In vitro fertilization for Orthodox Jewish couples: antagonist cycle modifications allowing for mikveh attendance before oocyte retrieval

A novel modification of gonadotropin-releasing hormone antagonist IVF protocols for postponement of retrieval until at least 7 days after cessation of menstruation allows for observance of ritual Jewish practices.


David E. Reichman, M.D., Anate Aelion Brauer, M.D., Dan Goldschlag, M.D., Glenn Schattman, M.D., Zev Rosenwaks, M.D.

Volume 99, Issue 5, Pages 1408-1412, April 2013



To describe a novel method of altering conventional GnRH antagonist IVF cycles, thereby allowing for the observance of ritual Jewish practices, and to investigate the impact of these cycle modifications on IVF outcomes.


Retrospective cohort study.


Academic medical center.


Orthodox Jewish couples undergoing GnRH antagonist IVF cycles at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College from January 1, 2007 to November 1, 2011 in whom cycle starts were delayed using GnRH antagonists and estradiol patches.


GnRH antagonist administration on cycle days 2, 3, and 4, as well as estradiol patch application on cycle days 2, 4, and 6.

Main outcome measures:

Days of stimulation, total cycle length, implantation, clinical pregnancy, and live-birth rate were compared for 42 orthodox Jewish couples undergoing a “mikveh patching protocol” versus 42 control patients matched for age, diagnosis, and IVF cycle characteristics.


The protocol modifications successfully insured the ability to visit the Mikveh prior to retrieval by extending total cycle length by 3.85 days on average, with no decrement in implantation (43.2% vs. 39.3%), clinical pregnancy (57.1% vs. 59.5%), or live-birth rates (50.0% vs. 54.8%) as compared to controls.


GnRH antagonist cycles can be successfully modified to allow for IVF that remains consistent with the observance of orthodox Jewish practices.

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