Blessed art Thou, Lord our God of the Universe, Who has formed man in wisdom and created in him many ducts and organs. It is revealed and known before the throne of your glory, that if but one of these be opened [that should be closed] or if one be closed [that should be open], it would be impossible to survive and to stand before Thee. Blessed art Thou, Lord, Who heals all flesh and works wondrous things.
Medical Solutions to Infertility
An observant Jew says the above blessing each morning shortly after rising. The blessing recognizes the intricacy and beauty of the human body. It expresses the fact that our bodies are a marvelous work of creation; they are truly God’s handiwork. Therefore, we praise God for the miracle that our bodies function properly.
Few systems in our body are as intricate and complex as our reproductive organs. Most people take for granted that sexual intercourse at the right time of the month will lead to pregnancy. Yet the system is so complex, and so many things can go awry, that we ought to praise God when the system succeeds. Numerous components must function smoothly for the sperm to reach and fertilize the ovum. There are hazards every step of the way. If one hormone is off balance in either the man or the woman, if one organ is malformed, if one event is ill timed, the process will fail.
The Reproductive System
Our assessment of medical solutions to infertility should be preceded by a quick overview of the reproductive process. This overview is by necessity sketchy; for a more thorough description, the reader should refer to the many excellent books on infertility.
For the woman, the monthly cycle is controlled by a delicate balance of various hormones. In the early days of the cycle, LH (luteinizing hormone) and FSH (follicle-stimulating hormone) produced by the pituitary gland stimulate ovary to produce estrogen, permitting the development of an egg. At mid-cycle, the large amounts of estrogen secreted induce a surge of LH, which causes the egg to break forth from the follicle. This process is known as ovulation. Estrogens also stimulate the growth of the lining of the uterus (endometrium), preparing it to receive the fertilized egg.
With ovulation, the cells of the ruptured follicle change form, becoming corpus luteum and producing hormone called progesterone. The progesterone allows further growth of the endometrium to nourish the implanted fertilized ovum. If pregnancy occurs, the placental hormone HCG (human chorionic gonadotropin), sustains progesterone secretion to support conceptus. The detection of HCG is the urine is the basis for current tests for pregnancy. Without pregnancy, the corpus luteum ceases to produce progesterone, the lining of the uterus is shed, and menstruation begins. The whole cycle the starts again.
Obviously, normal ovulation requires a delicate balance of these various hormones. In fact, birth control pills containing estrongen and progesterone work by throwing the entire process off balance. On the other hand, a basic part of infertility evaluation and treatment is the careful monitoring of these hormones. Sometimes infertility can be treated by administering these hormones artificially. In some cases the hormone level must be monitored daily. (This can be problematic for Sabbath-observant couples, an issue addressed later in this chapter).