Vatomer Devorah

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 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, I took the Receptiva dx, and I found out 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 up to half the women at a fertility clinic have as an underlying issue, and higher than 65% of “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”. Then you have personal context, which gives you the clarity to make choices.

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. Her offered her testing and immune regulators. Soon after, Sarah became pregnant naturally.

A couple spoke to their doctor after coming to the realization that they were investing iui’s even though the sperm count was actually below the recommended threshold. When they questioned further, the doctor told them they can go to a specialist for further diagnostics and treatment of the underlying issue. The couple seemed surprised that they weren’t told of this before being told to go ahead with the procedures. The doctor explained that she didn’t think it was necessary because they were going to do ivf next, and for that you only need a few healthy sperm. After looking into this, they realized that this was not great advice, nor was it a recipe for success. The couple went to another specialist who treated the underlying issue. They did do an egg retrieval, but shortly after, they were able to conceive naturally.