Infertility associated with precoital ovulation in observant Jewish couples; prevalence, treatment, efficacy and side effects

Isr Med Assoc J. 2012 Feb;14(2):100-3.

Abstract

Background: Religious (halachic*) infertility' results from precoital ovulation prior to immersion in a ritual bath (mikveh) 7 days after menstruation, as mandated by Jewish religious law. Previous authors recommended treatment with estradiol to postpone ovulation and enhance pregnancy rates.

Objectives: To evaluate the prevalence of halachic infertility in an ultra-Orthodox jewish community, and assess the efficacy of estradiol treatment in postponing ovulation and increasing pregnancy rates.

Methods: We reviewed 88 cycles, of which 23 were control cycles and 65 estradiol-treated cycles, and analyzed the files of 23 women who were treated with 6 mg estradiol/day from day 1 for 5 days of the cycle.

Results: The prevalence of precoital ovulation in the infertile population was 21%. Most of the patients (94%) ovulated before day 13 of the cycle. A short follicular phase due to low ovarian reserve orthyroid endocrinopathy was noted in 12% of the patients. While 64% of the women reported consultation with a Rabbinate authority, 68% of the patients sought medical therapy. Estradiol postponed ovulation for at least one day in 89% of the treatment cycles. Ovulation post-mikveh occurred in 73% of estradiol-treated cycles. The pregnancy rate was 12.5% per cycle and the cumulative pregnancy rate 35% per woman. Half the patients reported spotting during estradiol-treated cycles, and this postponed coitus.

Conclusions: Precoital ovulation is a major reason for infertility among observant couples attending fertility clinics. Estradiol treatment is effective in delaying ovulation and restoring fecundity; however, it causes some adverse effects that may decrease its effectiveness.

MeSH terms

  • Adult
  • Coitus
  • Drug Administration Schedule
  • Estradiol / therapeutic use*
  • Estrogens / therapeutic use*
  • Female
  • Humans
  • Infertility, Female / drug therapy*
  • Infertility, Female / ethnology*
  • Jews / statistics & numerical data*
  • Judaism
  • Menstruation / drug effects
  • Ovulation / drug effects*
  • Ovulation Induction / methods*
  • Pregnancy
  • Pregnancy Rate*
  • Prevalence
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Estrogens
  • Estradiol