New IVF program helps Orthodox Jews conceive

MONTREAL — An unusual collaboration between religion and science is making it possible for Orthodox Jews to undergo infertility treatment in Montreal.

Dr. Hananel Holzer

MONTREAL — An unusual collaboration between religion and science
is making it possible for Orthodox Jews to undergo infertility
treatment in Montreal.

Dr. Hananel Holzer points to the two incubators reserved for the
embryos of Orthodox Jewish couples at the McGill Reproductive Centre.

The Jewish Community Council of Montreal (Vaad Ha’ir) and the McGill Reproductive Centre, located at the Royal Victoria Hospital, have officially launched a program that strictly adheres to halachah while offering the latest technology, including in vitro fertilization (IVF).

The program has been a year in development, while the Vaad and the staff of the clinic train a volunteer corps of Orthodox Jewish women observers, who are present at all times when either the egg or sperm of an Orthodox Jew, or the resulting embryo, is exposed. This is to reassure a couple that it is, indeed, their reproductive material that is being used.

While a private infertility clinic offering supervision by observers trained by an institute in Israel was recently opened in Toronto, the McGill Reproductive Centre is the first university-based research institute in Canada to bear a certification from a rabbinical organization.

Previously, Orthodox couples often went to New York or even Israel to find this type of compliance with their beliefs.

The observers are known as mashgichot, a feminized version of the term used for men who supervise the kashrut of food. When on duty, they wear the same gowns, caps and shoe covers as everyone else at the clinic.

When no observer is present, the embryos are kept in one of two locked incubators reserved for the Orthodox program, and the eggs in two designated deep-freeze tanks that are also sealed, which were purchased with private donations from the Jewish community.

Only an observer and an embryologist normally have access to these containers.

The program came about by the coincidental arrival in Montreal from Israel within the past few years of Rabbi Yonason Binyamin Weiss, now chief of the Montreal Beth Din, and Dr. Hananel Holzer, an infertility expert who is in charge of the medical side of the program. He’s the only other person who has access to the special incubators and tanks, and then only in case of emergency.  

He and the centre’s embryologists, who are specialized biologists, trained the observers in the medical aspects of assisted reproduction, while Rabbi Weiss trained them in Jewish law.

There are now eight observers, and another group will start being trained in a couple of weeks because of the demand for the program, Holzer said. An average of two to four new Orthodox couples each week are seeking the centre’s services.

Rabbi Weiss, a chassid from Bnei Brak, is an authority on the halachic interpretation of medical and bioethical issues. Holzer, an obstetrician and gynecologist, was deputy director of the IVF unit at Hadassah Hospital in Jerusalem for 12 years, as well as founder and director of a fertility unit in the city of Modi’in, where he had a lot of experience working with haredi communities.

Holzer, who is not Orthodox, worked closely with many of Israel’s top rabbis to ensure that treatments met the letter and spirit of Jewish law.

“While the concept of kosher food may be familiar to many, not everyone realizes that Jewish laws also set out clear guidelines which cover reproduction,” he said.

Holzer said that two embryologists always normally witness the handling of any eggs, sperm and embryos. The Vaad-certified observers offer Orthodox patients, for whom lineage in of utmost importance, an extra level of comfort.

The couple is given the name of an observer, whom they make contact with themselves.

All of the staff at the centre have been instructed in Jewish law by Rabbi Weiss, and all may work with the eggs, sperm or embryo of Orthodox patients.

The program appears to be accepted by the even the most religiously rigorous  communities in the Montreal area. Holzer has a photo of Rabbi Meshulim Lowy, rebbe of the Tasher chassidim in Boisbriand, north of Montreal, on his desk, given as a token of appreciation.

Holzer said he and Rabbi Weiss are working well together. “I don’t interfere in the religious side, and he doesn’t interfere in the medical side.”

Overseeing the Orthodox program is not Holzer’s main job at the centre, however. His true vocation is developing techniques to make it possible for women about to undergo chemotherapy to benefit from IVF. Chemotherapy can harm ovaries, but only mature eggs can be frozen, and that requires stimulation with hormones, which is inadvisable with certain cancers. Holzer has had success in maturing harvested eggs in the lab.

Currently, infertility treatment, which can be very expensive, is not fully covered by medicare, but a bill was tabled in April in the National Assembly would make IVF reimbursable.

There are other considerations in treating Orthodox couples for infertility besides providing observers, Holzer said. Due to prohibitions on masturbation and contraception, the only way to obtain a semen sample from the man is to provide him with a special condom with a small hole at the end.

After intercourse, the condom is brought to the clinic. None of the semen is disposed of. After analysis, it’s always used in a treatment, thereby conforming to the biblical injunction against “spilling seed in vain,” Holzer said.

He also has to work around laws governing when a couple must abstain from intercourse, namely the seven days following the end of a woman’s menstrual period. Sometimes, medication is needed to ensure this is respected and that ovulation takes place at the right time.

A recent addition to the centre’s five-member medical staff is Dr. Michael Haim Dahan, a Montreal native who is shomer Shabbat and has expertise in treating Orthodox couples. He was previously on faculty at Washington University in St. Louis and Stanford University in California.

Due to the strong imperative to have children, Orthodox Jews have generally embraced the new technology, Holzer said, and, in many ways, have a liberal attitude to its possibilities. In Israel, they were among his first patients for IVF.

Success rates for IVF have improved dramatically, he added. “In 1996, only 17 to 20 per cent of IVF treatments resulted in pregnancy. Today, it’s up to 60 per cent.”

“The Orthodox call me the shaliach [emissary] of God,” he said.