RRT 205-211

THE FERTILITY PILL

QUESTION:

In recent years doctors have discovered a medicine in the form of a pill which is given to childless women and helps them to achieve fertility and even multiple births. Is such a pill, which seems to change the physical nature of the woman, permitted by Jewish tradition? (Asked by Rabbi Jonathan Brown, Harrisburg, Pennsylvania.)

ANSWER:

THE TALMUDIC LITERATURE has clear mention of medicines to prevent childbirth. They speak of “the drink of sterility” (kos shel ikrin; Even Hoezer 5:12), but I do not remember anywhere in the literature where there is mention of a medicine of the opposite effect, namely, a spur to fertility. Clearly such a medicine was not known to the ancients, since it is based on modern studies of glands and hormones, etc.

As to the general aim of these fertility pills, it is obvious that their purpose is in harmony with one of the central attitudes of Scripture. If there is any one blessing which God promises all through Scripture, it is the blessing of having many children. In Genesis (1:22) even animal nature, the fishes and the birds, are blessed by the Creator and mandated to “increase and multiply and fill the earth.” And when Adam and Eve were created (1:28), they received the same blessing that animal nature had received, to “increase and multiply.” The same blessing was given to Noah after the Flood. And when Abraham enters the land of Canaan, God’s blessing to him is that his descendants will be numerous as the stars in heaven and the sands on the seashore (Genesis 22:17). When Jacob leaves home, his father, Isaac, gives him a similar blessing (28:3). In Leviticus 26:9, the awesome chapters of blessings and curses, the people of Israel is promised, if they obey God’s commandment: “I will make thee fruitful and multiply thee.”

Of course, it may be argued that these blessings had great meaning in the early days, when our earth was largely empty, but today, with the threat of overpopulation and relatively insufficient food supplies, the old blessing to “increase and multiply” might be deemed to be no blessing at all. This may well be so, but as far as the Jewish people is concerned, the situation is somewhat different than with the world population taken as a whole. Within our own lifetime, we have lost, through mass murder, six million of our brethren, almost half the Jewish population in the world. We are again a people that is “few in number” (Psalm 105:12). To us nowadays, every Jewish child is doubly precious. For us, surely, the Biblical blessing is still a blessing. For that matter, among all peoples and all religions, there are numerous families that have been unable to have children and long for children of their own. To them, in spite of the threat of world overpopulation, the Biblical blessing is a longed-for blessing, and the modern fertility pill can be the pathway to it.

All this is clear enough from the point of view of sociology, but from the point of view of Halacha, there is much to consider in the matter of the fertility pill. The commandment to “increase and multiply” is the first commandment given in Scripture. It is the first of the mitzvos. But strange as it may seem, it is a commandment incumbent upon men and not upon women (m. Yevamos 6:6; b. Yevamos 65b; Shulchan Aruch, Even Hoezer 1:13). This means that it is a sin for a man to remain unmarried. It is his duty to provide children. But it is no sin if a woman remains unmarried. A woman may, under certain circumstances, use preventatives against conception (Nedarim 35b). But it is almost impossible to permit a man to prevent his seed from being fruitful (cf. Even Hoezer 5:12). If a man has begotten a son and a daughter, he is considered to have fulfilled his obligation “to increase and multiply.” However, even so, it is considered a sin for him not to continue to have children if he can afford to do so and is able to do so ( Yevamos 62b and Even Hoezer 1:8). But what if a woman is not fruitful? Generally the custom was, after ten years of childless marriage, for the man to divorce her and marry another (Even Hoezer 1:3 Isserles and Even Hoezer 1:14). This was indeed the custom, but it certainly was a source of sorrow. Why should efforts not be made to heal the barrenness of a woman, so that she can continue with her husband? We notice in Scripture that barren wives did not accept their fate calmly, but prayed that God would make them fruitful.

On this question as to whether a woman may resort to medical aid to become fruitful, there is some interesting discussion in recent law. Eliezer Wildenberg, in his responsa Tsits Eliezer (Vol. 11, pp. 105b ff.), has a long debate on this question. He cites the opinion of Menachem Mendel Paneth in his Sha’are Zedek, who says that barrenness is not a sickness involving physical pain, etc., for which she must seek medical aid. If a woman is barren, that is God’s decree. It is part of her nature. But Wildenberg refutes this opinion (which is rather an exceptional one) and says, first of all, that it is an established custom in all the generations that even the leaders of the community sought the help of doctors to cure the barrenness of their wives so that they might live together and fulfill the commandment. Wildenberg cites the great Spanish scholar Solomon ben Aderet, who tells of his teacher, the physician Nachmanides, who cured Gentile women of their barrenness. It is clear that to seek a cure for barrenness (even though it is not necessarily a disease involving physical pain, etc.) is well within the approval of Jewish tradition and custom.

However, the very fact that the duty to “increase and multiply” is incumbent specifically upon the man may nevertheless make a difference in the possible permissibility of the fertility pill. Let us assume, for the sake of discussion, that there is some danger to the general system in the taking of the pill. Now if a fertility medicine were given to the man, one could say that since it is his duty in Jewish law to “increase and multiply,” then he is justified in accepting some physical risk in order to fulfill the commandment. But since the woman is not at all mandated to “increase and multiply,” why should she assume any risk at all to her general health to fulfill that which she is not commanded to fulfill?

As to the above question of danger involved, I have consulted Dr. Harold Cohen, Clinical Professor of Obstetrics and Gynecology at the University of Pittsburgh. From him I have learned the following: There is no such thing as a fertility pill given to the man (who by Jewish law is mandated to “increase and multiply”). The pill is given only to the woman (who by Jewish law has no such mandate). Furthermore, as a matter of fact, there is a physical danger to the woman that may be created by the fertility pill. Her ovaries may be enlarged, and there is later danger of the necessity for surgery. Therefore physicians, in every individual case, will need to balance the physical danger against the family benefit. So, too, there will be considerable discussion in the Jewish legal literature, balancing the danger against the benefits.

So far I have found only one mention of the use of this pill. In Vol. 16 of Noam, published by Menachem Kasher (p. 43 in Kuntros Ha-refuah) , there is mention of a kadur heroyon, i.e., a fertility pill. The authority discussing this pill is concerned only with the question whether or not it may be taken on the Sabbath. On the Sabbath, sickness involving pain or danger may receive all necessary healing. But fertility pills, as also vitamin pills, do not involve physical pain which requires a doctor’s immediate attention—hence the discussion of whether the fertility pill may be taken on the Sabbath. But the very fact that the only question asked about the fertility pill was whether or not it may be taken on the Sabbath is an indication that for the present there is no general objection to it. On principle there could hardly be any objection to it. The idea of quadruplets or quintuplets was, at least on one occasion, looked upon as a blessing. When Scripture says (Exodus 1:7) that in Egypt “the Children of Israel were fruitful and multiplied,” the Midrash (cited by Rashi to the verse, of Exodus Rabba 1:8, also Yalkut Shimoni ad loc.) relates that “they gave birth to six infants in one womb.”

As the pill becomes more widely known, and the discussion concerning the dangers that might be involved is dealt with, the dangers will be weighed against the blessing the children may bring to family life. In consideration of the fact that to “increase and multiply” is one of the premier blessings of Scripture, and that the commandment to “increase and multiply” is a man’s primary mitzvah, it would seem that, although the Talmud knows only of sterility medicine, the use of the new fertility pill may win general, if grudging, approval in the law. Of course, if the medicine is someday so improved that it no longer has any harmful side effects, then it would be acceptable to the Halacha without any objection.