Americans speak openly about breast cancer and domestic violence — subjects that were taboo in recent memory — but infertility remains relatively hush-hush. Meanwhile, fertility struggles increase, as more Americans, including American Jews, delay parenthood.
For some, that reflects a conscious choice to delay parenthood into their 30s, or even their 40s, as they pursue advanced degrees and high-powered careers. For others, it’s a matter of not having met the right person earlier, or mysterious medical causes that puzzle even fertility doctors. Is there anything helpful we can tell these adults?
The short answer is yes. There is increasing awareness that both men and women struggle with infertility. Even more importantly, anyone currently struggling should know: You are not alone. Infertility may not be widely discussed, but it is surprisingly common.
THE JEWISH STRUGGLE
Infertility affects one in eight American couples, but that statistic reportedly jumps to one in five among Jewish couples. This makes infertility an urgent matter in any discussion about the Jewish future.
The first biblical commandment is “Pru urvu,” be fruitful and multiply, and because Jews don’t proselytize, the key to Jewish continuity has always been more Jewish babies. But what happens when the dream of parenthood remains elusive?
Like Mormons, the Amish, and other relatively small groups that tend toward intra-marriage, Ashkenazi Jews are more likely to be carriers of certain genetic diseases, including diseases that can negatively affect fertility outcomes. However, Dr. Jerald Goldstein, the founder and medical director at Fertility Specialists of Texas, emailed that even accounting for possible genetic issues, “age is the most important predictor regarding fertility issues.”
PARENTAL AGE IS RISING
As a recent British study published in “Human Reproduction [1], one of the world’s leading reproductive medicine journals,” found:
The prevalence of infertility was highest among women aged 35-44 years and among men aged 35-54. More than a third of women who became mothers aged 35 or older had experienced a period of infertility compared to fewer than one in ten women who had their first child before the age of 25.
Unfortunately, the Center for Disease Control (CDC) data on infertility does not differentiate between respondents with underlying fertility issues versus those where the primary issue is advanced maternal age. However, the CDC does report that “about 20% of women in the United States now have their first child after age 35, and . . . About one-third of couples in which the woman is older than 35 years have fertility problems.”
American Jews are clearly well represented within that group. For while Orthodox women still bear children in their 20s, the non-Orthodox (about 90% of American Jews) regularly delay child bearing into their 30s and beyond, like educated American women of all backgrounds.
The Pew Forum reports that “most Jews are college graduates (58%), including 28% who say they have earned a post-graduate degree.” Further, the median age at which women with a Master’s degree or more become mothers is 30, meaning many women start later.
STIGMA REMAINS
Every professional who works in the infertility support space — in the Jewish, or larger American, community and was interviewed for this article — agreed that stigma remains around infertility, in spite of its ubiquity. Robin Axelrod Sabag, LCSW and Assistant Director of Individual and Family Services at Philadelphia’s Jewish Family & Children’s Service shared, “Once the stigma’s uncovered, [people who’ve approached us] feel more free, get more help . . . I’m always very careful to say that everything is confidential and no one will find out about it. Like therapy, this is very private for people.”
Annie Glickman, the founder of Priya, which offers financial and emotional support to Jews facing infertility in Dallas and Kansas City, commented, “There’s still a very untapped area of repeated pregnancy loss. It’s something that’s common and still not really discussed.”
Of course, as painful as infertility may be in the general Jewish population, that pain can be amplified among the Orthodox. Maharat Ruth Balinsky Friedman, a spiritual leader at Washington’s National Synagogue and board member of The Red Stone, a group that supports Jews struggling with infertility in the nation’s capital, notes,
“Childbearing is expected to occur at a younger age and with more frequency. People think the reality is what they see: babies. You don’t see what doesn’t happen, so there are a lot of insensitive comments — Why are you waiting? Why haven’t you started yet?”
Amy Jablin Forseter, who founded The Red Stone, adds, “If you’re Shomer Shabbat (Sabbath observant) and you go to the mikveh (ritual bath), you are dependent on, and therefore stuck in the middle of, a community that places a heavy emphasis on families and children.” There are regular religious obligations, and observing them often occurs amidst families with multiple children. In other words, living a Jewishly observant life can offer a constant, painful reminder of what these adults might most want, but not have — unlike so many others in their tight-knit communities.
THE COMMUNAL CHALLENGE
Infertility is an intensely personal struggle, but for Jews, who function much like a large, extended family, there’s a communal piece too. Infertility threatens Jewish continuity, which means that individual struggles are everyone’s struggles.
The Pew Forum, which surveyed American Jews in 2013, found that Jewish adults ages 40-59 report having had an average of 1.9 children, compared with 2.2 children among the general American public. That 1.9 rate is below the replacement rate and simply unsustainable, if Jews want to remain a vibrant part of American society well into the future.
“One beautiful thing about Judaism,” notes Amy Jablin Forseter, is that “we think people should do anything they can to have a child. We want people in our [support] groups to understand that their religion supports them.”
Individuals need to make their own decisions about whether they to pursue fertility treatments including IVF, adoption, or some combination thereof, but what can the larger Jewish community do to support those going through this experience? That will be the subject of my next column.
Written by: Melissa Langsam Braunstein
Photo Credit: Christine Szeto
