The overturning of Roe v. Wade has brought forth heated debates about the rights of the mother vs. the rights of the fetus, but there are other lives that could potentially be affected by this Supreme Court ruling that we’ve heard less about: the desperate parents who are trying to conceive healthy babies.
We recently sat down with Dr. Sahar Wertheimer, an Orthodox Jewish fertility specialist based in LA. We discussed how IVF may change as states develop individual laws and how those changes could affect Jews experiencing infertility.
Wertheimer is an OBGYN at the Southern California Reproductive Center. She is also the president of the Jewish Orthodox Women’s Medical Association (JOWMA), which is an organization that brings together Orthodox Jewish female doctors.
Wertheimer explains that the Orthodox Jewish perspective on abortion does not fit neatly into the presented American offerings. Sometimes abortion is not only permitted but necessary in Jewish law. Many Christian perspectives, in contrast, place a higher value on the life of the fetus over the mother.
IVF involves fertilizing eggs and cultivating embryos in lab settings before implantation in the uterus. IVF is used to treat infertility as well as help carriers of genetic diseases conceive healthy babies. Some Christian perspectives believe that in vitro fertilization is impermissible due to the construction of an embryo that may not develop into a baby. Jewish law allows for it, as well as other forms of family planning and reproductive healthcare.
The definition of life has become very important in abortion cases, and in this new environment, that definition is not clear-cut from a legal perspective or a medical one. If life begins at the embryonic stage, then IVF procedures may be called into legal question.
The first successful IVF birth wasn’t until 1978 — five years after the Roe v. Wade ruling — so we’re in uncharted territory. The legal definitions of life of an embryo, in utero or out, never needed to be so concrete until the overturning of this case, Dr. Wertheimer explains. Now, the reproductive health community is having a particularly difficult time with these gray areas.
There are currently no laws regarding abortions for outlier or gray area cases, nor does the community have the precise verbage to describe it to laypeople or include these scenarios in state laws. “What we can discuss would be a lot of “what ifs.” Dr. Wertheimer explains, “why are we concerned, where do we think this may or may not touch, what could it mean.” She then describes a recent edit to the abortion laws in Idaho, which now classify an embryo existing outside a uterus as subject to abortion law, which is quite scary for the fertility world.
Dr. Wertheimer has seen multiple instances of Orthodox Jewish rabbis permitting abortions in her years of practice. When she was a resident in New York, she had a big family planning division, which included doctors who performed more complicated abortion procedures than a regular OBGYN might. She constantly conferred with rabbis to make sure that she was allowed to perform certain procedures. “I was often surprised by how many I was allowed to do,” she says. “I think it has a lot to do with the complex halachic outlook, and the different leniency levels depending on the gestational age of the fetus and what the reason for the abortion is.”
Because halacha will allow abortions for medical reasons, psychological burden, or a gray-area medical reason (such as the presence of genetic disorders in the fetus), Dr. Wertheimer explains, there is a lot of potential for clashing with new political abortion laws. There are acute life-threatening situations and there are subtler ones. Sometimes people have preexisting health risks, and pregnancy can exacerbate those risks. “Pregnancy is a risk at baseline. Even in a very healthy pregnancy situation, pregnancy is a risk for the mother,” she says.
Unforeseen risks can arise at any time even in people who are totally healthy, so all the more so in people with preexisting conditions. If halacha were to allow the termination of a pregnancy because the fetus may not survive the pregnancy or if it did would have severe limitations in life, it’s not so clear if it would be jointly permitted in the current legal climate.
While Roe v. Wade’s overturn won’t make California’s abortion laws more strict, Dr. Wertheimer has been receiving communication from colleagues in other states requesting to transfer embryos to her center. It’s currently very complicated, and it doesn’t seem like the anxiety surrounding the topic will let up anytime soon.
Genetic disorders are a big reason that couples may decide to abort a fetus. That being said, there are a number of genetic disorders that doctors can know about ahead of time — which is one of the reasons why genetic testing and counseling services like JScreen are so important. Autosomal-recessive diseases are most often carried by couples who are from the same ethnic background or otherwise procreating within their own community. Couples who are aware that they are both carriers for certain disorders can opt for alternative fertility and impregnation measures to ensure that their children don’t risk being affected by the disease.
There is so much more to discuss on the topic and Dr. Wertheimer has made it part of her mission to continue to inform people on it. For more resources and conversations on this aspect of women’s health, you can visit Dr. Wertheimer on Instagram at @saharwertheimermd.
This interview is in partnership with JScreen. JScreen’s mission is to prevent devastating genetic diseases by making genetic screening and counseling accessible and affordable. They’re based out of Emory University of Medicine’s department of Human Genetics. The program provides online education, at-home testing, and remote genetic counseling services across the US. Since its launch in 2013, JScreen’s primary focus has been on reproductive carrier screening for diseases prevalent in Jewish and other communities – the program has tested and provided genetic counseling services for over 25,000 individuals.
Coupon code JTC100 will take $100 off screening at JScreen.org. Expires 12/31/2022.