COVER STORY:Infertility

“How did I get so lucky to have you?”

When Sarah Ritthaler lovingly posed that question one day to her young son, Daniel, he gave a simple answer.

“Because you wished for me.”

If only it were that easy.

Ritthaler had thought that when the time was right to have a baby, it would happen the “natural” way, intimately and privately with her husband. She never imagined that, at 37, she would be waiting nervously in a doctor’s office for her fertilized eggs to be carefully implanted into her uterus.

And that was just the beginning of a long list of tiring procedures the Marin County resident endured while trying to conceive: shots, egg extraction, genetic testing, embryo insertion.

“To take all this and not get pregnant … It would be like ‘Fear Factor’ — eat the ground-up mouse and not win the money,” mused Ritthaler. But it all paid off for the Jewish 42-year-old and her husband, with the birth of their son.

An estimated 6.1 million Americans and one in six American couples grapple with infertility. And, according to Bonnie Rosen, director of the Brooklyn-based nonprofit support group A Torah Infertility Medium of Exchange, the numbers are inexplicably slightly higher for Jews: approximately one in five couples.

The American Society for Reproductive Medicine (ASRM) defines infertility as the inability to conceive after one year of unprotected intercourse — or six months if the woman is over 35.

While almost everyone faced with infertility experiences similar physical, emotional, financial and ethical challenges, the pressure Jews feel to have children is exceptionally high, contended Karen Erlichman, a San Francisco social worker who has worked in women’s health for more than 20 years.

“There is a particular kind of cultural pressure that Jews feel,” said Erlichman, who is Jewish. “It says in the Torah to be fruitful and multiply. The Jewish family is important to Jewish identity.”

Ritthaler, her disappointment mounting with each menstrual period, had sought professional help and was diagnosed with endometriosis, a disease that can cause infertility. That was the beginning of what she refers to as her two-year “journey.”

The journey of infertility can be caused by a number of factors. According to ASRM, the production of no or few sperm cells is the common cause in men; in women, the causes are more varied. An ovulation disorder, blocked fallopian tubes, endometriosis or structural abnormalities of the uterus are just some of them. And in about 20 percent of infertility cases, the causes go unexplained.

Ritthaler and her husband had planned on having an active Jewish life — as soon as they had a child. When Daniel was born, they joined a temple.

That is not uncommon, according to Rabbi Daniel Kohn of Mill Valley. “While there are plenty of older folks and singles and other people who join a synagogue that don’t have children, the vast majority of people usually only enter the door when they start to have children,” he said.

Family life is a central component of Jewish identity, he explained. And more importantly, Jewish continuity is directly related to fertility: “The promise of fertility goes back to Abraham!”

Kohn, 42, and his wife of 13 years, Deborah Stachel, themselves struggled with infertility before they ended up adopting the first of three children. It was one of the most difficult times of their lives.

As a rabbi at Congregation Kol Shofar in Tiburon, Kohn wrestled with one of the key responsibilities of his profession — addressing the spiritual and educational needs of raising a Jewish child. He struggled, privately, to meet that responsibility while dealing with the pain, frustration and exhaustion of trying to conceive.

Well-meaning congregants didn’t always help. Kohn recalls the time someone said to him, “Enjoy it while you still have peace and quiet in your home.”

Stachel recalls a congregant offering her old maternity clothes. That only pushed the couple further into privacy.

And like many infertile couples, Kohn and Stachel found it could be an emotional strain just to be around young children or pregnant women.

“I have to be honest,” said Kohn, now rabbi-in-residence at Contra Costa Jewish Day School in Lafayette. “Because I was in such pain and it was so difficult for me to function as spiritual leader at this time, my personal life and emotional state did have a deleterious impact on my ability to meet professional obligation toward congregants. … I would say that the issue of infertility was not an insignificant factor in the reason that my congregation at the time chose not to continue my employment with them.”

“Rebecca,” a 38-year-old Bay Area lawyer who requested anonymity, calls herself the “poster child” of infertility, with which she’s been struggling for 10 years. She finally adopted.

For Rebecca, the pressure and insensitivity she felt from the Jewish community aggravated an already sensitive situation.

“I’m surrounded by friends who are on their third kid with no problem. Most of whom are Jewish,” she said. “For Jews, everyone has multiple kids. There’s a focus on the family.”

Rebecca recited a list of offhand comments she’s heard that only

deepen her sadness and frustration:

• “Why don’t you just adopt?”

• “If you would relax it would happen.”

• “Come to my baby shower.”

• “You’ve been married for so long, why don’t you have kids?”

“It puts the blame on you,” Rebecca said. “Pregnancy is something you feel entitled to. It is just all around you. That’s part of being a woman.”

Making matters worse, she said, “a lot of people in my situation are high achievers, and lack of control is the hardest thing in the entire world.”

Career women face a challenge in that the longer couples wait to have children, the greater the likelihood they will struggle with infertility.

Dr. Philip Chenette of the Pacific Fertility Center in San Francisco said the issue of age-related infertility looms large in the Bay Area. The region, he says, is one of the leading areas in the nation dealing with age-related infertility.

“People put off having children until late in life. They’re so busy with careers that they don’t have time to consider a family until they’re in their late 30s.”

Fertility declines rapidly after the age of 35. According to RESOLVE, the National Infertility Association, by age 40 a woman’s chance of becoming pregnant has decreased from 90 percent to 67 percent. By the age of 45, her chances are down to 15 percent.

Mindy Becker, a 48-year-old stay-at-home mom in Orinda, was one of the luckier ones: She had her first child at close to 40 with no problem. She desperately wanted a second child, however, but was told her eggs weren’t going to be viable.

“It was not an option to not have another child,” she said.

So she and her husband sought out an egg donor. To their shock, 23 eggs were extracted from the donor. But, sadly for the Beckers, only three were viable. The pregnancy didn’t stick.

“We literally just sat and cried,” she remembered.

Becker found it cathartic to throw herself into researching their next option — adoption. To their surprise, the Beckers had an adopted child in less time than it would have taken to complete a pregnancy.

“Pregnancy is not the biggest part of motherhood,” she said. “It does keep you young. You have to take care of yourself.”

Becker estimated that she and her husband spent somewhere in the ballpark of $50,000 on infertility-related expenses.

They now have two adopted daughters, Lucy and Emily (who are biological sisters), and a biological son, David. They had all their children formally converted to Judaism and, among family rituals, they all gather together in the “Shabbat tub” — a hot tub, on Friday evenings.

Age-related infertility is something therapist Laura Goldberger, who runs groups for lesbian mothers in Berkeley and San Francisco, has been observing in the lesbian community.

Often, she said, lesbians wait longer in life to have children. Also, for the lesbian community, pregnancy can be a more conscious decision that involves going out and finding sperm, a process that may take years.

Even when not infertile, because they must procure sperm from outside their partnership, lesbians often experience some of the same emotions and issues as do infertile couples.

Goldberger said that similar to the experience in the straight community, they face misconceptions surrounding age-related infertility.

One of Lori Perlstadt’s greatest disappointments is with the medical community and the “no-problem” message she believes it gives to older women.

When she sought help, “all the stories you were hearing and visuals you were seeing was that it is so much more common for women to have children,” she said. “What you heard about were the successes and not the failures.”

She and her husband, Doug, married when she was 38. “We knew that we were both older and we needed to get a move on,” she said.

The San Francisco couple tried a wide range of treatments.

There are a growing number of treatments available for infertility. According to RESOLVE, more than 95 percent of those who undergo infertility treatments receive drug therapy, such as Clomid, a common drug used to increase egg production, or a surgical procedure used to correct structural problems. More advanced treatments include in vitro fertilization, when eggs are surgically removed, fertilized with sperm and then placed in the woman’s uterus, and intrauterine insemination, a procedure during which the woman is injected with sperm from her partner or donor.

Perlstadt miscarried twice.

“It was a tough year,” she said. “It

wasn’t even the routine of shooting needles into yourself on a regular basis and doctor’s appointments, but it is the emotional roller coaster that really gets you.

“How many more of these can you do and afford? We were blessed to afford more than some.

“How much trying is enough trying? Everyone has a different threshold.”

How far should you go? How much should you spend?

Addressing the ethical questions can be painful and confusing, said Erlichman. “How much intervention should I do? I’ll take Clomid but … Sometimes they do something they thought [initially] they weren’t willing to do.”

The Perlstadts ended up adopting their son, Elijah, who is biracial.

“There is the process of letting go of biological attachment,” she explained. “We could not love Elijah more.”

Her husband added: “We are not a traditional family. We are the face of the new Jewish family. We are changing the face of what Judaism is going to be about.”

Donor egg, donor sperm, donor embryo, or surrogate — often referred to as “third party” options — are other alternatives.

“Janet” and “Henry,” who also requested anonymity, have been married for 10 years. He is in his late 30s and she is in her early 50s. Because of her age, they realized fairly quickly they would need to locate a donor — a Jewish donor.

But they ran into a snag: Jewish donors, they found, are few and far between.

Dawn Hunt with Fertility Alternatives Inc., based in Southern California, often runs into such couples and makes a concerted effort in her services to track down Jewish donors. However, she said, in her nationwide database of 200 donors, only 22 are Jewish.

While Janet and Henry did locate a Jewish donor in Los Angeles, she charged $10,000 more than most donors, they said. After one harvesting and three attempts, however, Janet failed to become pregnant.

The couple is hoping to find a donor — one who will see egg donation as a mitzvah.

“From the very beginning we wanted a Jewish donor, the reason being we wanted to be honest with the child about its heritage,” said Janet. “We wanted to be able to tell the child where the ancestors are from.”

When Cheryl Selman of Belmont learned that her infertility problems were being caused by a rare uterine abnormality, she immediately thought she wasn’t ever going to be able to have children. However, after drug therapy that produced strong and unpleasant side effects, Selman became pregnant. But the pregnancy wasn’t viable.

‘Cheryl, this pregnancy is not going to bring you joy,’ the doctor said,” recalled Selman, 38. “And then I spent two weeks trying to kill off the pregnancy that I so desperately wanted.”

Erlichman helps couples develop healing rituals to deal with loss. She helps them identify what would be spiritually meaningful for them, from placing a rock in a garden to spending time in a place that brings them peace, such as the ocean or the redwoods.

“A miscarriage for someone dealing with infertility is, at best, profoundly disappointing,” she said.

“The whole process is a roller coaster. People are trying to find a way to either not be too optimistic or too pessimistic but find neutral ground.

“They have to get back on the fertility intervention wagon so fast. They don’t go through the grieving of a loss.”

Selman did end up getting pregnant — with twins. The pregnancy was a terrifying experience for her, but the babies were born healthy. She later got pregnant without assistance and had another child.

“Everyone has something that happens that you don’t plan in you life,” she said. “Just because you want to have children doesn’t mean you’re going to get to have children. I realized my body wasn’t what I thought it was.”

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