Vatomer Devorah

At one point during this journey I joined a small group of women reading Likkutei Moharan early in the morning. Hashem sent me a lifeline that enlightened me and helped me keep my sanity.

The past few months we read chapter 60, in which Rabbi Nachman talks about effecting Divine providence for barren women to have children:

“This is likewise the aspect of “Open your mouth for the mute,” which in turn brings about the aspect of unbinding the mouth of the barren. These words, which had been repressed inside them for so long because they were deaf and mute, now emerge, and they do so with great strength”.

Rabbi Nachman explains that by telling stories from ancient times, those who are spiritually asleep are aroused to speak to G-d, which effects special Divine providence allowing barren women to conceive and bear children.

In this light, I want to share the following story from ancient times:

Vatomer Devorah el Barak ( Shoftim 4:6)

Devorah spoke to Barak and said that Hashem commanded him to go and attack Sisera, the Canaanite general who oppressed the Israelites with his 900 iron chariots, and Hashem would give Sisera into his hands. Barak says he will only go if she goes with him, and Devorah agrees. She adds that the glory will not be on his way because Hashem will give over Sisera in the hands of a woman (Yael).

Sisera’s 900 iron chariots represent technological superiority. The Malbim explains that Sisera relied on external dominance and control through force. He achieved many victories; however, he left many people trampled and crushed. Now I understand why Devorah said Hashem will give over Sisera into the hands of a woman. According to the talmud, “Bina yeseirah nitnah ba’ishah”- Extra discernment was given to a woman. It was not Barak’s military strength that defeated Sisera, rather it was Yaels discernment and timing.

In the fertility field, there is a lot of silence regarding the prevalence of uterine inflammation. Evaluation of endometrial inflammation, receptivity, and related conditions are commonly introduced only after many months or years of failed treatment with assistive technology. This translates to many couples investing in a process which they may not need, and with much lower success rates because of their underlying inflammatory condition. Because receptivity of the womb is most commonly ignored until assistive technology has failed, there is no vessel to receive these magnificent efforts. A lot of people are crushed, physically, emotionally, and financially.

According to a study in the European Journal of Obstetrics and Reproductive Biology (Volume 305, February 2025, Pages 86-91), “the presence of CE (chronic endometritis) has also been shown to reduce the possibility of conceiving spontaneously or by in -vitro fertilization, while antibiotic treatment of the disease has been found to improve pregnancy rates and complications.” In this study, chronic endometritis was diagnosed in 50.91% of women with infertility. When left untreated, chronic endometritis negatively affects the possibility of both natural and assisted conception. Going through this process, felt like 900 iron chariots when I needed antibiotics. I also benefited from immune protocols that directly addressed the inflammatory environment of the womb.

After experiencing this journey, spending large sums of money, and demanding so much from my body, while having very little information to understand or address the underlying issues, I realized this was something I wanted to integrate more deeply. My focus began shifting from hypervigilance, outputting and constant effort, toward receptivity- receiving what G-d has already prepared for me and believing that it is already there. It’s definitely a new operating system for me- which I think is called faith.

By the time people become aware of immune factors, they have put in what they thought were your best efforts, however, without a vessel these efforts are often futile. According to the Receptiva dx website: “Women who test positive for BCL6 ( an inflammatory marker associated with endometriosis and progesterone resistance) and are left untreated are 5 times less likely to succeed in IVF than women who test negative.”

I remember coming into one of the offices for the first time on my birthday. The nurse looked at my information and she said, “You are already 37”. In general, the conversation was stilted. She gave us very brief responses to our questions and mentioned to us that ivf is very expensive. We then went with another nurse who gave us a very basic biology lesson. Blood hormone levels were tested and came back normal. I didn’t know that progesterone resistance, a common uterine condition which impacts uterine receptivity, does not show up via bloodwork. I was offered clomid and from there increasing levels of investments in assistive technology.

Technology is not a problem in and of itself, it is a gift to many people with fertility challenges. It’s just that it was being used out of order- the Divine order. In the torah, if you want to receive Hashem’s blessing, you first and foremost must prepare a vessel. You don’t put in all your efforts and investments and to come back around and find out if you have a vessel for them. Because when you have a vessel you are naturally receptive to the blessings that G-d is sending your way.

The womb is the vessel of life. Thats why I believe that reproductive technology will have the greatest benefit with those who operate with bina – discernment, and prepare the womb first.

There is another piece to this story.

In mid- October, right after Sukkos, my husband got a new pair of tefillin. He brought his tefillin to the sofer (scribe) and was surprised to find out that they were over 100 years old, according to the sofer. The words were very faded. It would be too expensive and difficult to fix them, so he bought a new pair, even though we did not really have the money at the time. The sofer asked him his price range and said that there was a pair he had for him, that was already written. Apparently, before Rosh Hashana a man came in and ordered tefillin. After the sofer had written them, the man told him that he is a lefty and did not realize that he forgot to specify that. These tefillin were written for someone right-handed. As my husband paid for them, the sofer told him that they were written for Rosh Hashana and sealed for Yom Kippur.

We became aware that the pair of tefillin my husband had been using were his grandfather’s. We realized what a big zechus (merit) it was for my husband to have used his tefillin. He was a big tzaddik who survived the war and accomplished may great things in his lifetime.

But it was clearly time to get a new pair. We thought about all those tefillin had gone through. They had been written in Eastern Europe before the war, traveled to Shanghai, China with the Mirrer Yeshiva, came to America. They survived many transitions, war, upheaval, and rebuilding torah foundations in America, which my husbands grandfather took part in. All this before my husband had used them. We also felt that some of our experiences in the years prior to and including our fertility journey contained some of those descriptions. There was both the honor and zechus of using the tefillin and the feeling of closure from a time of transition and turmoil, trying to build foundations on many levels. In the sefiros, the channel of fertility is called yesod -foundation. It is the channel that connects the upper sefiros to the lower physical world (malchus).

Tonight as I’m editing this post, it is the 41st day of the omer, which is yesod she’byesod, foundation of foundations. Shlomo hamelech says that a tzaddik is an everlasting foundation that remains standing even through whirlwinds and storms (Mishlei 10:25).

Rabbi Nachman says, “He is the aspect of holy of holies/Foundation Stone…..These are the tzaddikim upon whom the earth was founded… They all come and are encompassed in the tzaddik of the generation, who is the aspect of the Foundation Stone… And through this all the constrictions are mitigated” ( Likutey Moharan I, 61:7). The Zohar explains that a tzaddik is called the foundation of the world- “Tzaddik yesod olam” (Mishlei 10:25), because he acts as a channel bringing shefa (abundance) and bracha (blessing) down into this world. My husband’s grandfather was a great tzaddik, and we felt more strongly connected to him, and to our roots – our foundation.

The goal for writing this blog is the hope that we continue the work of the tzaddik in our own small way, in being a channel of blessing in this world by sharing our experiences along this journey and the things we learned along the way.

Throughout this journey, one of the prayers I’ve said daily is the 42 masaos-the 42 stops that the Jewish people made in the desert, along with Ana BeKoach. This includes the text of the 40 years of travel in the desert of what should have been a short, straightforward path from Egypt to Israel. We are told that the reason all these stops are written down is because all of them serve a purpose, whether it is evident or not why they had to take these routes.

I realized that the baby is due the week of Parshas Devarim, right after Matos Masai- where the 42 travels are written. Devarim means words. While you are in the midst of a difficult journey it is hard to have the words to speak about it and be vocal about the experience. It is often only afterwards, or towards the end that you can speak and share your experience in a meaningful way.

Rabbi Nachman says that through the power of speech, one can effect Divine providence for barren women to conceive and bear children:

“This is likewise the aspect of “Open your mouth for the mute, which in turn brings about the aspect of unbinding the mouth of the barren. These words, which had been repressed inside them for so long because they were deaf and mute, now emerge, and they do so with great strength..” (Likutey Moharan l, 60:8)

The commentary (218) explains that by telling stories from ancient times, those who are spiritually asleep are aroused to speak to G-d, and these words emerge with great strength. They are then able to effect special Divine providence allowing barren women to conceive and bear children. G-d willing, I will share a story from ancient times in the next post.

After realizing that uterine inflammation was involved in our fertility issue we went to Dr. David. At the initial appointment we spoke to Dr David for quite a while, going through something like a comprehensive checklist of underlying health and lifestyle factors. To Dr David everything was a context clue. Something I noticed was that Dr David did not mention any general statistics about egg quality or tell me about my age demographics at all. After the appointment my husband commented that he has a “ruach acheres”- a different spirit.

Dr David recommended we do testing for subclinical infections and related immune factors, like natural killer cells (even after ERA came back negative). The testing came back positive. He prescribed antibiotics and intralipid infusions which act as an immune modulator, creating a more favorable uterine environment. He also suggested I take cough syrup.

Since I became aware of the uterine inflammation, I had also been on a much more specific anti-inflammatory diet. Although in general I had always tried to eat healthy, I realized that previously I was just keeping things at bay. Once I had information about what was going on in my body, I was able to be more proactive in addressing it.

Our first appointment with Dr. David was in early September.

I had started writing this blog in August, and I felt compelled to write for months. Almost every day I added something or edited. Until one day very early in November, I felt that I couldn’t write anymore. I was writing about da’as, and I felt that I didn’t have the da’as, embodied knowledge- because I didn’t yet have personal experience of fertility restoration. After a few days, I wrote one line: Hashem, please give me the da’as.

A few days later I went in for blood work. I didn’t feel very hopeful at the time, although later that day while I was walking, I found a 10 dollar bill on the street, and I felt a flutter of hope.

The next morning, we were reading from Likkutei Moharan when I found out about the pregnancy. I was reading a summary on Chapter 60 about effecting Divine providence for barren woman to conceive and bear children, through speech- telling stories of ancient times and arousing people to speak to G-d. My husband came home early and asked me if I saw the email from the lab. I took a break from the call to check the email.

It was a congratulatory email. The baby is due in July-Thank G-d.

According to the Tanya, Da’as is the knowledge that binds the mind and the heart.

Something I found hard to wrap my mind around, after some time on this journey, was the fact that there are common immune factors that affect the receptivity of the womb. But this hasn’t been integrated into diagnostic guidance when it comes to navigating fertility treatments (or avoiding them). There was something that felt out of order about it. Something foundational was not established before going ahead with interventions -the womb. To me, this felt like a lack of compassion (rachamim), which leads to leaving out the womb (rechem). They looked at the womb structurally, but without the da’as that would allow blessing and life to flow into it.

Regarding Pharoh, it says that he did not “know” Hashem – G-d. This is because he had knowledge that he did not integrate and internalize. Pharoh saw the hand of Hashem again and again through the 10 plagues, but he hardened his heart again each time Moshe stood before him. This is the difference between intellectual knowledge and internalized knowing. Underneath Da’as in the sefiros is Tiferes. Tiferes is the realm of truth. It is also the realm of rachamim, compassion. When knowledge is translated to integrated awareness, it leads to rachamim. When it is not, it leads to exile, as it says in Yeshaya, “Therefore My people go into exile for lack of knowledge.” (5:13)

When a couple walks into a fertility office the question on their mind is, “Why?” That is a very different attitude than people usually get at most offices.

When clarity is revealed, it brings geula- redemption to the world, that is why it says regarding the final redemption that the earth will be filled with the knowledge of Hashem. (Chavakuk 2:14).

Leaving Egypt

There is the feeling of being a slave to the system, when things are “unexplained” or partially explained. You feel like you just have to go through the process. In most cases, relevant diagnostics are reserved until after people have tried many protocols including invasive and expensive treatments. However, many people give up before then because of financial or other considerations. And many people go into debt by then. Now I understood why fertility intervention is a huge undertaking for so many. The cards at the office say to donate to help 1 in 6 couples who are struggling.

I realized, on this journey, it had to be magnifying everything that I already struggle with. Along with the roller coaster of emotions, I felt a lot of constriction, isolation and stress. Waiting on appointments, the unknown, anxiety, trying to control and micromanage things… and more.

I had to repair my da’as, that must be key. I tried to work through the anxiety, pressure and limitation that I felt, in order to restore my vitality.

The tribe of Levi corresponds to the sefira of da’as. In Egypt, the tribe of Levi did not integrate with the standards of the rest of society. They did not join in the stress of the “avodas parech” that their brothers and sisters were involved in. According to the commentaries, the people were working as slaves in a system that did not have regard for their physical constitution or treat them differentially. Because the ground lacked a foundation, the work they did sank into the ground. In Egypt the people lost their da’as, and their perception changed, believing that slavery was inevitable and their lives had to revolve around this toil. (That is often how people going through fertility treatments feel. Their schedule, finances, physical, psychological and emotional state revolve around the investment.) They were “short of breath” because of the stress and strenuous work, and they no longer believed in their redemption. The tribe of Levi, however, maintained yishuv hada’as – a settled mind. They operated with clarity and therefore they never succumbed to the pressure around them and joined the work. That is why the job of the Leviim is to connect people to G-d.

In chasidic thought Pharoh represents the constriction of da’as-he saw each plague in isolation and therefore hardened his heart each time, instead of integrating new awareness. Without da’as, negative experiences to narrowed and limiting perception. In the fertility field, important pieces of knowledge- uterine factors, are known, yet often not integrated at the beginning of a couple’s journey. Instead, they are addressed only after many failed interventions. People start to believe that there is something inherently wrong with their fertility or broken, and that their “chances” are really low- a narrowing of perception shaped by repeated experiences without clarity.

So how do I repair my da’as?

According to Rabbi Nachman,

“Breathing is the main factor in the proper functioning of the intellect. This is because in order for the intellect to function properly, so that it can attain contemplation, above all it needs the oils in the body.…All the moisture and oils in the body are maintained by breathing…”( Likutey Moharan l, 60:3).

Rabbi Nachman explains that shallow breathing is associated with vanity, and it leads to poverty. Extended breathing is derived from fear of G-d, leading to wealth, and deep contemplation of torah (Likutey Moharan l, 60:3).

I started to try this. Every morning doing a small breathwork practice before I joined the learning. I also tried to slow down and “breathe”. For example, when I went to get the train, I intentionally walked slowly as I got to the platform. Normally I would rush, in case the train was already there. In small ways it helped me affirm the belief in Divine providence. Because even though I believed in Divine providence, moving differently helped me feel like I didn’t really have to stress.

Rabbi Nachman says, all constriction (dinim) must be healed in the mind. He says that there are separate intellects where constriction and suffering must be mitigated, because that is where they are rooted. These are all referred to as “Holy”- Kodesh. However, when we connect to the Upper Wisdom, that is where all of the constriction can be mitigated at once, and that is called, “Holy of Holies”- Kodesh Kedoshim or the foundation stone ( Likutey Moharan l, 61:6).

Certainly da’as, which is also knowledge of G-d, is connected to Upper Wisdom. That must be why when we did start to operate with da’as, it felt like all the pieces were being put together at once into an expanded picture, instead of working with fragmented pieces that reinforced the constriction that we felt. We were finally seen as whole people instead of numbers or statistics. I also began to expand my da’as, albeit incrementally, in trusting even in small, mundane ways, that things unfold by Divine providence (hashgacha pratis). This has everything to do with breathing, and allowing life and vitality to flow again in place of constriction.

In the Torah, information is a form of love. It is called Da’as.

Along this secondary fertility journey, I remember talking to someone from one of the organizations. During the conversation, he said, “I’m sure you know you have to advocate for yourself”. I recall thinking, “please fill me in on what I should advocate for, because I don’t know what to ask”. I went online on a forum where people spoke about their fertility process. How much they had been through, how much money they had spent. Often times 10’s of thousands of dollars and years in they learned to ask for an additional test, or something additional to be added to an intervention.

I eventually learned that there are conditions for which testing seems to be sidelined. Often having to do with the environment of the womb, and immune factors. (The womb is an immune organ). One is endometritis, as I discovered in my experience. However, after looking into this further, it seems the doctor was kind enough to offer testing to us “early”, considering that many people go many years while investing into invasive interventions without considering common uterine infections, even though they are common, treatable and affect fertility outcomes.

We became aware that the office we were using was based around interventions, from “least to most” invasive. It seems right to start with the least invasive- like coming in for rounds of monitoring- bloodwork, and ultrasounds, ovulatory medications. However, moving people along with the least information and understanding of underlying issues often leads to more interventions and financial, emotional and physical investments, in a series of expensive procedures, or trial and error.

Do we have a gambling problem?

It felt that way, and our bank account reflected that.

Years in, when I took the Receptiva dx, I discovered that I had inflammation in my uterine lining. Something that couldn’t be picked up by blood tests or ultrasounds that I routinely came in for. It is associated with excess estrogen and progesterone resistance. It’s something that many of the women at a fertility clinic have as an underlying issue, higher than 50% in “unexplained” cases. Even without the test, there are ways to connect the dots. Things like systemic inflammation, digestive issues, chronic fatigue- and walking into a fertility clinic, all point to the fact that inflammation and receptivity of the uterine lining should be considered.

When I looked up the statistics on elevated bcl6, the inflammatory marker I tested for, and how prevalent it is, I wondered why most doctors weren’t so interested in those statistics. When I went through a miscarriage, the doctor sat us down to show us a graph of statistics. And that was basically it for the meeting. I was thinking at the time, “I do have google”. I felt that, as a specialist, he could have told us something more helpful, but at the time, I didn’t know what. It’s confusing when you are sharing a lot of data, but you did not gather the data about me.

Fast forward to half a year later, and the doctor went over the results of the Receptiva dx. He was telling me that we needed to suppress estrogen and I realized that everything we did up until then was blind.

Something my husband told me about life – חיים – Hashems name is in it, surrounded by מח, the mind- consciousness, understanding, and חם, warmth- emotional investment.

According to the Tanya, conscious awareness with emotional investment is called Da’as. Da’as is the awareness that bonds the mind and the heart, bringing abstract wisdom and understanding into embodied knowledge that’s personally applicable. When you have da’as, you are empowered with clarity and guidance. Da’as is also relational, it builds relationships and trust. Without da’as, information remains abstract and disempowering.

Leah was scheduled to have a procedure on the day of ovulation. She went in for monitoring with increasing frequency for about two weeks. One day the nurse called her afterward to tell her that she had already ovulated. Then the nurse told her that the doctor said she could come in the next day for the procedure if she wanted to. The words “if you want to ” stuck out in her mind. She asked to speak to the doctor who admitted that she would not actually recommend that Leah pay $1500 and come in for that procedure the next day but she wanted to give her the option. After that Leah and her husband switched to another doctor at the clinic.

At one point we again sought advice from someone from an organization. He was kind and helpful. However, he mentioned that he generally is an “in the box” kind of person. I thought at the time, “maybe he is ok being in the box from his vantage point because he is not actually in the box”. All I wanted to do was get out of this “box”. The box of “infertility”, general assumptions about age and demographics that you are told you fit into. Expensive investments into procedures done really in desperation. I felt very limited and confined.

In some ways I felt that I must be “unexplained”, because I didn’t know that so much could be explained, it’s just that the explanations offered were very limited. Going through this felt like a very narrow and constricted way of operating In Hebrew, Egypt is called “Mitzrayim”, which is from the word ‘Meitzar”, narrow or constricted. All of the Israelites were slaves in Mitzrayim except those from the tribe of Levi. The tribe of Levi corresponds to da’as, something they always maintained, and therefore, they operated with clarity.

Without information people can’ ‘t really make sound decisions while financially, emotionally, physically and spiritually investing themselves in treatments. Even though G-d can make any effort successful, we are told to make aligned efforts and not to rely on miracles. Before we got to Dr David we looked into endometrial specialists, and realized that we really did not have the budget for that because we had spent so much money (and time) doing interventions, which were in retrospect unjustified. But it feels kind of like a right of passage as you are going through the system. Of course, Hashem has a plan all along and there is always an answer.

Chochma–Bina–Da’as Wisdom–Differentiation–Embodied Knowledge

When you arrive at da’as, you are no longer “in the box”, because you have personal context, which gives you clarity to make informed choices. P m

After many treatments, Sarah was offered testing to look into immune factors, and she was positive for an inflammatory marker called bcl6. She was offered the option of months of estrogen suppression. At that point, Sarah realized that her fertility issues had to do with her immune system. (The womb is an immune organ and “inflammation” means that there is elevated immune activity). With this information, Sarah went to an RE who incorporated immunology into his fertility practice. He offered her testing and immune regulators. Soon after, Sarah became pregnant naturally.

Today, I was listening to a class on Likkutei Moharan where Rabbi Nachman spoke about mishpat. We translate that as judgement, but he says it means to make an accounting of one’s deeds. This is best done during hisbodedus- personal prayer in your own words. Talking to G-d. This is important, he says, because it will cause the fire in your heart to burn strong, and you will not be influenced by the residual evil of people who you are bringing closer (mekarev) to G-d.

This was interesting, because I’ve been thinking about bina/ discernment. Bina is the womb, and it is also a midda/trait. The word “bina” starts with the letter ב/beis, which also means “home” or container- like the womb. In some ways, I feel that Hashem has gifted me with Bina for the first time in my life. Partly in the ability to allow the sparks of truth that I feel to develop and gestate into something productive instead of corroding my nervous system.

In sefer Shoftim, Devorah is called Eishes Lapidos. This can be translated as the wife of Lapidos, “torches”. She speaks to Barak, telling him that Hashem said to go to war to defeat Sisra. Barak means lightning. Devorah seems to be surrounded by people whose names mean fire. Some commentaries say that this is a description of Devorah herself. Eishes Lapidos means she was a woman of flames. The Yalkut Shimoni explains, Devorah and her husband made wicks for the Mishkan. She would make sure they were thick wicks so that they would have much light. Hashem said to her: “Devorah, you intend to increase My light. I will also increase your light”.

In theory, fire is a source of illumination and light. But during this journey, we did not feel illuminated much, more gaslit and in the dark. I also felt consumed, inflamed and burned out. My body felt more inflamed with each intervention, and I wondered if this was conducive toward fertility and life. I asked Hashem if He could give me the anesthesia some people seem to be on, that numbs them so that they don’t ask many questions.

I started to talk to G-d more, and I asked Him to restore my fertility. Numerous times I had tried to let go of the desire for fertility, however, I did not feel that was really possible. I realized, it’s because I’m not the one who planted it. That was G-d. What helped was eventually recognizing that my feelings, insights, goals and dreams were actually not just my own. I am not separate from G-d so I didn’t need to convince Him of anything. He wants my palm tree to thrive, after all He planted it.

The Tanya teaches that the conscious awareness of recognizing that we are part of G-d and there is nothing apart from Him brings inner stillness or awe and opens the mind. Then insight can enter. That is Yiras Hashem which preceeds chochma, insight. But chochma itself is not enough. You need bina, which is the vessel to contain and develop a process that you can’t see all at once.

I began to take a little more of an observer’s stance, slightly less reactive to things that were draining us physically, emotionally, psychologically and financially. When I started writing, it was like taking the sparks that could have developed into an electrical fire and giving them a space to glow, where they could shed some light. Instead of trying to suppress the flames that were consuming me, I tried to gather them into a torch of light. As I wrote, I felt less consumed and more illuminated. This must be the fire of the heart that Rabbi Nachman is talking about. The kind that protects you from residual evil when you bring people closer to G-d.

בינה אקרי אמא עלאה (Zohar)

So, after a certain amount of procedures and interventions a woman may be informed of diagnostics that look at the environment of the womb. Is the uterine lining receptive to progesterone, is it inflamed? Up until then it is assumed that you can proceed with interventions without this knowledge, even though uterine inflammation is highly prevalent as an underlying cause of infertility.

So many doctors proceed without bina- without discernment and without knowledge of the womb. Women are ofteb told they have no issue with the hormones being administered during treatments, when they do. They have excess estrogen and progesterone resistance, which is only looked at much later.

Chana* was ready to have an egg retrieval. Her doctor explained that these are hormones just like the ones in her body that she has no issue with. She was put on medication to stimulate the ovaries. At one point the doctor raised the estrogen to a higher dose, but then lowered it back to the original recommendation, when her estrogen spiked. In the days during and after the egg retrieval , Chana had some intense stomach pain and she did not feel well at all. She spoke to her friend, the nurse who was helping her administer the meds, who told her this was not normal. Chana contemplated going to the hospital because of how much pain she was in.

Some time after this she did the receptivadx and it was positive for the bcl6 inflammatory marker. The doctor explained that her body had an issue with excess estrogen. He recommended months of Lupron shots -estrogen suppression.

I discovered that there are some doctors who take endometriosis/uterine inflammation into account and gather this information early on. It doesn’t even need to be through the Receptiva test. There are doctors who have something like a checklist or questionnaire, simply by being familiar with signs of inflammation, they assess whether this may be an issue to consider with their patient. There are also other tests available that look at the uterine environment. But why is the health of the uterus simply ignored by most doctors for as long as possible?

The Standard of Care

I don’t know the answer to this question, but I know that most fertility offices are protocol driven. Looking into these underlying factors is not seen as a basis for care, but as a last resort, even though that means many people go through months or years of treatments that have much lower success rates when the womb is inflamed.

After seeing and experiencing this standard of care, I wanted to see it upgraded. I wanted people to have access to information and early diagnostics that consider the environment of the womb, before they go through many months or years of interventions which can be upwards of tens of thousands of dollars or much more, and take a large physical and emotional toll.

I remember going to a general naturopathic office and another couple sitting next to me. At this point I had started to contemplate writing down my thoughts. The husband randomly turned to me and asked what I think of this doctor. Then, surprisingly, he shared that they are going through fertility challenges and coming here for help. I remember looking over at his wife and recognizing myself in her face. I saw a kind of repressed anger, a silent feeling of helplessness behind her smile.

The next day I was still contemplating writing down my thoughts. I went shopping to buy a dress. On the way there I thought, G-d, I need a sign, maybe I will find a dress with palm trees on it.

I got to the store and there were no dresses with palm trees. It was the end of August, and the summer stock was already out, and the new fall collection was on the shelves. I went to the counter to pay. In front of me was a women wearing a very unusual dress. It was a brown dress with green palm trees printed all over it. Later that day I started to write.

One way to describe the trait of Bina is receptivity- receiving information, processing it and absorbing it using discernment and gaining understanding before taking action.

After being on this journey for some time, I was offered to take the Receptiva dx test. It is known to test for “silent endometriosis”. It actually measures BCL6, a marker associated with inflammatory signaling and progesterone resistance, most commonly correlated with endometriosis but also seen in other inflammatory uterine conditions. We decided to do it, thinking it was pretty unlikely since it’s brought up as an afterthought. About a week later the results came in and I was positive for a marker that indicates inflammation in the endometrium. The doctor recommended months of hormonal suppression of estrogen and mentioned that surgery is the gold standard for actually diagnosing endometriosis and removing it.

I was kind of shocked. I had been coming in all the time for testing and ultrasounds, and I was told everything looked fine. And I didn’t have the classic symptoms of endometriosis. But inflammation, I was familiar with. Digestive inflammation, chronic fatigue and some other symptoms that now I was starting to put together.

I looked up statistics. Apparently, endometriosis (known or “silent”) is one of the most common underlying factors in women who go in for fertility treatments. Especially, in “unexplained” cases (>50%!). I asked the doctor why this test is offered as an option after much time and expensive interventions if the results are considered highly clinically significant and actionable. There wasn’t really an answer. I also wondered why doctors often treat estrogen as a non-issue until a woman is tested and then recommend suppression. I wondered if they would adjust medications or the recommendation of rounds of clomid if they know there is an elevated inflammatory marker. Endometriosis is fed by estrogen. Elevated bcl6 is often associated with excess estrogen and progesterone resistance, the hormone necessary for pregnancy.

Oh.

Until then, I was encouraged (but confused) by the constant testing indicating that everything appeared normal. I was encouraged to take estrogenic drugs like clomid and to do interventions that were quite expensive and draining. I felt like it was all without basic context.

I learned that there are other tests that indicate uterine inflammation from chronic infections in the uterine lining or endometritis, which is also very common. According to the NIH, when the inflammation in the uterine lining is addressed, pregnancy rates significantly increase.

Shira* went to a fertility specialist and did some preliminary testing in which it was found that she had a uterine polyp. She was advised to have it removed, as the doctor explained that it could be an obstruction. About a year later, she went to another doctor. At that point Shira* and her husband went through months and months of interventions which included many blood tests and ultrasounds, iuis, egg retreival. At that point, she was offered the Receptiva dx test and found that her uterine lining was inflamed- she had elevated bcl6 marker. She was advised to take lupron or do excision surgery before transfer.

Shira remembered the polyp. It had been a while, but she realized after looking some things up, that uterine polyps are associated with excess estrogen and inflammation. So, years ago and since then, she was not advised to look into that even though she was struggling with fertility and had a sign of excess estrogen and inflammation in her uterus.

She and her husband were pointed elsewhere until they came back around after a process of many interventions, to what would seem obvious unless you are not really looking for context.

According to the National Institute of Health, among women with endometrial polyps, 51.35% have chronic endometritis- that means they have chronic infection and inflammation affecting the uterine lining. The prevalence of CD-138 positivity among those women was 70.73%. CD-138 is a marker for chronic endometritis.

https://pmc.ncbi.nlm.nih.gov/articles/PMC870053

Recently, I was reading the morning blessings and these words jumped out at me:

אשר נתן לשכוי בינה

Hashem gave the rooster bina- understanding, intuition, discernment, to differentiate between day and night.

The rooster is clearly a male bird. Bina is a feminine trait that women are especially endowed with. Why did Hashem give the rooster bina?

The rooster crows and heralds the coming of the dawn because it is able to discern between day and night before anyone else can. It takes action only after using the trait of bina, discernment. The dawn actually represents renewal and new life, just like each day begins anew.

In fertility care, proceeding with interventions without environmental context of the womb, is proceeding in the dark, without knowing whether it is time for dawn to arrive. The womb is the environment in which new life begins. It is where new life dawns. That is why רחם (womb) is written with the same letters as מחר (tomorrow).

“And she would sit under the date palm of Devorah…” (Shoftim 4:5)

The commentaries say that Devorah sat under a date palm to judge the people because it was a place of openness and transparency.

In the torah, the date palm is a symbol of blessing and fertility.

The date palm is evergreen, enduring drought and heat, it’s roots reaching deep to find water. It produces sweet, nourishing fruit even in desert conditions.

The date palm teaches patience. It grows slowly, taking many years to bear fruit, but once it does, it continues for generations.

The date palm is straight and rises higher than other trees, its overarching height and unbranched trunk represent unity and truth.

According to Bamidbar Rabbah 3:1, The date palm is entirely beneficial. It provides dates to eat, branches for schach ,trunk for wood, fibers for ropes.

My intention in sharing this website- vatomardevorah.org, is to share all the date palm has to offer with you. A fertility journey can feel like wandering through a desolate and barren desert, making stop after stop, trying to find answers. That is where this date palm grew. In sharing my thoughts along the way, I hope they can provide some much-needed resources, and to remind you of the promise written by David Hamelech/ King David: “The righteous shall flourish like the date palm” ( tehilim 92:12).

My name is Devorah, and in recent years I read a book written by the Ramak, R’ Moshe Chaim Cordovaero, a page every day. The book is called Tomer Devorah. It is about the 13 attributes of Rachamim/mercy and how we can emulate the ways of Hashem. I had stopped reading it a while ago but picked up again after I started writing this blog that I called Vatomer Devorah. It reminded me of the book.

Rachamim is almost the same as the word Rechem (womb). In Hebrew when two words share the same root, they are intrinsically connected.

In Chassidic teachings, Rachamim (compassion) is the merging of judgement with kindness. The womb is the most tangible form of rachamim. It is enclosed and boundried, protecting the life inside it, while nurturing it with overflowing kindness. The intent of vatomerdevorah.org is to help restore this life- giving balance. It’s an accounting for the purpose of restoring sweetness and renewed life into a field where that is the stated goal: fertility care.

Restoring balance means putting both the Rechem (the womb) and rachamim (compassion) at the center of fertility care, so that it is patient centered- compassionate, curious, and progressive, rather than mechanistic.

In fertility care today, the womb is often overlooked, as people go through expensive and draining procedures, without accounting for underlying factors, like endometriosis and other uterine inflammation, even though they are common. They often come around to this after spending much money, time and energy. Getting back to a womb centered approach means applying the principles of rachamim, which is not only compassion, but also the merging of kindness with justice. It’s where underlying and root causes are used clinically as a basis for care.

It also means restoring the feminine principle of bina/discernment, where people can benefit from a full circle of professional knowledge and experience rather than assembly line thinking. In the torah, bina is also a reference to the womb. All of these things are found in the torah, and my experiences have led me to reconnect my roots to its living waters and fertile soil. Rabbi Nachman of Breslov teaches that we find G-d in the obstacles that we encounter. That is where my date palm blossomed. And it is not just any date palm, it is a tree of life.