Dr. Baruch Brooks is about to create a baby. With a steady hand and beating heart, he examines the microscopic egg sitting in the Petri dish. Now, it's his job to pick one male reproductive cell out of hundreds at his disposal for the second half. The genetic composition that he chooses will create a baby. Is there anything closer to playing God than that?
Dr. Brooks, an embryologist and Jewish law supervisor of the IVF unit at Shaarei Tzedek Hospital in Jerusalem, dismisses the idea that the choice of his hand will determine the makeup -- actually, the entire destiny -- of the unborn child.
"I'm not choosing," says the bearded, rabbinically-imposing Dr. Brooks. "I'm just a shaliach, an emissary from the Creator of all Life. The Talmud tells us that 40 days before the formation of the fetus, which means the time of conception, a heavenly voice pronounces his shidduch, the marriage partner for this baby. This means that when I'm doing my work, it is already known who this baby will marry. So my will at that point isn't really my own. I know I'm being guided. If I thought I were on my own, my hands would shake too much."
Dr. Brooks sees himself as an extension of the triangle needed to create a baby -- a father, a mother, and God.
Dr. Brooks sees himself as an extension of the triangle needed to create a baby -- a father, a mother, and God. He works on two fronts. By day, Dr. Brooks bends over microscopes and Petri dishes at Shaarei Tzedek's IVF lab. He is also the lab's mashgiach, supervisor, who makes sure all procedures are done according to Jewish law, halacha, and without error of mix-up in the biological material.
By night, he is scientific director of Zir Chemed, a non-profit organization which offers counseling and medical services within a halachic framework to religious couples faced with infertility. Although he's not a physician -- his PhD is in biology -- Dr. Brooks is often the first stop for religious couples facing the daunting road to hoped-for parenthood, accompanying them on the sometimes threatening, often turbulent journey into the world of fertility science.
Any couple entering the secret realm of fertility treatment faces the confusing search for the right doctor and the most effective procedures, accompanied by anxiety, hope, fear, and a selection of other polarized emotions. For religious couples, there are additional challenges. Which procedures are permitted by Jewish law and which are not? How long should a couple wait before beginning treatment, and where should they go?
"There is a feeling that artificial procedures are something religious people don't want to do unless there is no other way," says Dr. Brooks.
He explained that while there is a commandment to "be fruitful and multiply" and have children, according to the opinions of this generation's leading halachic authorities Rav Elyahsiv and Rav Shlomo Zalman Ohrbach, zt"l, this obligation only extends to the couple's ability to conceive within a natural framework. Furthermore, there could be halachic complications in the extraction of the biological material, and even more so in using donor material. But because having a family is a prime value, couples are encouraged to make their best natural efforts in this area, and depending on the circumstances, might receive permission, or even a blessing, to proceed with artificial means.
"I assume most couples, religious or not, will prefer not to use artificial procedures, but sometimes these procedures are the quickest way to conception. A religious couple will not want to consider these options unless there is really no other choice. So we always try minimal invasive treatment first, exploring all avenues even if they are more time-consuming and use more laboratory resources. Often by paying careful attention to detail, by looking carefully at certain blood tests or hormone tests, we can succeed without moving into hi-tech."
MAZEL TOV! IT'S QUINTUPLETS!
Dr. Brooks is no stranger to the wonders of God's hand in creating a family. Twenty-eight years ago in London, his wife Raizel gave birth to quintuplets. At the time they had a four-year-old daughter. Perhaps, says Dr. Brooks, a multiple birth is the fantasy of all infertile couples, but Raizel Brooks, for one, doesn't have glorified or heroic memories of those early years. The babies were born at 28 weeks, and their underdeveloped immune systems made them prone to myriad illnesses. For the first two years, all five were in and out of hospitals.
"People would hear about this miracle and say to me, 'Oh, what a heroine!' or 'What a blessing!' but I couldn't relate to that part at all. I felt at the time like I was in one long dark tunnel. I remember feeling jealous of friends who would come to visit with their one baby, whom they would cuddle and hug. I could never do that. There was no time. It was impossible to just sit back and cuddle my babies."
The quints, three boys and two girls, are now all healthy and married with growing families of their own. In the 21 years since they moved to Israel, the Brooks' have had another five children (individually). "So," says Dr. Brooks, noting the blessing of a large family in explaining his tireless devotion to childless couples without receiving financial remuneration, "I have a debt to pay back."
Today, you never know which child you see playing in the park might be a 'hi-tech' baby. This could be any baby produced through artificial means, with 'test-tube', or IVF, conception being the most extreme. But other procedures to achieve conception, such as artificial insemination which involves washing and re-injecting, hormone stimulation to the ovaries, and technology determining when the woman will ovulate, are all based on developments which have taken years to perfect. New developments in micro-manipulation, where just one male cell, instead of a million, is enough to achieve conception, have put science on top of the challenge of male infertility.
Ten years ago when Zir Chemed was founded, Dr. Brooks got the push from leading rabbis in Israel to not only set up a counseling service, but to set up a clinic with a lab and a staff of gynecologists. Because of constant scientific advances in the areas of infertility and genetic manipulation, Dr. Brooks, who is both a scientist and a Torah scholar, is an invaluable resource for rabbinic authorities who must render decisions in Jewish law for couples in this area.
IMPORTANCE OF FOOLPROOF SUPERVISION
One of the first conditions for technologically-induced conception is the quality of supervision of the biological material. Last year, the public was horrified by the story of a (non-Jewish) British woman who, after years of infertility, was finally able to conceive with her spouse through IVF. The Caucasian couple was joyous when they learned she was carrying twins -- until they were born Black.
It's horrifying to think that a woman going into treatment might accidentally have a baby by a man who's not her husband.
"You can't imagine how often such mistakes occur," says Dr. Brooks. "What is so frightening is that in this case it was only discovered because the babies were born with a different skin color. How many times might a woman have had a same-race baby, but not through her own spouse? It's horrifying to think that a woman going into treatment might accidentally have a baby by a man who's not her husband. Certainly no one is going to do DNA testing on his own child to make sure he's really the father. The bottom line is that scientifically and medically the lab has to function in a way that errors won't be merely minimized, but that they simply won't occur. From a Jewish perspective, to create a foolproof lab there must be a G-d-fearing mashgiach, supervisor."
That's part of Dr. Brooks' job at Shaarei Tzedek. When the hospital, 14 years ago, made the brave decision to open an IVF unit, Dr. Brooks was approached by Rabbi Yaakov Strauss, the rabbi of the hospital. Agreement to open the unit was contingent upon finding a full-time mashgiach, not just a religious man with a beard, but a professional who would also be part of the intricate scientific workings of the lab. Dr. Brooks retrained as an embriologist, and has been with the unit since.
"Professionals in the field are still wary of me because they think I'm too hot on the supervision issue. They are afraid it will obstruct their work, that it is an invasion of privacy, that no one but the doctors should know what's going on. I sympathize, and that's all the more reason people who are in supervisory positions should also be part of the team."
Other labs have supervision, but Shaarei Tzedek is extra-strict, and was in fact a trailblazer in the area when no one else thought it was necessary. When the Dr. Brooks is not there, the lab is locked, and only he and the hospital rabbi have the keys.
Today, a woman undergoing IVF treatments anywhere in Israel can request an "escort," a religious woman trained in the intricacies of IVF whose job is to guard all biological material from the time it is extracted until it is re-implanted in the womb. These women are trained by the Machon Puah organization, which, like Zir Chemed, gives fertility counseling to religious couples.
Shaarei Tzedek, under Dr. Brooks' authority, has the only unit in Israel run according to Jewish law from start to finish. "This means that we don't accept a couple for treatment without going through a halachic committee to make absolutely sure that this is the only solution for the couple and that there is no other way to achieve pregnancy. Were all hormone and other therapies tried first without success? IVF might be simpler and faster than other therapies and doctors might justifiably look for that faster, easier way. But we can't take expedience into account."
When Dr. Brooks is involved with a couple, he will turn over every stone, try every other reasonable method, to produce the desired results without the couple having to enter the IVF program. The pain and trauma to the woman are great, as well as the physical danger and the tremendous strain on the marriage. But if that is the only option, Dr. Brooks sees to it that the couple gets into the program quickly and is there as a shoulder for them through the duration of the treatment.
Fertility issues can sometimes place an enormous strain on a marriage. It takes tremendous inner resources for the couple to weather this without resentments.
While challenges in marriage can bring a couple closer, sometimes fertility issues can strain a marriage and throw a woman into hopelessness. "Most treatments, especially IVF, fall onto the woman, even if the problem is with the husband," Dr. Brooks explains. "A woman might feel, 'I have to go through all this just because my husband has a problem?' Now we can tell her, well, you're married, you have to face your challenges together, and so on, but when it comes down to having to inject herself with painful injections every day for two weeks, when the doctors have to take over her body and turn her into an egg machine, where she will produce 15-20 eggs a month instead of one, when she is put into artificial menopause and then has her ovaries stimulated with hormones, what can you tell her? It takes tremendous inner resources for the couple to weather this without resentments. Sometimes I've found myself serving as referee."
Until recently many couples opted to find the solution to their problem abroad where they would incur tremendous debts -- $10,000 or more per round of treatment, but according to Dr. Brooks, more and more couples are actually coming in the other direction. For Israelis, the Kupat Cholim health fund pays for the first few IVF procedures, and in practice most couples will go to another committee to get authorization for another four or five procedures. It's not unusual for a couple to go through ten procedures, all at the expense of Kupat Cholim. Furthermore, couples who already have children might also be eligible based on specific circumstances, and couples who have had successful conception through IVF could be eligible for more rounds. There are women in Israel who have families of two or three 'test-tube' children.
"Israel spends more on fertility per capita that any other country in the world," says Dr. Brooks. "The level of motivation among doctors doesn't exist anywhere else. I always tell people that if you go to a fertility clinic in Israel, even the lady who cleans the floors is cheering you on.
"In the religious community there is an additional problem of secondary infertility, where there is already one or more children but the mechanism has stopped, although the desire hasn't. Outside of Israel, doctors are rarely inspired to help a woman who already has children. A religious couple is usually motivated to have not just one child, but many. No other medical system in the word is geared to that level of motivation except in Israel.
In the religious world where large families are the norm, couples face not only resentments, but feelings of guilt and inadequacy and of not being "normal."
"The first thing I do with young couples is to encourage them that they are normal," says Dr. Brooks. "First I have to get rid of the guilt. Fifteen percent of couples have some fertility issue, so once they see they are in the normal range, they have the wherewithal to face the blood tests and other medical indicators. It's vital that the young woman understand exactly how her cycle works. I condense three chapters of a textbook on reproductive endocrinology into 15 minutes. The doctor is going to give her drugs. He needs to know her follicle size, what her E-2 levels are. I don't want her to be totally lost. She should have a basic understanding of what her body should be doing but isn't. Then she'll fully cooperate with the doctor. And better compliance gives better results.
"One thing that is very difficult is parental involvement. Sometimes the mother makes the first phone call, but I encourage couples not to involve their parents. It's natural that the parents, after a certain amount of time without 'news' will get nervous. I tell these couples to tell their parents, 'we're making our efforts, and you can make yours by praying for us.' They don't need to know any more than that.
"Of course, I will never discuss a couple in counseling, with anyone else, even with their parents. We use extreme discretion. It's ironic that Zir Chemed, which is so strict in its protection of the privacy of its clients, actually suffers financially because of this noble code of modesty. I once traveled abroad to raise money for Zir Chemed, where I met a wealthy man who could have given a substantial donation with little effort. But this man only gives to institutions that he directly benefits from. So he gave me $36. I could not tell this man that his own son and daughter-in-law had been to see me and my counseling enabled them to have a child, his grandchild. The son hadn't told his father, so neither could I. This repeats itself all the time. No one is going to stand up and give a testimonial to how our organization helped them.
"It's vital that when a couple comes to me, they know they can discuss the most intimate details of their personal lives without worrying about a leak. So I rarely go to brissim, even though I am, thank God, invited quite often. For the parents' sake, I don't want anyone to suspect I was somehow involved in this baby's existence."