September 5, 2004

Most infertile Israelis believe the rewards of reproduction technology far outweigh the risks. In many countries, news that a 64-year-old local woman had just given birth to a healthy boy would have provoked a loud ethical debate or even a public outcry.

Not in Israel.

While the baby’s birth in late June did inspire some colorful headlines and a warning or two from concerned obstetricians, it didn’t strike Israelis as anything terribly out of the ordinary.

In Israel, which performs more in-vitro fertilization cycles per capita than any other nation, where surrogate motherhood and parenting arrangements between gays and straights are legal under strict guidelines, physicians are
constantly pushing the reproductive envelope.

On a national level many Israelis view having children as a religious and/or social imperative, and government policy has long reinforced this principle by offering free fertility treatments for the first two children,
excellent mother-and-child clinics and affordable day care.

This child-friendly policy, which extends to restaurants, museums and even many workplaces, is one reason Israeli women have an average of 2.89 children during their lifetime: Jews overall average 2.64 kids; Muslims 4.58; and Christians 2.29.

Mordechai Halperin, chief officer of medical ethics at the Ministry of Health, attributes the Jewish government’s obsession with children to a
number of historical, religious and demographic factors.

“I think the main reason is the Holocaust,” said Halperin, a physician and a rabbi. “After the Jewish people were murdered, it was a very basic national instinct to do whatever possible to ensure the survival of the Jewish people. It’s sometimes unconscious, but it’s an important motivator.”

More recent traumas have also led to a national push for children, Halperin said.

“People lose children in wars and terror attacks and realize it is wise to have more than one. It’s a factor but a more minor one,” he said.

Halperin noted that both Jews and Arabs have long viewed children as an important weapon in their long-standing national conflict, a fact that has shaped government policy in both Israel and the Palestinian territories.

“A while back Yasser Arafat declared that he would win the fight against Israel by using the weapon of the womb,” Halperin said of the Palestinian leader. Likewise, Halperin recalled,” David Ben-Gurion, Israel’s first prime
minister, understood 50 years ago that in order to survive, you need more than 600,000 Jews in a region that has millions of Arabs.”

Religion, of course, is the deciding factor for many religious and traditional Jews, according to Rabbi Gideon Weizman.

Weizman, who works at the Puah Institute, which deals with fertility and Jewish law, stressed that “in the Torah, the first commandment to humanity is to be fruitful and multiply.”

For this reason, Weizman said, even the most ultra-Orthodox rabbis “are very, very sensitive” to infertile couples. “When there is debate over whether a certain treatment is permissible,” he noted, “the rabbis definitely try to facilitate it.

So do Muslim clerics, according to Dr. Mohammed Fatum, a physician at Hadassah Hospital.

“Although fertility is not stressed in Islam to the degree Judaism stresses it, children are very much valued,” Fatum said. “Islam permits IVF as long as the embryos come from both parents who are lawfully married.”

While any Israeli with a fertility problem stands to gain from reproductive technology, for very religious couples it can make the
difference between an empty nest and a houseful of kids.

Orthodox Jewish women who ovulate during the two-week “nida” period during which they may not have sexual relations with their husband are
permitted to undergo artificial insemination or IVF.

Technology is also vital in cases where a family known to carry the gene for a very serious disease will not consider abortion on religious grounds.

“Because they will not have abortions, most haredim (ultra-Orthodox Jews) undergo genetic testing for Jewish diseases prior to becoming engaged,” said Dr. Ehud Margalioth, director of the IVF unit at Shaare Zedek Hospital. “If both young people test positive for Tay-Sachs, for example, they do not get married.”

Since introducing PGD, a test that identifies certain diseases in the pre-implanted embryo, physicians at Shaare Zedek have been able to help married couples at risk of having a child with Tay-Sachs, for example.

“We had a couple with four children. One was healthy but the second had died from familial dysautonomia,” Margalioth said, referring to a Jewish genetic disease that severally impairs the autonomic nervous system. “The third is severely ill with the disease and another has a milder form. They wouldn’t do an abortion but wanted a child free of this devastating disease.

“The rabbi gave them his blessing for PGD,” Margalioth said.

Dr. Ruth Halperin-Kadderi, an expert in family law at Bar-Ilan University’s Rackman Center, is all in favor of reproductive technology that
can spare a family preventable pain and suffering. But Halperin-Kadderi is highly critical of “the overall push to advance fertility by all means, at any cost.”

She regards women who agree to become surrogate mothers as “abused women,” and points to abuses by a handful of doctors who overstimulated the ovaries of women undergoing fertility treatments in order to provide other
women with eggs.

“There are dangers inherent in reproductive technologies,” Halperin-Kadderi warned.

Despite a few well-publicized cases, most infertile Israelis believe the rewards far outweigh the risks.

“If I lived in the States, I would never have been able to afford the price of fertility treatments,” said Hannah Vered, whose 11-year-old
triplets were conceived through IVF, and whose 3-year-old twins were born as a result of ordinarily exorbitantly expensive drugs her Israeli HMO provided free of charge.

Vered, who immigrated to Israel many years ago from the United States, said she is grateful to the state of Israel for giving her a family.

Watching her older kids amuse the younger ones on this hot summer afternoon, Vered said, “Israel is the home of the Jewish people and having families is a top priority here. It’s taken very seriously.”

(Reprinted with permission of Religion News Service. Copyright 2004 Religion News Service. All rights reserved. No part of this transmission may be distributed or reproduced without written permission.)

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