility or who have suffered a miscarriage are grieving without anyone even knowing. They are forced to spend their days interacting with others as if all is well, when in fact it isn’t.
Worse than the indifference of friends and acquaintances, these women described, is the unintentional insensitivity of so many who have been blessed with healthy children and who make comments, tell stories, share pictures, or complain about their kids.
I walked away from the conversation pledging to myself and committed to encourage others to be better, more sensitive, and more aware of the comments and passing remarks we make at Shabbos tables, in shul, and on Facebook. If it were our son or daughter, or our brother or sister suffering with infertility, we would measure our words, think carefully about what we say, and anticipate the potential impact of all we do. When planning our simcha we would think about how we could be sensitive to our loved one who may never be in a position to make a bar or bat mitzvah or a wedding.
Well, those suffering are our loved ones. They are our brothers and sisters and we must bring that level of vigilance and mindfulness to our behavior to ensure that we don’t even unintentionally contribute or compound their already unbearable pain. When hosting a simcha or sharing about our children or grandchildren, minimally, we should always reference how fortunate and blessed we feel, that we don’t take it for granted and that we pray for those who don’t have children. We should mention the challenges of infertility in Chassan and Kallah classes, not to God forbid scare the young bride and groom, but to responsibly manage their expectations.
Resolve has a helpful page on its website called infertility etiquette in which they remind us not to be nosy, ask inappropriate questions, make assumptions, gossip, or minimize someone’s challenge. Instead, they say “The best thing you can do is let your infertile friends know that you care. Send them cards. Let them cry on your shoulder. If they are religious, let them know you are praying for them. Offer the same support you would offer a friend who has lost a loved one. Just knowing they can count on you to be there for them lightens the load and lets them know that they aren’t going through this alone.”
Our matriarchs and patriarchs ultimately saw their dreams fulfilled and we are here today as a result. May all those yearning for healthy children see their hopes and aspirations come true and may we all get only yiddishe nachas from the children whom we are so blessed and fortunate to have.
For those who haven’t dealt with infertility, it’s difficult to imagine the plight. That is understandable, since it’s even hard for those of us who have experienced infertility to explain it in words.
How do you convey the feelings of longing for a child? Something you’ve never known, but can still feel? Like a piece of your heart is missing or a wish that is always just out of reach. How do you describe the poison that grows at the pit of your stomach with each failure? How do you label what is not so much physical pain, but an emotional weight pressing heavier and heavier against your body? How can you possibly help others fathom your relentless despair?
There are a lot of articles on what not to say to the fertility challenged. The soundest advice is to avoid sharing your advice. But we humans have a tough time keeping in our opinions. So the advice will come. And when it does, here’s what we can do about it.
Make the Most Of It
We’ve all heard it. “Just relax.” “Go on vacation.” “Stop stressing — it will happen!” Most of the infertility advice is not very helpful, but sometimes there are nuggets that just might surprise you. People share their stories with you because there is hope in them. The “magic pills” that worked for their friend who tried to conceive for years and then got pregnant after a couple months. The “Robitussin trick” that makes it easier for sperm and egg to meet. The great acupuncturist who helped your cousin get pregnant when the fertility doctors said she had no chance.
Don’t assume their advice isn’t valid. You just might find that sometimes, there are helpful nuggets to be found if you don’t tune all of the advice out.
View Their Advice as Love
When the well-meaning advice comes rolling in, imagine the words surrounding and comforting you. Instead of steaming over what seems like a careless comment, avoid the negative energy and see it as a positive. Your friends and family are trying to help. Sometimes, they just don’t know how. Yes, the advice can be very annoying. But you have the power to view the glass as half full instead of half empty.
Tell Them How to Help
You can help your loved ones by telling them what they can do for you. Are they good at research? Ask them to find an answer to a question that’s been nagging at you. Are they good listeners? Tell them you’ll reach out to them when you need a shoulder to cry on. Do they have a flexible schedule? Bring them along to some of the tougher appointments when your partner can’t be there with you.
Be honest with them. Tell them the encouraging words, “I love you, I’m here for you, and I’m listening,” are more helpful than anything else they can say.
Infertility is a tough road to travel alone. Having friends and family by your side will give you the extra strength you need on the toughest days.
‘Shoebox IVF’ hope for infertile couples
By Cathy EdwardsBBC Health Check
Could an IVF kit that fits in a shoebox and some kitchen cupboard essentials provide hope for people who long for children?
Infertility is a source of distress the world over, but in many places the terrible stigma attached to childlessness makes it even harder to bear.
The answer could be a pared-down system that can fit inside a shoebox and uses cheap ingredients you might find in a kitchen cupboard.
In the past infertility has been neglected in developing countries, partly because of a focus on controlling overpopulation.
But experts argue that true reproductive health has to address both sides: family planning for those who want to avoid pregnancy, and fertility treatment for those who long to have children but can’t conceive naturally.
Nosiphiwo, from South Africa, had been trying to conceive for years when her husband’s family asked her for their lobola back – the bride price they paid when she married their son.
She was ostracised by her in-laws for being childless, and felt cut her off from the rest of her community too. She says women in her situation sometimes turn to suicide.
“I thought of doing that. Because you don’t have any option.”
Sophisticated labsThe prohibitive costs of fertility treatment mean that worldwide, most couples cannot afford it – though their desperation can be such that many become destitute trying to pay for it, selling property or going into debt.
One of the biggest obstacles is the cost of the complex, sophisticated labs where “in vitro” egg fertilisation takes place.
Belgian obstetrician Dr Willem Ombelet worked in South Africa in the 1980s and saw many cases like Nosiphiwo’s.
He carried out IVF treatment for those who could afford it. Those who couldn’t came to the hospital on other pretexts – but the real reason was their longing for a child.
“They would wait shyly around the corner and ask if there was anything we could do for them.”
Back then, the heartbreaking answer was no.
But he has campaigned ever since to improve global access to infertility care, co-founding The Walking Egg non-profit organisation to raise awareness of fertility in developing countries.
DIY embryo transport
The centrepiece of the Walking Egg’s mission is a simplified system for egg fertilisation.
The embryos didn’t care if they were in an expensive triple walled incubator or a thermos flask.”
Professor Jonathan Van BlerkomEmbryologist, University of Colorado
The best conditions for a sperm to fertilise an egg outside the body are slightly alkaline, at a temperature of 37C (98F).
Usually this involves a sophisticated laboratory equipped with huge ventilators, complex incubators and a supply of expensive gases.
But when Dr Ombelet met the embryologist Jonathan Van Blerkom in 2008 the idea of a cheap, portable lab was born.
Van Blerkom revived a technique he used in the 1980s when transporting cow embryos long distances across Nebraska.
By mixing baking soda and citric acid he created his own CO2, periodically adding it to the solution holding the embryos to maintain the optimal CO2 concentration and alkalinity levels.
IVF in a shoeboxFor humans the technique had to be refined to create a closed system and thus minimise any risk of contamination.
Precise quantities of citric acid and sodium bicarbonate are mixed in one test tube. The CO2 bubbles this creates are fed via a tube into a second test tube containing a culture medium for the embryo.
To maintain the perfect temperature for egg fertilisation and embryo development, Van Blerkom tried out various low-tech methods.
“I put the test tubes into a thermos at the right temperature – that worked. I put them in an aluminium heating block, and that worked too. The embryos didn’t care if they were in an expensive triple walled incubator or a thermos flask.”
Once the atmosphere has stabilised, the egg and then the sperm are injected into the test tube containing the culture medium.
The next day this test tube goes under a microscope to see if it contains an embryo – meaning egg fertilisation has taken place.
If a successful embryo is created, it is transferred from the test tube to the woman’s womb after about six days.
This simplified system reduces the whole IVF lab to an aluminium heating block containing one pair of test tubes for each embryo, all inside a shoebox-sized container.
For additional safety the human trials of the system have so far been conducted inside a sterile laboratory.
The team are developing a self-contained unit to house the system in hospitals or health centres that don’t have advanced lab facilities. This would provide heated, sterile air and space to examine the embryo under a microscope.
The researchers believe that – because of the closed nature of their system – this unit is not strictly necessary, but will help convince health authorities of the quality of the system.
“Embryo quality”Trials began in Genk, Belgium in 2012, and so far 17 healthy babies have been born using the system.
Dr Ombelet is thrilled with their preliminary results, saying they indicate fertilization and pregnancy rates are similar to expensive IVF methods.
“We have proved that with our system embryo quality is at least as good as with regular IVF.”
Geoffrey Trew, a consultant in reproductive medicine and surgery at Hammersmith Hospital in London who is not connected with the research, agrees this is an exciting technique.
“It has been shown to work in a developed country. Now we’ve got to see how well it is reproduced in the developing world where the conditions are more fickle.”
Fertility on a shoestringThe trials are due to be rolled out in South Africa and the UK later this year, and the team hope that by early next year the system can be tested in the kind of low-resource settings it was designed for.
Each IVF cycle costs less than 200 euros (£159) using this system, not including staff and medication costs, which vary from country to country.
But Dr Ombelet says they can decrease the normal price for IVF in any given country by at least 70-80%.
“With very low dose medication schemes we hope to perform IVF in developing countries for less than 500 euros (£399)”
Prof Thinus Kruger and Dr Matseseng are fertility experts from Tygerberg Hospital in Cape Town.
They already have a special fertility programme that cuts costs by economising on medication and staffing – Nosiphiwo was one of the many women who was helped to conceive by this programme.
Nosiphiwo eventually conceived through a low cost fertility programme in Cape Town
Now they want to see how the tWE system compares to their normal laboratory procedure.
“It’s really theoretically amazing,” says Professor Kruger.
“But we will have to see how patient and scientist friendly this system is. It is a little lab, so you still need the knowledge to handle those small embryos.”
Prof Van Blerkom believes that efforts to bring the cost of fertility treatment down would please the IVF pioneer Robert Edwards, whose work led to the birth of the first test tube baby, Louise Brown.
“People can make fortunes through IVF. But Bob Edwards was a real believer that IVF should be universal, because he knew the suffering that infertility caused.”
Listen to The Truth about Life and Death: Fertility on a Shoestringon the BBC World Service on Wednesday 25th June 1932 GMT.
The fertility clinic guessing game: Canadians have no way to find out success rates of pricey IVF treatments
Even as the U.K. and U.S. break new ground in medical transparency, Canadians know relatively little about how their health facilities perform. Saturday we asked why surgeons’ OR results are not published. Today: how Canada lags in reporting success rates of fertility clinics.
For all Rhonda Levy knew when she sought out fertility treatment 20 years ago, one clinic offered much the same odds of having a baby as another.
Then she endured three fruitless rounds of artificial insemination and four of in-vitro fertilization with her chosen facility, at a cost roughly equivalent to a high-end luxury sedan.
When Ms. Levy finally switched clinics, she conceived after the first IVF treatment she received.
The experience left the former high-finance lawyer convinced that the quality of Canada’s many fertility centres varies enormously.
For patients seeking out the pricey, emotionally wrought service, however, choosing the right facility is virtually a guessing game.
There has to be some way for patients, who are making such a profoundly important choice … of conducting an analysis of what their odds for success might be
Government agencies in both the U.K. and the United States require clinics to report their success rates — how many pregnancies or births they produce per treatment — which are then published online. Despite the growing popularity of the largely for-profit business in Canada, this country lacks any independent source of information about which clinics will give patients the best chances of having a child.
In fact, a federal agency tasked with at least collecting that data — and possibly releasing it — was disbanded a year ago.
“There has to be some way for patients, who are making such a profoundly important choice, … of conducting an analysis of what their odds for success might be,” said Ms. Levy, now a Toronto-based consultant who guides others through the process. “It’s better than having to take a completely blind leap of faith.”
Hard evidence from other countries suggests that results can differ markedly from clinic to clinic, arguably due in part to varying abilities at creating embryos and transferring them into patients’ uteruses.
Some doctors in the specialty, while warning of possible pitfalls, agree it may be time to take action here.
“I think there’s a lot of value in trying to provide transparency and honesty to patients,” said Tom Hannam, who heads a Toronto-based clinic. “If there’s a good painter for your house and a bad painter, you want to know which is which. It’s probably the same for fertility clinics.”
Meanwhile, getting medical help to have children continues to surge in popularity, with 23,000 treatment cycles performed in 2011 at 32 clinics across the country, up 50% just since 2008. It can be lucrative work; a recent Quebec lawsuit indicated that the director of a Montreal clinic was earning more than $1.5-million a year as long ago as 2005.
Patients spend as much as $10,000 per in-vitro cycle, not including the cost of ovary-stimulating drugs. Quebec is the only province where IVF is routinely subsidized by medicare, though the Ontario government has promised to follow suit.
The association representing assisted-reproduction physicians and other professionals has for years collected statistics on its members’ work, with a small sub-committee examining clinic-specific success rates and even offering remedial help to outliers who fall well below the average.
But the Canadian Fertility and Andrology Society [CFAS] has always rejected the idea of letting the public see those individual-clinic results, suggesting the figures could be misleading to patients — and potentially prompt dangerous changes in practice.
Different couples have different chances of getting pregnant depending on their medical condition, and success rates do not necessarily reflect the mix of patients at each clinic, said Al Yuzpe, head of Vancouver’s Olive Fertility Centre and a spokesman for the CFAS.
The fear has always been that clinics would try to goose their statistics by cherry-picking the easiest cases to treat, leaving more challenging patients in the cold, he said.
“If patients just look at the number as an isolated number, they can’t really appreciate the clinic for how good it is,” said Dr. Yuzpe.
South of the border, complaints about the public reporting of success rates are common, said Dr. Hannam, though he still favours releasing the numbers.
If there’s a good painter for your house and a bad painter, you want to know which is which. It’s probably the same for fertility clinics
“It has dramatic implications on the financial health of that clinic,” he said. “They feel themselves under immense pressure to distort their practices in ways that, as clinicians, they don’t want to do.”
Proponents of the idea respond that the information could be adjusted to reflect patient characteristics, and that some transparency, even if flawed, is better than none.
The experience elsewhere shows that odds do differ from practice to practice, sometimes dramatically. The chances of giving birth after a fresh-embryo IVF treatment at clinics in Australia and New Zealand, for instance, ranged from 3.6% to 25.9% in 2011, a university research team reported.
The report cautioned that the blend of patients at individual facilities, and the small number of procedures in some could skew the results. A 2010 study, though, found that a wide, three-fold range in pregnancy rates between clinics in the Netherlands narrowed only slightly when patient attributes were factored in.
“If you look across Canada, there is variation among clinics,” argued Art Leader, head of the Ottawa Fertility Centre. “People are putting a lot of their hopes, emotions in the treatment they’re getting. … It would be nice to know what the chances are in the clinics they’re going to.”
In the United States, Congress passed legislation more than 20 years ago that requires clinics to report their rates to the Centers for Disease Control (CDC), after some facilities were accused of putting out false results to lure customers.
The CDC website offers up a variety of figures, including percentage of single births, triplet births and pregnancies per IVF cycle, for several different age groups. It does not factor in other patient characteristics that might affect outcomes, though. Still, the high, out-of-pocket cost of the service makes reporting results particularly critical, argued Dr. Dmitry Kissin, head of the agency’s assisted-reproduction team.
Caffeine: Does it Affect Your Fertility and Pregnancy?
By Samuel A. Pauli, MD and Donna R. Session, MD
Published in Resolve for the Journey and Beyond, Winter 2009
Chocolate, coke, coffee, cappuccinos, espresso, lattes… the list goes on, let’s face it, Americans love caffeine. Caffeine is one of the most widely available drugs. The website coffeeresearch.org estimates that more than half of adults consume coffee daily and another quarter of adults are occasional drinkers. A matter of fact, a recent survey of more than 10,000 caffeinated beverage drinkers estimated the average woman of reproductive age consumes approximately 100 mg of caffeine a day with the top ten percent of caffeine drinkers exceeding an excess of 229 mg a day.
With such widespread consumption of caffeine, the potential health impact of caffeine use cannot be underestimated. Caffeine is a nervous system stimulant which helps provide that morning pickup for millions of Americans. However, caffeine also affects other organ systems of the body. Caffeine consumption is responsible for a rise in heart rate and blood pressure, revs up metabolism and increases urine formation.
Multiple studies have suggested that caffeine consumption increases the risk of miscarriage. A study published last year demonstrated an increase in the risk of miscarriage with increasing caffeine intake. Women consuming greater than 200 mg of caffeine per day had twice the miscarriage rate (25.5%) as compared to nonusers (12.5%). Moreover, pregnant women may be more sensitive to caffeine as it is metabolized or broken down slower during pregnancy. An additional concern in pregnancy is the ability of caffeine to cross the placenta and directly affect the developing baby.
While studies suggest the importance of limiting caffeine use during pregnancy, caffeine may also impact the ability to become pregnant. Several studies have shown that caffeine increases the length of time it takes to conceive. One study showed that women who drank more than one cup of coffee a day were half as likely to become pregnant per cycle as compared to women who consumed less. Another study in patients undergoing in vitro fertilization (IVF) demonstrated that women who consumed even modest amounts of caffeine (50 mg) were likely to have decreased live birth rates. While the exact mechanism by which caffeine affects fertility is unknown, the answer may be related to the ability of caffeine to influence the quality of the developing oocyte (egg). Preliminary studies in mice and monkeys suggest caffeine inhibits oocyte maturation. An immature oocyte does not fertilize and therefore is unable to produce a pregnancy.
With most studies indicating that the effects of caffeine are related to amount of caffeine consumed, it would seem prudent for women contemplating pregnancy to limit caffeine consumption. Thus some experts have suggested an arbitrary threshold of less than 100 mg per day. Caffeine intake may be derived from several sources including coffee, tea, soft drinks and chocolate (see Table). Women who consume large amounts of caffeinated beverages should taper their caffeine intake gradually to avoid withdrawal symptoms such as headaches, irritability, restlessness and nausea. Ultimately, as no “safe” level of consumption has been documented, the goal should be judicious consumption during the preconception period and during pregnancy to minimize any potential harmful effects.
Samuel A. Pauli, MD is a Clinical Fellow, Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics at Emory University School of Medicine. Donna R. Session, MD, Associate Professor and Chief, Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, at Emory University School of Medicine. For more information, contact Samuel A. Pauli, MD. at firstname.lastname@example.org or 404.778.3401.
|Common Caffeinated Beverages||Amount (ounces)||Caffeine (milligrams)|
|Starbucks Grande Coffee||16||330|
|Starbucks Latte or Cappuccino||16||150|
|Plain Drip Coffee||8||95|
|Red Bull Energy Drink||8.3||76|
|Dark Chocolate Bar||1.55||21|
|Milk Chocolate Bar||1.55||9|
|Chocolate Ice Cream||8||4|
(Sources: Starbucks Corp., 2009; USDA National Nutrient Database for Standard Reference, 2008)