I: Things you may not know about sheva nekiim and infertility

The topic of sheva nekiim is up for discussion, following an an orthodox obstetrician's suggestion to abolish the practice of counting 7 clean days before mikvah, since it is largely responsible for many cases of infertility and is founded on a chumra rather than halakha. I suspect that because the topic is treated with such modesty and privacy, there is a lot of confusion and ignorance. I would like to clarify a few things. [My opinion is based on experience as a married woman in the medical sciences. I cannot comment on the halakhic aspect of the issue.] But first, read the Haaretz article that sums up the original debate, and My Obiter Dicta’s review and excellent commentary (via Mentalblog).

First of all, missing ovulation because of niddah is more common than expected. So common , in fact, that most NY ob-gyns are familiar with niddah laws (as I imagine all physicians who treat orthodox women are) and refer to this particular situation as Orthodox Infertility. They say it laugh though, because technically this does not constitute medical infertility and is easily fixed for most couples. The typical medical treatment involves lengthening the women’s menstrual cycle via hormone therapy so that she ovulates later in the month, namely after mikvah.

There are many couples who elect not to see a physician but rather a Rabbi for their taharas hamishpacha issues. I am aware that Rabbanim deal with each question on an individual basis, but this common issue is usually treated by shortening the women’s period via herbal treatment, so that she can immerse in the mikvah before ovulation.

For most couples, one or the other treatments works. Very few couples remain unable to become pregnant because of bad timing alone. Treatments are relatively simple and mostly painless. I choose my words carefully because on one side there are people saying that hormone treatments are life threatening while the other party insists that they are no trouble at all. In this case, I feel both sides are being dishonest. Here is a more practical overview of treatment effects.

A typical rabbinic endorsed herbal cocktail includes high doses of herbs that are known to stop bleeding and cause uterine contractions, i.e. nettle, thistle, cohosh, roots of certain teas, etc… They may also recommend a Bioflavonoid to maintain small blood vessels in tissue lining (which may be the cause of excessive bleeding) and bathing in chamomile (I don’t know what this can do but it sounds relaxing).

Many people are under the misconception that because herbs are natural, they are completely safe. In fact, herbs are very potent and can have powerful effect on the body. (Many prescription medications are made from herbs or their derivatives.) In short, taking herbs for medical purposes without medical supervision seems to me like a dangerous practice. The same holds true for those ‘magic pills’ that kallah instructors give out so the bride’s will be guaranteed not to menstruate around the time of the wedding. These birth-control type pills are secretly imported because they are not FDA approved, and not surprisingly many brides have problems after taking these pills, such as sudden bleeding before the wedding or not menstruating for many months after the wedding. Also, because herbs are readily available, people who don’t know better will rely on unprofessional advice and possibly hurt themselves. I once heard a newlywed complaining about spotting during pregnancy; her also newlywed friend recommended several herbs that her Rav had given her to end her spotting. Anyone who takes unknown substances while pregnant is incredibly irresponsible and stupid. Case in point—one of these particular herbs had been used for generations by Native Americans to induce abortion! Had the pregnant woman taken the herb that “the Rav recommends for spotting”, she could have caused a spontaneous abortion (miscarriage). I am not suggesting in any way that Rabbanim are harming people by disseminating dangerous herbs, but the risks are apparent and people should use their heads.

The risks involved in hormone treatment, i.e. cancer or stroke, are much more frightening but are also much less likely (by a great magnitude) to occur. Oral estrogen is associated with certain female cancers, but so is chlorine bleach and possibly trans fat. The risks may be there, but they are not substantial or direct enough to render a short treatment plan unsafe. The immediate side effects that result from taking hormones include weight gain, nausea, possible migraines, trouble sleeping, mood swings etc. I would label these side effects relatively mild, compared with other infertility treatments that are far more invasive, expensive, and painful.

The problem of missing ovulation due to niddah is not entirely solved. While the medical cause can be easily repaired (to read research articles, type in "orthodox infertility" into search bar), there are many people who don’t know the cause of their infertility and for one reason or another do not seek medical or rabbinic help. The woman in the Haaretz article who thought she was infertile until her late 40’s, only to find out she had always been missing her ovulation, is cited as a victim of sheva nekiim. She should sooner be cited as a victim of her own ignorance and neglect! Why hadn’t she seen a doctor or discussed her condition with anyone who could direct her to help? Blaming the practice for her condition is unjustified, but claiming that the condition is independent of the practice is also untrue.