A Delicate Balance: Fertility Techniques and Orthodox Beliefs : Medicine: A doctor helps couples comply with Jewish law, whose tenets prohibit some of the standard methods of aiding conception.

Menashe and Leah Glassman would do anything to have a baby--anything except violate Jewish law.

The Westside Los Angeles couple (who asked that their names be changed to protect their privacy) are among the thousands of religious Jews who live in Los Angeles. From the day they stood under the marriage canopy six years ago, the Glassmans have been trying to have a baby.

Leah fantasizes about having her children around her on the Sabbath. When she sees other observant families, she said, she cannot help thinking: “We’re the only couple who don’t have children.”

But the Glassmans’ desire to have children is even more urgent because of their faith. As observant Jews, they believe that having children is a mitzvah, an obligation as well as a blessing, a fulfillment of the biblical commandment to be fruitful and multiply.

Infertility is a heartbreaker for any couple, and its treatment is a growing concern for Orthodox couples who are aware that standard methods may be in conflict with religious prohibitions such as that against the destruction of sperm.

The Glassmans said they feel fortunate to have found Steven Presser, a physician with a rare understanding of what they were going through. A fertility expert with offices in Beverly Hills, Presser, 38, is an Orthodox Jew who specializes in helping frum , or observant couples, reconcile their longing for children and their commitment to following divine law.

From the preparation of food to the timing of marital sex, every aspect of Jewish life is shaped by Halakha, Jewish law.

Early in their efforts to have a child, the Glassmans went to their rabbi. Leah, they had discovered, was not ovulating, and their questions included whether it was permissible to have a donor egg fertilized with Menashe’s sperm in a laboratory procedure, then implanted in Leah’s uterus. They also wanted to ensure that their offspring was Jewish.

As Nachum Sauer, a Los Angeles rabbi and expert on Jewish medical ethics, said, there are some fertility related issues on which almost all Rabbinic authorities agree. Artificial insemination with donor sperm is forbidden. The rabbinate is concerned that a genetic brother and sister might unwittingly marry.

Some rabbis additionally believe that a child so conceived would be the offspring of an adulterous union. Such a child, called a momser, would be allowed to marry only other children of adulterous unions.

The fact that the Bible predates Baby M and other high-tech offspring by three millennia does not mean there is no Jewish law relevant to such procedures. Jewish law, Sauer said, is always able to address the pressing issues of the day.

Sauer compares the emergence of Jewish law on infertility issues to the Rabbinic response 100 years ago to the invention of electricity. At that time, volumes were written on such questions as whether a Jew could switch on the lights on the Sabbath (the short answer was no).

“Jewish law always meets the challenges of new technologies and new things that are happening in society,” said Sauer, who is director of graduate studies at the Yeshiva of Los Angeles. “It is really a very dynamic system of law.” Sauer has prepared a series of tapes on the Halakhic implications of current medical and business issues, including the Jewish law pertaining to borrowing a car.

In the area of infertility treatment, many issues have yet to be resolved authoritatively, Sauer said. In light of such uncertainty, the Glassmans said, it is reassuring to have a doctor who knows the latest medical thinking on infertility and much of the relevant Jewish law.

When a non-Jewish or non-religious couple are being treated for infertility it is standard procedure to get sperm samples from the man for testing or for insemination. Masturbation is the usual way to produce these samples.

But masturbation is an abomination to observant Jews, and Presser is able to advise observant couples on alternative methods, sanctioned by some rabbis. These include collecting the sperm from the woman after intercourse or using a condom to collect it. Presser also counsels that the condom must be free of spermicide, not only to safeguard the sperm for medical reasons but because of the religious prohibition against destroying seed.

Presser emphasized that he does not try to be an authority on Jewish law and advises couples to consult their rabbi.

Presser, who has been in private practice since last fall, got his medical degree from University of Health Sciences/Chicago Medical School in 1983. He worked at Case Western Reserve University, UCLA, Cedars-Sinai Medical Center and USC, where he had a fellowship in reproductive endocrinology and infertility. Treating the fertility problems of observant Jews, he said, is a professional challenge and a source of personal satisfaction.

“Twenty percent of the reproductive-age community has fertility problems,” Presser said. “Why should the frum community be any different?”

In fact he suspects that those who are observant from birth may have somewhat fewer fertility problems than the population as a whole. He speculates that the incidence of tubal scarring may be lower in lifelong observant women because it is often caused by sexually transmitted infections and premarital sex is forbidden among the Orthodox.

Certain aspects of treating infertility in the Orthodox are more or less standard. Frum couples must have a shomer, a kind of religious security guard, who oversees the handling of the sperm to make sure that it is not switched or adulterated with that of another man.

Asked why a shomer is required, Sauer said: “Dr. Jacobson pretty much answered that.” The reference was to the recent case of Cecil Jacobson, a Virginia fertility doctor who secretly impregnated dozens of patients with his sperm.

Yet to be resolved are such issues as who is a child’s mother: the genetic mother or the woman who gives birth?

“The greatest Halakhic authorities are just not sure,” Sauer said. There are fewer than a dozen such experts worldwide, he said, and until they agree, observant couples who use donor eggs from non-Jews or non-Jewish surrogates are advised to have the resulting children undergo conversion to ensure their Jewishness.

As for the Glassmans, they have yet to hear the wonderful news that Leah is pregnant, but they are hopeful.