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Facing Tefillah, Community, and Family as a Couple Struggling with Fertility

Rosh Hashanah and Yom Kippur. It is a time of reflection, a time of spirituality. For many people, tefillah, community and family feel like a warm embrace. To others, such as those experiencing infertility, these can feel more like a straight jacket.

I always ask my patients about their religious affiliation. Religion can be a tremendous comfort when someone is in pain, but it can also be a stressor. During the chaggim, it can be both to the couple experiencing infertility. If you are in this position, please try to understand how you feel, what you think the experience will be like for you this year and discuss with your spouse some strategies to assist you during this time of year.

First, let us set the scene: The davening during the High Holy Days has many images and themes. It discusses G-d as King; a G-d who is slow to anger, full of mercy and compassion. But it also speaks of a G-d who is deciding, “Who will live, and who will die…who will be born and who will perish.” The language used in our prayers can evoke strong feelings.

Communities spend more time together in shul at this time of year than at any other time. But with packed shuls, and often assigned seats, the couple experiencing a difficult personal time often feels crowded and overwhelmed. Young children and pregnant women seem to be everywhere, parents revel in bringing young children in for shofar blowing, and babies are passed from relative to relative. All of this can serve as powerful emotional triggers.

Lastly, family gatherings are often part of the yom tov season. Some families are very sensitive to members who are struggling with infertility, and some are not. Some couples have shared their fertility struggles with their families, and some have not. Intrusive questions, whether well-meaning or not, can ruin a holiday for a couple. The same can be said when families seem to only focus on children and not on the adults at the gathering. Many clients of mine have related how they feel that their parents “only care about the grandchildren,” and so even though they are expected to attend, it does not seem as though they are important as well.

What are some suggestions for the couple who is struggling with infertility to get the most out of the holiday experience and minimize painful experiences?

Family:

  1. Talk with your spouse about how much to disclose to family members. Decide what you will share and what you will not share BEFORE you are with the family.
  2.  Remember there is an inverse relationship between privacy and support. The more privacy you have, the less support you may receive. Decide together where the line is with each family member. If you both feel someone will be a big support to you, consider sharing with them your experiences.
  3. In these pre-chaggimdiscussions with your spouse, be honest about family members with each other. Not every family member is the same. If one of you does not feel comfortable sharing with someone, respect each other’s feelings.
  4. If you are with family that can be intrusive, come up with some phrases that you can repeat throughout the holiday. “Thank you for asking. We have decided to keep that private for now.” “We will let you know when there is something to know but have decided to keep the details of treatment to ourselves.” “Thank you for caring, but it’s not something I am comfortable talking about right now.”
  5. Know your limits. Create a signal between you and your spouse so that when you have reached your fill, you can take a break and leave the environment. You can take a walk, read a book or separate yourself in another room.
  6. Discuss with your spouse where you want to spend yom tov. What do you need as a couple now? What do you want to do for the chaggim THIS year. It does not have to be a permanent plan.
  7. Try to make sure that you cope together. Couples struggling with fertility are generally newer couples, couples who are still finding their way in each other’s extended families. Make sure you turn towards each other, not away.

Shul:

  1. Distractions: For some people, it is hard to concentrate, to have kavanah, when they have little children or a pregnant person in their line of sight. You can often move to the wall and stand and have some private time to daven off to the side.
  2. Change of minyan: There are times that you are better off in a different environment. Some minyanim seem to be more “family-oriented”; this may not be the minyan you chose to go to this year.
  3. Plan ahead: Know yourself. If you do not want to stand “catching up” with everyone after tefillah, make a plan with your spouse or another family member or by yourself to leave as soon as services are over. If you plan it ahead of time, it can reduce the anxiety through shulthat you will have to make small talk, and if others know you are leaving right away, it reduces the need to find them and tell them where you are going. Make a plan that “We will meet at home.”

Machzor:

  1. Take some time in this month of Elul to look through the tefillot. Even though it is familiar to you, you may be in a different place emotionally and spiritually this year; spending some time with the machzor ahead of time can help reduce the emotions of the words that poke at your wounds.
  2. Try to find the images and the words that bring comfort to you, words that help you relate to this experience so that they will stand out when you are saying them in shul. For example, is the image of “G-d as King” or “G-d as a caring Father” more helpful to you this year such that you want to make sure you focus on the verses that contain that image? You can use sticky note flags or mark those passages so that they envelop you during services.
  3. Spend some time with the more challenging images ahead of yomtov. What do they mean to you? How can you relate to them this year? How do they contribute to your relationship with G-d, and how do you talk to G-d about that? The conversation with G-d can begin at home, in a quiet room, just you and a machzor, and can continue through yom tov. While Rosh Hashanah is a two-day holiday, and Tishrei is a month-long, ideally we are in a lifelong conversation and relationship with G-d.
  4. Consider your resources: Some of the words and images may be difficult. Images of “barrenness” and of judgement are particularly jarring. If you have a relationship with a religious leader or current or former teacher, consider meeting together privately beforehand to discuss it if you think this can help.

Overall, you will have your own strategies and methods for coping with the holidays. Be thoughtful about who you and your spouse are, and what strategies work well for you and what does not. Know your limits and what you can change and what you cannot. Most of all, in the spirit of Yom Kippur and forgiveness, forgive yourself. Forgive yourself for having complicated emotions and sensitivities. Be kind to yourself and take care of yourself, as an individual and as a couple.

Shana Tova Umtuka

By Karen Wasserstein

Dr. Karen Wasserstein is a psychologist in Maryland and Virginia with a specialty in working with those facing fertility challenges. She can be reached at drkwasserstein@gmail.com. This article was written as part of the Just for You: PuahCare Article Series. Because your fertility journey is so much more than a medical experience

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Rosh Hashanah 5774
Hannah: A Modern Interpretation

וַיְהִי֩ אִ֨ישׁ אֶחָ֜ד מִן־הָרָֽמָתַ֛יִם צוֹפִ֖ים מֵהַ֣ר אֶפְרָ֑יִם וּשְׁמ֡וֹ אֶ֠לְקָנָ֠ה בֶּן־יְרֹחָ֧ם בֶּן־אֱלִיה֛וּא בֶּן־תֹּ֥חוּ בֶן־צ֖וּף אֶפְרָתִֽי:  וְלוֹ֙ שְׁתֵּ֣י נָשִׁ֔ים שֵׁ֤ם אַחַת֙ חַנָּ֔ה וְשֵׁ֥ם הַשֵּׁנִ֖ית פְּנִנָּ֑ה וַיְהִ֤י לִפְנִנָּה֙ יְלָדִ֔ים וּלְחַנָּ֖ה אֵ֥ין יְלָדִֽים
(1Samuel 1:1-2) Now there was a certain man of Ramathaim-zophim, of the hill-country of Ephraim, and his name was Elkanah, the son of Jeroham, the son of Elihu, the son of Tohu, the son of Zuph, an Ephraimite. And he had two wives: the name of one was Hannah, and the name of the second Peninnah; and Peninnah had children, but Hannah had no children.

They were on many accounts successful. They had careers and a house and family and friends that loved them. But they had no children.


וּלְחַנָּ֕ה יִתֵּ֛ן מָנָ֥ה אַחַ֖ת אַפָּ֑יִם כִּ֤י אֶת־חַנָּה֙ אָהֵ֔ב וַֽיהֹוָ֖ה סָגַ֥ר רַחְמָֽהּ
(1:5) But to Hannah he would give a special portion, for it was Hannah he loved, but the Eternal One had shut her womb.

They saw doctors and specialists who could find nothing to repair. They ascended the ladder of interventions steadily and were lifted into the realm of Assisted Reproductive Technologies.

   וְכֵ֨ן יַֽעֲשֶׂ֜ה שָׁנָ֣ה בְשָׁנָ֗ה מִדֵּ֤י עֲלֹתָהּ֙ בְּבֵ֣ית יְהֹוָ֔ה כֵּ֖ן תַּכְעִסֶ֑נָּה וַתִּבְכֶּ֖ה
(1:7) And as he did so year by year, when she went up to the house of the God, so [Peninnah] vexed her; therefore [Hannah] wept,

And so this happened year by year. She continued to prayer for strength and health and asked God for compassion. And he began to work extra to pay for the medical bills. And life vexed them as the rest of the world seemed fecund and others with good intentions would comment. They went to more specialists, had more procedures, and had more losses. And as they slowly moved through life, pregnancies ended.

    וְהִ֖יא מָ֣רַת נָ֑פֶשׁ וַתִּתְפַּלֵּ֥ל עַל־יְהֹוָ֖ה וּבָכֹ֥ה תִבְכֶּֽה
(1:10) And she was in bitterness of soul–and prayed to the Eternal, and she wept deeply.

And her soul was in pain and she prayed to the Eternal One. And she wept bitterly.

  וְחַנָּ֗ה הִ֚יא מְדַבֶּ֣רֶת עַל־לִבָּ֔הּ רַ֚ק שְׂפָתֶ֣יהָ נָּע֔וֹת וְקוֹלָ֖הּ לֹ֣א יִשָּׁמֵ֑עַ
(1:13) Now Hannah, she spoke in her heart; only her lips moved, but her voice could not be heard;

Just before one of the IVF procedures, when she and he, the doctor and nurse, the lab technician and the assistant were present, she tried to pray for strength and health and ask God for compassion.  But only her lips moved and no words came out. So he read the words for her. And they all wept with hope.

Yet that too ended in loss.

So they began to ask God and themselves different questions.  They began to count their blessings differently. They made a commitment to help others who wanted children too but did not have such blessings.

    וַֽיִּזְכְּרֶ֖הָ יְהֹוָֽה:  וַֽיְהִי֙ לִתְקֻפ֣וֹת הַיָּמִ֔ים וַתַּ֥הַר חַנָּ֖ה וַתֵּ֣לֶד בֵּ֑ן
(1:19-20) And the Eternal remembered her. And it came to pass, when the time was come about, that Hannah conceived, and bore a son

And the Eternal One remembered her.  At the turn of the third year, blessed with the resources to secure the doctors and a clinic, a donor and nurses, and the strength to try again, they conceived. The following summer their twin daughters were born.

 וַתֹּ֨אמֶר֙ בִּ֣י אֲדֹנִ֔י חֵ֥י נַפְשְׁךָ֖ אֲדֹנִ֑י אֲנִ֣י הָֽאִשָּׁ֗ה הַנִּצֶּ֤בֶת עִמְּכָה֙ בָּזֶ֔ה לְהִתְפַּלֵּ֖ל אֶל־יְהֹוָֽה:  אֶל־הַנַּ֥עַר הַזֶּ֖ה הִתְפַּלָּ֑לְתִּי וַיִּתֵּ֨ן יְהֹוָ֥ה לִי֙ אֶת־שְׁאֵ֣לָתִ֔י אֲשֶׁ֥ר שָׁאַ֖לְתִּי מֵֽעִמּֽוֹ
(1:26-27) And she said, O my God, as you live my God, I am the woman that stood with you here to pray to the Eternal One. For this child I prayed; and the the Eternal One has granted me my petition which I asked of Him;

And when she planned to wean them, they went to the House of the Eternal One. They remembered their petitions to God and knew it was the time to fulfill the commitment of helping others. And the Hasidah Foundation was brought into life.

Hasidah comes from the root Hesed – lovingkindness. Hasidah means stork. The Hasidah Foundation’s purpose is to build Jewish families by providing financial support for Assisted Reproductive Technologies, which is the term that includes in vitro fertilization (IVF) and the many related treatments and procedures.

The reading above is the story of Hannah and Elkanah. There are many Hannahs and Elkanahs today whose prayers for children are not answered as expected. Feeling denied of the fundamental human ability of bearing children, being unable to fulfill the commandment to be fruitful and multiply, cuts deeply. Nobody is raised to think they may not be able to bear children in the traditional way. Quite the opposite – we are repeatedly cautioned of its ease.  The world of infertility then becomes dark and lonely. It is – it was – deeply personal and painful.

So there is silence, sadness, sometimes anger, and a loss of control. Balancing the hopes and the fears can become a Herculean effort.  And for some, during the difficult time of dealing with infertility, there is also an insurmountable financial barrier between them and Assisted Reproductive Technologies, which can be a potential solution.

Assisted Reproductive Technologies have been able to address many of the variables that cause infertility. Medical issues, cancer, genetic factors, male factors, female factors – there are many situations where Assisted Reproductive Technologies can provide real possibilities for having children. There is access to the procedures here in Columbus and around the country. The statistics for success are in our favor. However, the financial barrier is a real one for many. It can cost from $10K to over $40K all inclusively for one IVF cycle depending on what all is involved.

Hasidah’s goals are to build awareness about infertility in the Jewish community, to help ease the financial burden that for some is a complete barrier, and ultimately to build Jewish families.

To you who are reading this, thank you for recognizing this issue. We hope you will continue to spread awareness to those those in need and those who can help.

To the Hannahs and Elkanahs today in our community, my prayer for you is for strength, patience and hope and to know which one you need at which time.  May God and all of us hear your silent prayers and take notice of this affliction.

:וַיִּשְׁתַּ֥חוּ שָׁ֖ם לַיהֹוָֽה
(1Samuel 1:28) And they worshiped the eternal one there.

הָרַחֲמָן, הַמְרַחֵם, רַחֵם עָלֵֽינוּ
May the merciful One, Who acts mercifully, have mercy upon all of us.
Now and always.

שנה טובה
Good wishes for the New Year

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