Fertility Issues and Shabbos (Rav Gideon Weitzman)

on issues relating to fertility there are a lot of fertility related issues that come up on shabas um injections and other things and uh and and the whitesman is uniquely qualified to be able to deal with these issues and to and to to answer these Shas and to tell you what all the gim have to say about these Shas because he spoken to them uh personally um so uh again as I mentioned to the previous group that uh more than than than just I it would be important enough to hear this year and to be able to uh to learn about these issues um but even more important is to be able to learn who who R Whitman is who is so that you'll know where the address is when these uh when these questions inevitably come up anyone is going into r as I said yesterday anybody who's ever going to have that asks some questions are going to have to uh is going to have to deal with uh with fertility related uh related questions it's something that's a very very very very common thing nowadays and uh and we're very privileged to have one of the world's experts here with us this [Music] morning you forgive me from reading from the computer I'm sorry thank you very mucht um for asking me to to speak to this uh very very mad uh following says know the already says USB says you can't do any Shabbat if the I came out then we're allowed to do certain things on Shabbat so the says so we'll explain in this which is says the person who has a pain discomfort shouldn't put on oil or vinegar since it's we say it's to do anything onab it's clear that someone's who's who's ill we know ask what about another category we said says the eye is out it's it's a it's that it's that it's it's we're worried that they're going to lose the use of the ey or we're going to limit the use of the ey so that see we see that someone who's [Music] sick so when a person is sick even if they're not in danger prison is in danger even in danger what does it mean says the the tells us that you're not allow to do any you a lot of things so what is it talking about someone has a sum discomfort and he's walking around happy or at least then you're not allowed to do anything then it's that's what the means that he says others to suggest there are four if we listen carefully there are four categories of that's the most severe that allow to do anything go the least is what's already said it's someone that's um he's walking around he seems to be okay it's okay he's got how do we Define that we'll get that in the moment and there's two in between categories mean someone who's got a danger to a limb how do we find danger moment and what does mean what is the category of what does it mean what's the definition how do we def find that yes can't do normal activities like play the piano you know the guy the guy comes he goes to an operation he comes out and he says to the do doctor says you'll be fine he say will I will I be able to play the piano doctor says yes he says it's wonderful because I couldn't play the piano before so that's is that considered to be that's the so so one is one you say is you can't do normal activities what else anybody else another definition a it's a common it's a it's An Occurrence we have every single Shabbat every single Shabbat you have a question about what is it we don't even know what it is yes staying in bed what does that mean so we have a very very important category says brings it in remember it's a long if you didn't see you see that he has a long description of the other of the passible permutation as to what you're allowed to do we're not going to get into that because it's not that relevant for our discussion today we never Define what so says there in in says [Applause] sorry it comes there's no shabb not but you already know whether it's we do whatever it needs who defines what what's I'm in the middle of writing my PhD on that what's how do we Define om in a place in which there was no medical training who decides who's in a place in which there was no medical schools and nobody went to medical school we mentioned before in in the previous year that he says he says it about you have to go and ask doctors which doctors did they ask so in no there were 11 people that that were in in two of them had any sort of Medical Training they never went to medical school none of them and that's what what [Applause] it's a they need we don't know then what do you do have there's a limit to what's a there's a limit to what's let's imagine that I would say so every Shabbat I'm gonna go to the beach why because there's a chance that on this Shabbat somebody Dr and I know how to save their life so since it's a it's G me to go to the beach every week that's clearly not understand so there has to be some sort of level of sa speaks about that when he explains that the the why are you allowed to to to save when you're not allowed to save him what's the limit of says [Applause] know so let's imagine so that's a very nice interesting idea we came all the way from to tell you that you can hear from the you can actually open up on the Shelf how does this relate to fertility so is there a case in fertility there's potentially lifethreatening so the truth is the fertility of itself we'll speak about in a moment in Greater detail is elective there's no there's no there's no there's no danger that a person is in that are needed to have treatment elective it's something that you choose however within treatment what we do for all fertility treatment it doesn't matter whether it's IVF IUI or whatever you're doing or even basically ovulation stimulation of induction is we give hormones that's what what with just a little bit of biology is that the the brain sends a message epma sends a message to the gonads in the case of a woman ovaries to produce eggs that is given that's a hormone hormones of messages that come from the brain through the blood as opposed to messages that come like here I feel that clapping I can feel on my hands that comes through my that's not a hormone that comes through my nervous system but the hormones are the changes so I see people in this room have beards in fact you have beards is a because you're you have testosterone that's a hormone that comes to your body that enables you to grow bit that's that's that says you're a male okay so hormone say a hormone that comes called follicle stimulating hormone when the body responds to that when the ovary responds to that there's an uptake that says enough we got enough FSH thank you very much we're good what if the body doesn't respond to that then the brain produces more and more FSH so we give hormones that are either FSH either follicle stimulating hormones or lower level CH citrate which is stops that uptake which says we're going to break that message and therefore the body doesn't know that they've got enough so it keeps producing more FSH what's the problem with that the problem with that is that we can cause hyper stimulation I'll just read you quickly hypers stimulation is an ex I just read what I R from from my notes Here is an exaggerated response to excess hormones generally what happens when I give hormones is the body creates what's called super ovulation ovulation is to respond to one egg superovulation is to is to the body releases more than one egg it can be one it could be two we had a woman this week one of my ranim we have was was established 30 years ago in founded by bin and uh today we have 15 ranim in in y five women who councel 50 we have 80 women on a hotline in the evening for more uh intimacy questions personal questions we have two rabim here in North America one in New York and one in Los Angeles we have two raban in Mexico we have a presence in Paris and we have daughter organizations South Africa and Australia uh M gets about 300 calls every single day so uh every Thursday we get a lot of Shabbat calls work up Thursday Friday Shabbat so I have 15 I have 14 rabim that I work with colleagues and one of them came to me this week is from in the and he had the following question a woman came and she had 35 follicules there supposed to be one 35 follicules that's a lot and it came out of course that it has to be on Shabbat and the doctor said look if we even to mon shabat or Sunday it's a big problem so it became question of of doing treatment ask on Friday afternoon it was um so there was this this case hyper stimulation so the what what's the what's the ramification how did he get to it or what's the ramification okay so hypers stimulation potentially is life-threatening because what will happen if we have too much o if there's too much uh too many follicules and the and the ovary ruptures internal bleeding is potentially life threatening now I've never in my have a case in my entire life I've been in on over 25 years I never had a case of anybody dying from it but but in the literature it say it's potentially life ring is that potentially life rending I think so so that's the only case I think that we have in fertility that nothing else I can think of any in anywh that has I never heard of such anything so it's not apart from hypers stimulation which is rare very very rare said there's a case he came in you know was all flustered 35 eggs that's a lot and we not you get usually between 10 15 and usually we know how to deal with it usually it's not a problem that was a unusual case that's a case in which we have you know there's going to be we'll see bleeding we there women who bleed because of ovulation we know that right it's also related to the previous class about about women who bleed because of ovulation there also chickens that bleed because of ovulation that chicken bed because of relation so leave it on why we get why we get eggs why we get blood and eggs okay so the most severe category of probably not appropriate here so we're we're going down one category so let's go to the bottom category what's what's the category says you see him he looks okay someone that's that's experiencing fertility treatment they look to be fine in fact that I'm sure that we all know maybe very very closely people who are undergoing fatil treatment that we don't even know about it it could be good friends of our we don't know that they're undergoing F treatment when you going have a Sho and you're going to talk about things you have to be so sensitive as a gar says that says to ra what do you want for me says the says the what did he say it's not me it's they have to be such a sensitivity to speaking because you don't know your community who's going through T treatment and you'll only know if they come to you and ask and they only come to you and ask if you feel if they feel that they have someone to listen to someone who's going to listen to them someone who's going to talk to them someone's going to understand what they're talking about someone's going to be empathetic someone who who's knowledgeable very important in your Kil that that first of all you should you should be knowledgeable in that you should learn should learn about it and maybe it's good to have I was just now in Aila in in in the New Jersey they're having a women's health day that's a very very important thing every sh should have women's healthy which is completely tailor made for the age of the women in your sh the younger women you speak about fertility the older women you speak about menopause the older than that you speak about other other post menopausal assets things that about myomas about cancer they should speak about in your sh there should be something about fertility because it's very common about one in seven couples have a problem with the with with fertility doesn't mean everybody's going to need do in vro fertilization doesn't mean everybody's not going to get pregnant there's a question how long do you have to wait in order to decide that we have a fertility problem so generally the the accepted opinion among the all of the medical associations is one year why do you get to one year because the chance that getting pregnant every month is about 20% that's when optimal conditions so if you were less than 6 months we're going to say you're still in the in the statistical average but that's only with optimal who say you have every every month so therefore we times that six months by two so there a big question what point do we say you're allow to do treatment do get into even Beyond Shabbat just to do a simple assum analysis question of it's the question when you allowed to do that so says many people will get pregnant a year many people get pregnant after two years for some people just left it they get they would get pregnant what would we do it's very very important is to reduce pressure the pressure comes from their internal pressure their societal pressure the things that are they're looking around everybody's pregnant so we have to be conscious that in in a we have to be conscious that don't only do children's activities we had now what do you do for p it's p now almost almost P not real p a real so on the Thursday that's already almost complete but uh Pur is gonna be on a Friday so Thursday so so and every every p is a children's day right it's a children's day we had in our when we first started the sh so we had an an a party in the evening for in our house just for adults no kids and know people said we never ever celebrated P before we don't have any kids or our kids had a home or we never had purm think about that think about people in your K that for them PM is the worst day of the year because I don't only kidsbody dress up so be sensitive to that so if someone looks well they look well that seems to be mamash extr mamash fertility if that's the case if the she would end here then what we say you can't do anything why because we just said that you can't do anything you can't get you couldn't take medication you couldn't take clate you couldn't take shorts you couldn't take any there would be no treatment at all so that if the if the end of the day the answer was that couple consider to be then it would be very that would be it there's not much you can do and there a lot of people to say like that told me that who's the you know so he said that they're not sick and he had a beautiful beautiful uh BR he said to many people I've used this BR many times he said many people ask him okay but I need to do treatment he said it's doing treatment only studless no one promises that treatment is going to be successful he studless so this keeping Shabbat is also he says on the that you kept Shabbat you'll have children I use that many many times not in cases where I really thought I need to do treatment cases that were questionable that you think is gy so then we get to the how do we Define listen [Applause] carefully say it again Rashi said say that if we didn't do this treatment the child the person wouldn't die but they need this treatment Russia doesn't talk about the level of illness by the way the fact that they need the treatment treatment is essential it's essential treatment but they're not going to die if you don't give it to them we mentioned before says how do we Define say you got to be in bed if you're not in bed what are you the the way the time in which you change from being you're in bed or not in bed there's got to be some an external how do we Define RA man's going to come and say what I don't if you're going to die you're not going to die every like that and therefore that's no difference between what's m someone has a headache you have a you have a migraine every Shabbat I get up I have a migraine every Shabbat usually I get up quite early usually by the time I get to SCH it's it's going and by the time I get to the Dr I'm usually fine that's the that's the the cloud that's but it's still a if I was on a regular day maybe I take aad maybe I take a Tylenol but it's but so I need it so I'm so what what did you change from if you're not in bed you're not you're walking around got a headache maybe don't feel so well a little bit of a cough so the C the C which you stop being you become says in or a little bit complicated doesn't have to be in bed H we what we call house ridden why didn't you come to sh on Shabbat I wasn't feeling well oh every Shabbat I go to my father is 89 years old and every Shabbat either went to sh or didn't go to sh and that's always the discussion if he didn't go to SCH why didn't he go to SCH and if he went to SCH how bad was SCH this week every week it's bad every week the B was terrible the was terrible this was terrible oh was terrible terrible so that's I said you have consistency in your life that's always a good thing to see so how do I know is no is it home home yes remember says that a child is always question why so a child doesn't have that ability to know at what point he's sick or not sick he's always has a has some some question about his ability to understand his own situation but I know if I'm SI I I stay home you got a headache or a stomach AE you got a bit of a heartache walking around well someone's coughing they go to work they come to sh they go to okay you're coughing okay don't C for other people but you're okay someone said before if your whole body sick he goes he's fetching he's he doesn't look good even though he's actually can leave his house okay that's as though he's not why did he why did he come out he the what's going do he's going to be a home it's what's he going to do long or is wor even though it's not longer par it's much more complicated who so it has to come oh is the rabbi Rabbi has to go to sh he's not going to come to sh he prepared the of the Year this py doesn't feel well Friday morning on this I'm going to have to go so he's actually but it's as though he was in bed you're in bed you're not in bed you're not we know always follow so is the huge huge he's and and he I said him couple don't have children they in bed no they don't Ed that's it C is a fascinating Chu the ca was asked about a gentleman who has a stutter and he has to do breathing exercises had a tal who was a in in speech impediments he knew what it was I didn't know what it was and he's asked can he do it on Shabbat if you tell me you not do any exercise on Shabbat so maybe it's a ass to do the breathing exercises so so the C are following a stutterer who everybody sitting down it's going to be a fascinating CH wait a second the guy is walking around he's not how's he become how did you get from says says his problem in his voice box LS listen carefully somebody said it here recently before somebody who is subf functioning less than other people that's sometimes you in your heart something in your head something your in your goads in your SP production or your egg production that's [Applause] so has a fascinating definition of much better than the definition of the World Health Organization we have a terrible definition of Health you look at it you Google it you say it's terrible this says there's a much better much better definition the definition of is are you functioning or not functioning if you're sub functioning sometimes you're that it's dangerous to your sub functioning your heart isn't functioning you're and if you're s functioning but you're still working you're you're not in danger then so the whole sub functioning and it comes to the point in which it's not really sub functioning having a headache that's that's his that's his definition ah if that's the case then we can say fertility fits into this category because obviously no functioning look everybody children children different category someone that's considered to be depends on the circumstance but if a person's in terrible personal anguish that's considered to be says person is allowed to remove not talking about talking about a person's allowed to remove a scab or feces from their face if if you're suffering it's causing you pain if you to look beautiful says the if the S has is I'm embarrassed to go among people I I'm FR I look I'm gonna it's a bu it's an embarrassment sh it's m there's no greater I'm surprised didn't bring that beautiful talk about s it's a beautiful what s s is I'm embarrassing someone else I'm not sub functioning physically necessarily but I have now if we say the is considered to be then maybe we can bring these two Den together and we say that infertile couple definitely have tells us that and one of them is so therefore maybe we can say that's said to me then maybe the other one there is someone who poor is someone poor also question there's a lot of uh there's a lot of weight a lot of research to say that definitely fertility is connected to depression caused by depression and connected to depression causes depression it's clearly that's for men and for women when we know but it's even studied for men so can we bring together so as as said a lot of lot of and I'll tell you that the of the that I saw was the we always said we just mentioned is one of the great also very close to he also said can't do anything on Shabbat what do on Shabbat do before Shabbat do after shabb said to me there's no he said no the AAR isn't working the VAR isn't working that you can see that it's not functioning so it's like we bring in the C with together with the with the Gar so he said now most cases it's not true most not s if we do some if we look at someone and we we tested them and there's no real reason that's what we call unexplained infertility that's a very very undiagnosed uh condition meaning we don't know what the problem is there's a problem we don't know what if someone doesn't have a functioning ovary and I give you hormones that make you ovary function that I understand that's and most of theim said the following told me also the name ofos he said what do you mean a the s that a person has fertility that's considered it's not a question told me the same goldber told me the same came told me the same many we said oh so we have we can do certain things on Shabbat so let's speak a little bit about what can be done on Shabbat so testing an ovulation we can test ovulation by a blood test well we don't need a blood test but but we can do it by testing temperature said you're allowed to test temper you're allowed to do temperature testing on Shabbat to find ovulation why shouldn't be a p on Shabbat okay how's a b p on Shabbat I didn't understand what does it mean we're testing ovulation in the morning it's it's basic body temperature in the morning B basic body temperature so what's the na so I find out Shabbat morning I'm ovulating so what do I do that my husband doesn't go to sh we have Rel we didn't have relations yesterday like what exactly is the is the ofab is a very wide category a home test where you color where a woman urinates onto a strip like a strip of a pregnancy test that said to me is not a problem on Shabbat why you throw it away have no have no IND of the it's not a problem it's not it's not real SE analysis can be done on Shabbat we don't need to do it on Shabbat an alter only in a case where we think Sak St do it Friday do it Sunday you don't need to do it on sh it's no EAS to do we're taking medication medication do you take every day on the other hand many many we know say is not in our generation without getting into the Su learn inat um there's a question about medication is doesn't necessarily have to be exactly at the right time every day it's also important question I have to take the shorts every day I take it every day at 8:00 in the morning you can take it at any time you take before Shabbat and after Shabbat taking shorts can you take a short not shots like that sh like like so shorts so there's someone wrote there was a book on fertility old book old book and he wrote that it's a question of intravenous uh injections intravenous injections where we doing it into the vein so there you want to see the blood's coming out to make sure you're hitting a vein not hitting something else kill you so um so intervenous injections are sh subcutaneous which under the skin is not a question it's very true but I don't know any intravenous injection infertility so you have to also know a little bit about to give a at the end of the day so it's not true all subcutaneous subcutaneous intramuscular is not a problem you're not drawing blood we don't need to do it don't need to do it but there are there's a there's a process without getting into the the into the whole details there's a process in which weep prare the body and then we give a last shot which is releases the egg that last shot has to be time sensitive that has to be that has to shabat also talking about sometimes three days of R sh II an insemination well a can't do it it's only we said so we have a non-jewish doctor an entire non-jewish staff not so easy to find a hospital has no Jews working there depend definitely not in this area there's a lot of people there's a lot of Jews working working in this fertility infertility field even outside of the city but in definitely in in large Jewish centers uh the other thing is you can time it there are many Dogers from dogs I never ever did I have a friend never ever did an insemination of Shabbat why I time it I know I'm giving the medication I know it's going to happen so therefore very important when you tell your K you tell the couple asking you when you preparing tell the doct miros that I'm going to have a problem with Shabbat the doctor will not be a to time it don't give me the question on a Friday afternoon ask already a month ago a month ago tell the doctor on this and these days we're going to be these and these days a good idea not to start treatment around the because you have either three days or you know two days and a one day and you're gonna have don't we don't do don't do it around around yes start treatment I don't know when you say start treatment I just don't know what that means so that's a long Tre that's a long question but it's about we have in order to get a woman to ovulate we said we're giving treatment to get to ovulate and especially for an IUI we're not giving chence CID we're giving them FSH and LH with great so we uh that's about a two we process that we're monitoring a woman we're giving her medication and we're seeing how she ovulates so it's excellent question right so I need that I know that miros now if I give it if I give you know the treatment I started on this day and that day I can make it the Assumption what's going to happen but also if I if I look at the the dosage I can I can play around with it a little bit so it's important to know that it worked out it has to be a has to be on Shabbat so the other question we have a non-jewish doctor question is how do we get to the hospital how do we get toing back to and can we get back from the hospital getting to the hospital says maybe it's treatment we can ask an onu getting back is not so P I can ask an onu to take me back what's the problem stay in the hospital is the other thing we have is that every treatment every every uh F treatment we have supervision to make sure there's no mistake made in the lab there was a very famous case recently in Israel in which a woman gave birth to a child that was not her own genetic child not hers and not her husband's and that recently two weeks ago the judge decided that the child after two years will go back to the genetic parents after being raised by the birth parents terrible terrible case so we have a supervision you have to realize is the supervisor able to get there on Shabbat we just had a case now I was speaking to Hime of my supervision when re we met this morning had a Supervision in New York and uh she has a case in which uh it's in a slightly out of the place out of the way place on a Friday in 2 o'clock in the afternoon I I just can't put anybody there it's not even on a Shabbat it's on a Friday I can't put on so you have to think about that as well that's IUI that's insemination where we take the sperm and we inject it IVF in vro fertilization as a gentleman asked is much much longer and more complex process that involves not only giving hormonal stimulation but drawing the eggs bringing the sperm and ways that we're not going to speak about today because not it's not a Shabbat question and bringing them together developing it between three and seven days in the laboratory and putting it back so we have retrieval the egg is ready do we do retrieval on Shabbat and where we never do retrievals on Shabbat only in places where they're not where the doctors want to make more money my wife and I were in a particular City for Shabbat once in a hotel and opposite the hotel there's a there's a hospital Fertility clinic and we come out for our stroll after after a kidish in the morning and I see three doctors that I know outside the outside the clinic I said to my wife look how sad this this situation is all those three believe me are set up financially for life why are they doing it to make more money they could do it on Friday they could do it on Sunday they could there's no reason to have it on Shabbat if you know how a time no other the public hospitals don't do it on Shabbat but let's say here we have it suddenly works on Shabbat it's a non-jewish doctor can we do the retrieval on Shabbat sometimes it could be if we don't do the retrieval like we said the woman with the 35 eggs it could potentially be dangerous that's but maybe Amir non Jewish doctor can we do the transfer on Shabbat well a lot of times the transfer can be done later don't I said between three and seven days I once sat with an embryologist here in the city we sat for about an hour going through every single permutation when we could bring it earlier and when we could make it later you can say they make it later someone said that will compromise the treatment we have however we talking about a couple who are older Who The Limited chance of getting pregnant that may be very significant for that day we have a question maybe it's Bor especially for is not a problem so we have a lot of questions related to treatment most of the times we're able to get away from it the most the biggest question is really taking the shots that's really the biggest question you also have to not everybody can administer it to themselves have to go to a doctor there's another sh Shabbat says that a that we do Brit a child is born on Shabbat but only a case in which it's what is the case of sa the brings the child was born through the wall what we call cesarian what Shakespeare said in McBeth he about MCD he was from his mother's womb untimely plucked so you know sh scholar Ah that's all that's all I remember from high school that's it that he was from his mother's woman time PL so the other case it brings is a person's child is born mahul or born androus or born why and then she has so when we have the Continuum then we have we have BR me says out crazy A crazy is a very important thing to have in your in your Rolodex L because you always have crazy questions they can't ask a regular but a crazy so they ask a crazy what was the question who pregnant Mar not Mar how's it [Applause] possible said I can have relations without breaking maybe maybe not common that that you don't break the through [Applause] relations maybe she got pregnant in the bathtub says what does it mean can that in the bathtub a man went into the bathtub there were General bathtubs Wonder was like a swim and they went the man went in ejaculated a woman came in and then she got pregnant says therefore say maybe the if that's the case IVF is is can you imagine how I learned that g 200 years ago what do it mean now we have every single morning five minutes from here in all of the you walk down Fifth Avenue one to go after another every single day he didn't say there wants to say he said it's a it's not a I heard from his children I never heard from directly I heard it from his children didn't so now you come to you knows a couple had of IVF and they have a child born on Shabbat ma next Shabbat will be there's no T there's no said that why the doesn't take a complete Continuum of that P what is the the P has four Clauses first clause or first two Clauses then all about none of them about conception so therefore you can't say we have a complete Continuum from is until says I reject assumption told me that's not not why not not because it's common because he said you put Zer and and B together you put egg and and SP together that's regular normal so I said what would happen if I would create a sperm cell for a heroization I would take a regular gtic cell and I would divide into two and I create a sperm cell and I put I I use that to to to implant the egg would that be considered to be merism said no that's regular where the SP that's very nice but that's not that doesn't change so I said okay what if I clone an egg ah cloning he said that's maybe Mass I something that's unusual no it has to be something that's unnatural but the the the the the rner said said that the britad is not but the M doesn't have to ask however later on in the Sho he said he does the most fascinating answer was from rosos told me Brit after II ination after IVF why that's it you going toos you know I feel you feel bad you're disturbing him like there was you know they said about R there was a man who studied for 90 years and people came to disturb him that was his life again like you felt like I don't want to but I had no idea what he just said like I what just happened so is a in it says the following regular is what's WR what's the Tor regular intercourse [Applause] whatever is normal in an unusual way that depends on the place on the time someone who put in his elbows let's imagine it changed and it would be crazy world that people would take things out on their El on their sleeve I don't know a cell phone or something they walk around with that so if that would happen What would say says would be the way that it's normally done he speak shab speak what say that's that's aism because no one it's unusual not because it's in natural it's unusual but he says IUI today is not unusual insemination is Is Not Unusual very okay so that what about IVF RAB didn't write about IVF again RAB was killed by the Nazis in 1944 and the first IVF was in 1978 you know what happened those 33 years so tell so I understand the the that says is wrote about II is something normal when it's normal then IVF is still abnormal about that was already a relatively young man he was maybe 99 at the time was young a couple of years later a couple went to him with exactly the same sh came from me they came went to him and they said ra said the IVF also does the Brit on Shabbat why because in those two years there became more and more more cases that became normal it's not my S him anymore it's it stops being when it becomes a Norm the norm now is IVF IVF is in in Israel one in every 20 births is after so it's a that he able to change his mind at the age of 100 plus and I mentioned before we talking it's a beautiful it's a beautiful idea what is the Tora is is T isn't what happened on T is what's going on now what's going on now we writing out that's what Tor is tor is is is now Tor is a living thing Tor is is idea that's the way people get pregnant that's considered to be normal for the Tor not Tor so that's so I think the today is that everybody would say that the BR the way we get there I think is a very uh interesting uh is an interesting journey and also explains to us about the how the posim really started accepting fertility treatment much more and that process of how everybody said at one point is user now became everybody says basically it's mut not only M became the norm I think it's a very fascinating process that I was able to be witnessed to in the past 25 years working for pu everybody should be well and happy and not have any but when we have questions about we should know how to define what's what's and be able to give a competent appropriate response shalom shalom