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

Ronit Haimov-Kochman*, Chana Adler, Eliana Ein-Mor, Daniel Rosenak, Arye Hurwitz

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


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 or thyroid 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 estradioltreated 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.

Original languageAmerican English
Pages (from-to)100-103
Number of pages4
JournalIsrael Medical Association Journal
Issue number2
StatePublished - Feb 2012
Externally publishedYes


  • Halacha
  • Infertility
  • Jewish law
  • Mikveh
  • Religion
  • Ultra-orthodox


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