N.Y. Clinic Becomes An Unexpected Fertility Lifeline For Agunot

Jewish women trapped in broken marriages — often for years — because a husband refuses to provide a get, or religious divorce, face a variety of forms of exploitation along their hard-fought journeys to freedom.

For a husband looking to gain a more favorable separation settlement, running out the clock on a woman’s childbearing years is a particularly pernicious ploy being used, according to experts working one-on-one with agunot, women “chained” to unwanted marriages.

Now, a nonprofit that works to help agunot is offering clients the option to freeze their eggs — a reproductive technology that allows women to extract, freeze and store their eggs until they are ready to have children.

“We know that get-refusers can weaponize a woman’s biological clock against her,” said Keshet Starr, the executive director of the Organization for the Resolution of Agunot (ORA), which helps to resolve cases of get-refusal.

While in the past ORA has offered a variety of resources to agunot — including private investigators, mental health support and financial planning — over the past few months, the organization has introduced a grant that would financially sponsor at least one agunah to freeze her eggs; the national average egg freezing cost is $11,000 per cycle, according to a 2017 report.

While no agunah working with ORA has yet opted in, the response to the new option has been “overwhelmingly positive,” said Starr. “We were nervous about presenting the grant to agunot because the issue is so sensitive, but every woman so far has been grateful to learn about the option.” ORA works on approximately 75 active cases at a time, about a third of which are resolved each year. One Step Forward, the organization’s help hotline, fields nearly 1,000 calls annually.

The initiative is introduced in partnership with Extend Fertility, an egg-freezing clinic in Midtown Manhattan that is increasingly targeting women in their 20s and early 30s. The sleek office feels more like a co-working space than a doctor’s office; patients first meet with physicians in small, brightly lit rooms with round tables and glass doors. Doctors and nurses inquire about a patient’s personal interests, career trajectory and family-planning goals.

While the history of egg-freezing is short — the American Society for Reproductive Medicine only removed the “experimental” label from the procedure in 2012 — the popularity of the endeavor is booming. The New York Times reported in 2018 that more than 20,000 American women have elected to freeze their eggs, compared to just 475 women in 2009 and 6,207 in 2015, according to data from the Society of Assisted Reproductive Technology.

The rapidly increasing numbers are due in part to advertising campaigns sponsored by “boutique” clinics, including Extend Fertility, that frame egg-freezing as an empowered, feminist choice, rather than a last resort. “Options Preserved” reads an advertisement for Prelude Fertility, a national network of fertility clinics and egg donation centers. “Find that right person. Pursue your career. Finish your education. When you bank your eggs, you take the pressure off.”

For agunot, relieving some of the pressure is key, said Starr. While recalcitrant husbands “very often” leverage a get to exact financial and custodial arrangements that suit their interests —‘You get a get and I take the house,’” cited Starr as one example — the power differential is exacerbated when reproductive biology comes into play.

“A woman who feels the time crunch of fertility is more likely to say, ‘OK, take whatever you want,’” said Starr. “Abusers excel at identifying vulnerable points and exploiting them. A woman’s desire to have children — or have more children — is one of her deepest vulnerabilities. Preserving reproductive options is essential to preventing this type of exploitation.”

The unlikely pairing of Extend Fertility and ORA — a small group based at Yeshiva University’s uptown campus — was orchestrated by Dr. Bat-Sheva Lerner Maslow, a New York-based reproductive endocrinologist at Extend who is also an active member of the Orthodox community. (Maslow, a graduate of Albert Einstein College of Medicine, was selected last year as one of The Jewish Week’s 36 Under 36 young leaders.)

“Our goals overlap,” said Maslow, speaking to The Jewish Week in a lull between patients at the Midtown clinic. “We’re making a concerted effort to help women in the waiting period.”

Maslow was inspired to strike up the partnership by a former patient who came to explore egg-freezing while her ex-husband was denying her a religious divorce. “She didn’t want her ex-husband holding fertility over her head,” said Maslow. At the time, she was struck by the patient’s foresight. “Our partnership with ORA is a way to proactively educate women about their options, even if they’re not there yet.”

In the larger Orthodox community — from ultra-Orthodox to Modern Orthodox circles — egg-freezing for single women is becoming increasingly popular. “This is 100 percent a trend,” said Maslow.

Indeed, nonprofits that previously catered to couples experiencing infertility are pivoting to educate non-partnered women about their options.

The Puah Institute, an organization that primarily assists Jewish couples experiencing infertility, recently began promoting seminars for single women to educate them about egg-freezing options.

Last week, more than 50 Orthodox women — some married, most single — gathered in the living room of a home in Crown Heights. The flyers advertising the gathering read “Egg Freezing: Are we headed towards a halachic obligation?” Women discreetly took notes on index cards passed around. Puah recently held a similar seminar exclusively for unmarried Orthodox women in Flatbush.

The two men in the room were the presenters: Dr. Richard Grazi, the medical director of a Brooklyn-based fertility center, and Rabbi Elan Segelman, the rabbinic adviser who staffs Puah’s Brooklyn-branch. (The organization’s primary office is in Jerusalem.)

“I would say egg-freezing borders on obligatory because it can protect and maintain a woman’s emotional stability and psychological health,” Rabbi Segelman, 30, told The Jewish Week in a phone interview after the event. The “immense pressure” placed on Jewish singles to get married and start families can cause women to “jump into unhealthy relationships that they would otherwise avoid,” he said. “Egg-freezing allows her to take a step back.”

And though women are not obligated by Jewish law to have children (the biblical injunction to “be fruitful and multiply” only applies to a man, said Rabbi Segelman), egg-freezing does facilitate this “end goal,” he said.

“The choice is becoming more popular,” said Rabbi Segelman, who has worked for the organization full-time for two-years. Though he does not have a medical background, he has schooled “hundreds” of single women about their fertility-preservation options.

“The basic idea is not to allow your biological clock to govern your future,” said Rabbi Segelman, a note of urgent excitement in his voice.

That message, albeit within a distinctly feminist spin, is motivating the national onslaught of interest in the previously niche medical practice, said Maslow of Extend. “As prices drop and technology improves, the option will become increasingly available to a much broader demographic of women,” she said. The image of egg-freezing as a luxury for female executives climbing the career ladder is “outdated and inaccurate.”

Over the past few months, Rabbi Segelman’s efforts to “get the word out” about egg-freezing have been met with some resistance among other communal rabbis — he declined to specify which ones — because of fears over unforeseen consequences.

“Some rabbis feel like if women freeze their eggs, it’s an expression of yeush,” the Hebrew term for ‘despair.’ “They’re afraid the level of comfort gained by freezing eggs could cause women to take a step back and be less proactive about dating.” The end-goal of egg-freezing at Puah is so obvious, it remains mainly unspoken, said Rabbi Segelman: “having a family with a husband.”

ATime, another Jewish nonprofit geared towards helping couples navigate fertility issues, claims to be the first organization to promote the then-radical option of egg-freezing in the Jewish community.

“We’ve been encouraging women to freeze their eggs since the procedure was still experimental,” said Vivian Moskowitz, the medical director for the organization’s helpline. (Moskowitz, who joined the organization 17 years ago after her own experience with difficulty getting pregnant, does not have a medical background.)

According to Moskowitz, “hundreds” of women have already taken the organization up on the invitation over the last five years; some traveled to New York from other countries to freeze their eggs with ATime’s guidance, said Moskowitz.

“We’ve already had quite a few babies from the frozen eggs,” said Moskowitz. “The technology is just getting better and better — today, frozen sperm is almost as good as fresh sperm. We’re hoping the same will be true for eggs.”

In recent months, ATime has increased efforts to educate women about the option; an informational call-in about egg-freezing over the summer had “hundreds” of women on the line; now, the organization is in the process of booking three separate venues in New York and New Jersey for events on the topic.

Similar to the trend in secular circles, Orthodox women are opting to freeze their eggs at younger and younger ages.

“In the beginning, it was mainly an option discussed with women who were getting older and panicking,” said Moskowitz, referring to women in their late 30s and early 40s. With the conversation becoming less taboo, Jewish women in their early 30s are entertaining the possibility.

For women trapped in loveless marriages, egg-preservation offers an unlikely but quiet comfort, said Starr of ORA.

“Women are cautiously intrigued,” said Starr, who said rolling out the new grant has been a slow and delicate process. At first, the team at ORA feared presenting the option to clients would make women feel worse about their situations. That has not been the case.

“They appreciate the offer,” said Starr. “I think just the possibility of choice — of regaining some sense of agency — lightens the load.”