– Author: Rav Bentzion Shor
Perhaps one of the most difficult halachic issues regarding the purification process from the state of nidda is the problem of early ovulation, a.k.a. “halachic infertility.” For almost two thousand years, there have been Jewish women who have struggled to conceive, and some that could not do so altogether. Over the past hundred years,[1] different solutions to this have been proposed, tested and implemented in order to help women that suffered from this particular problem reach the goal of childbearing and raising a family. In this article, we will explore the basic halachic and medical background to the issue, the different solutions offered, and some of the disagreements that have arisen with respect to the different solutions.
Brief Overview of the Menstrual Cycle
Stimulated by gradually increasing amounts of estrogen, discharges of the blood (menses) flow stop, and the lining of the uterus thickens. Under the influence of a complex interplay of hormones, the egg develops and in approximately mid-cycle, an ovocyte is released in an event known as ovulation. After ovulation, the ovocyte only survives for 24 hours or less without fertilization. The body then starts producing large amounts of progesterone. Under the influence of progesterone, the uterine lining changes to prepare for potential implantation of an embryo to establish a pregnancy. If implantation does not occur within approximately two weeks, the body will cease to produce the hormones, causing a sharp drop in levels of both progesterone and estrogen. The hormone drop causes the uterus to shed its lining in a process termed menstruation.[2]
The typical length of time between the first day of one period and the first day of the next is twenty-one to thirty-five days in adults, while the average is around twenty-eight days.[3] The time from the beginning of the last menstrual period (LMP) until ovulation is, on average, 14.6 days.[4]
The most fertile period (the time with the highest likelihood of pregnancy resulting from intimate relations) covers the time from some 5 days before until 1 to 2 days after ovulation.[5]
There are a number of ways for a woman to know when she is ovulating. The simplest is a home urine test that measures the amount of the LH. Other methods include blood tests, ultrasounds, measuring the woman’s temperature, and differentiating between the discharges from the uterus.
In order to conceive, a woman must have relations around the time of ovulation. But it is not always possible to do so from a halachic perspective, as we shall discuss shortly.
The Halachic Status of the Menstrual Cycle
According to the Torah, a woman who bleeds from her uterus can have one of two statuses – she is either a nidda[6] or a zava.[7] Her status is dependent on when during her monthly cycle she saw the blood.
A nidda is a woman who sees blood during the first seven days of her nidda cycle. A zava is a woman who sees during days 8–18 of the cycle.[8] According to most Rishonim[9] as well as the practical halacha,[10] the cycle restarts every time a woman sees blood after the previous cycle. This means that in order for a woman to become a zava, she must see blood during days 8–18 after previously establishing a sighting (day 1–7). It could be a consecutive bleeding, or a two-phase bleeding. On the other hand, the opinion of the Rambam[11] is that the cycle starts when a woman has her first period and then restarts every time on the 19th day without any dependence on the actual bleeding or non-bleeding from then on. According to this opinion, even if a woman did not see blood at all for a while and started bleeding during days 8–18 of her cycle, she will have the status of a zava.
There are a few differences between a nidda and a zava, but the main distinction that is of interest to us is the number of days that the woman must wait before she can go to the mikveh.
A nidda must wait seven days from the beginning of the bleeding. Even if the bleeding continued during the seven days, as long as it stopped before the end of the seventh day, a woman can go to the mikveh that evening. On the other hand, a zava must count seven days after the bleeding has stopped. Only after these seven “clean” days can she go to the mikveh and become pure again.
All of this applies on a Torah level. However, during the times of Chazal the difference between a nidda and a zava became blurred due to two decrees.
The Decree of Rabbi Yehuda HaNasi
The first was the decree of Rabbi Yehuda HaNasi.[12] His decree[13] was composed of three parts. The first was that every woman who bleeds for even one day must count seven days (including the day she bled) before going to the mikveh, in line with the laws of a nidda de’oraita. Even though the woman might have bled during her zava days, which would only necessitate that she wait one clean day[14] according to Torah law, we fear that she might have lost count of her cycle and is in fact in her nidda days.[15]
The second component of the decree was that a woman who sees blood for two consecutive days must count the seven days from the second day, and not from the first as the Torah permits. Two reasons are given for this decree:
- As mentioned above, women might get mixed up and lose count of their cycle. If so, a woman might think that both days of bleeding were part of days 1–7 of the cycle and therefore she needs to count seven days from the first day, when in fact the first day of bleeding was day 18 of the previous cycle (the last day of the cycle), and therefore she must count 7 days from the second day of bleeding.[16]
- The bleeding of the first day may have been of a color that does not make the woman a nidda,[17] and only the blood of the second day must be taken into consideration in the counting. Since we are not sure anymore that we can differentiate between colors of blood,[18] we start the counting from the last day of the bleeding.[19]
The last component of Rabbi Yehuda HaNasi’s decree was that every woman who bleeds for three consecutive days must count seven clean days before going to the mikveh, even if the bleeding occurred during the first seven days of the cycle. This is in line with the first reason mentioned above, that we fear she may have lost count of her cycle and the bleeding might have occurred during days 8–18, which means that she is in fact a zava.
Rabbi Zeira’s Stringency
A second decree is attributed to Rabbi Zeira, approximately 100 years after the first decree. He is quoted[20] as saying that Jewish women[21] accepted upon themselves a stringency that a woman must count seven clean days before going to the mikveh for any amount of bleeding from the uterus, no matter when she saw the blood – either in the nidda or zava part of her cycle.
The reason for this stringency is to set a unified system. Since in certain cases even a drop of blood may cause a woman to count seven clean days – such as a woman who bled on the last[22] day of her seven clean days,[23] therefore, in order to prevent confusion, the custom was to follow the same protocol in all cases.
In other words, Rabbi Zeira’s stringency effectively erased the category of nidda[24] and set forth that all bleeding from the uterus treats a woman with the stringency of a zava. However, it is important[25] to note that Rabbi Zeira’s stringency did not add much to the first decree of Rabbi Yehuda HaNasi. The stringency added only one more day in cases of a very short period (1–2 days), and nothing at all in cases of a normal period which lasts between 3–7 days.[26]
In any event, the decrees of Chazal (or the women of Israel themselves) prolonged the time that most women must wait before going to the mikveh from seven days (from the beginning of the bleeding) to somewhere between 10–14 days.
These decrees were unequivocally accepted by the Gemara,[27] Rishonim[28] and the Shulchan Aruch,[29] and have been the practice among Jewish women for almost two millennia.
Emitting Semen
Another factor that prolongs the time for which a woman is a nidda is the halacha of a woman who discharges her husband’s semen.
The Mishna[30] derives from the fact that the Jewish people were forbidden from having relations with their wives three days before the giving of the Torah[31] that a woman who emits semen is impure.[32] The Mishna[33] brings different opinions as to how long after relations semen still makes a woman impure, and the Gemara[34] — according to some versions – brings another opinion.[35]
There are different opinions as to the implications of this halacha regarding the halachot of nidda. Does the impurity that results from emitting semen cancel all the clean days that a woman has already counted (like seeing blood), does it only prevent the day of discharge as being counted, or does it have no effect at all? Some Rishonim hold that the impurity has no effect at all.[36] Others[37] rule that indeed the days that a woman discharges semen cannot be counted as part of the seven clean days, but this is only regarding the first 36 hours (max)[38] after the day or night[39] that relations took place. Another opinion[40] is that the period of time during which the semen causes impurity is three full days,[41] and therefore a woman who had relations right before she saw blood should not start counting her seven clean days before waiting the three days during which the semen might cause impurity.
The Shulchan Aruch[42] rules like the last opinion that the count can only start from the fourth day after relations took place. In addition, the Rema[43] adds three stringencies to this: (THIS DOESN’T NEED TO BE LIST. Can be in text)
- One must wait another day before the start of the count out of fear that some may get confused and start the count too early.[44]
- One must wait even if relations did not take place before the bleeding began.[45]
- Even though most Rishonim agreed that there are ways to bypass this additional wait,[46] the Rema[47] holds that we are not proficient in the proper way of doing so and therefore cannot rely on it.
According to these rulings, the earliest time a woman can go to the mikveh is after the 11th day since the bleeding began according to the Shulchan Aruch[48] and the 12th day according to the Rema.[49]
Early Ovulation
Now that we are familiar with the halachic basics, we are ready to investigate how it corresponds to the biology.
As mentioned above, ovulation takes place, on average, 14.6 days after the prior menstrual period. However, it is more correct that ovulation takes place approximately 14 days before the next menstrual period, and since every cycle is different in its length, it is impossible to know exactly when the woman will ovulate.[50] Nevertheless, the average time between periods is 28 days, and therefore ovulation takes place around day 14 from the previous period. In a case where a woman bleeds for between 4–6 days, she would be able to go to the mikveh before the time of ovulation[51] according to all opinions. This is demonstrated in the following diagram:[52]
This is true not only for a 28-day menstrual cycle, but even for a 27 or 26-day cycle.[53]
However, there are two types of menstrual cycles that clash with the halachic principles. The first is in the case of a short cycle. A woman who has less than 25 days between periods[54] and sees blood for 5 days will ovulate before she can go to the mikveh,[55] as can be seen in the next diagram:[56] DIAGRAM 2
This situation is quite rare, and a more common type of menstrual cycle that clashes with halacha is that of a long bleeding phase. If a woman sees blood for more than 5-6 days, even a slightly shorter than average cycle may end with ovulation before mikveh. For example, the next diagram shows a 26-day cycle with a 7-day bleeding phase:[57]
DIAGRAM 3
In both types of cycles, the ovulation occurs before the woman is halachically permitted to have relations with her husband. Some therefore term this situation “halachic infertility.” In such a case, the woman is perfectly fertile, and the observing of halacha is what causes the inability to conceive.
The Medical Solutions
The common solution offered today to this problem is taking pills with hormones that delay the time of ovulation by a few days until after the mikveh. Usually, taking a small amount of estrogen for a couple of days is enough to delay the follicular phase by a few days and push off ovulation. The amounts needed are small enough that the side effects are not significant and do not cause a multiple pregnancy.[58]
Another solution, in the case of a long bleeding phase, is to give medications that help blood clotting, such as Hexakapron. This causes the bleeding to end sooner, allowing the woman to go to the mikveh before ovulating.[59]
In the rare cases that taking medication is not an option for different reasons, another solution offered for pregnancy is artificial insemination (IUI) during the seven clean days. This option is not frequently offered due to its complications as well as the halachic debate around the issue of artificial insemination during the seven clean days.[60] However, when necessary, it can be done after consulting with a halachic and medical authority.[61]
Another “biological” solution that is sometimes offered is to change the woman’s diet. According to some, a dietary change and an early breakfast can sometimes help in pushing off the ovulation time.[62]
The Halachic Solutions
Halachic authorities of the previous generation came up with different halachic solutions for this problem (when the medical solutions were not yet as available). Most of the solutions were directed at shortening the days the woman must wait before starting to count the seven clean days.
The simplest solution regards a woman who ovulates on the 12th day after the prior period. As mentioned above, according to the Shulchan Aruch, such a woman can start counting seven clean days on the fifth day after the beginning of the bleeding, whereas only the Rema holds that the woman must wait another day. There are many poskim[63] who rule that in such a case, due to great need, even those who rule like the Rema may begin the count of the seven clean days on the fifth day like the Shulchan Aruch, and in so doing thereby synchronize between the mikveh and ovulation.
When the ovulation occurs even earlier and there is a need to shorten the time before the woman can start counting the seven clean days even more, there are a few different options.
According to the ruling of the Shulchan Aruch (mentioned above) if no relations took place before the bleeding started, then those days can be counted as part of the four days that must come before the seven clean days. We saw that here too, the Rema is stringent that the count can only start from the beginning of the bleeding. However, some poskim[64] rule that in cases of halachic infertility, even those who usually rule like the Rema may rely on the ruling of the Shulchan Aruch. According to this, if a couple knows that the woman ovulates early, they can avoid having relations during the days before menstrual bleeding begins and thereby start the count of the seven clean days much earlier.
However, other halachic authorities do not accept this ruling and only permit reducing the five-day waiting period if the couple were halachically prevented from having relations.[65] They suggest different ways of reaching this situation. Some[66] propose that the wife may tell her husband that she is impure[67] five days before the bleeding starts. Others[68] suggest that the wife skip going to the mikveh for one month and then she need not wait at all before counting the seven clean days.
The problem with all these solutions is that they shorten the time needed to wait before the starting of the count of the seven clean days. However, this only helps if a woman stops bleeding within a day or two. Since most women see blood for 4–5 days and sometimes even more, the number of days that she must wait due to the emitting of semen is practically irrelevant, as she has to wait in any event for the bleeding to stop. For women whose halachic infertility is due to short menstrual cycles (the first type mentioned above) and have a very short bleeding phase, these halachic solutions may offer an answer. But in most cases, halachic infertility is due to a long bleeding phase (the second type) and these solutions do not help; therefore, one of the medical solutions must be used.[69]
Another Halachic Solution
Many of the authors[70] with experience concerning this issue have suggested that perhaps the solution for the long bleeding type of halachic infertility is actually to be more observant of the halachot of nidda – not regarding the stringencies, but rather regarding the leniencies that are well accepted among halachic authorities.
A study done in Machon Puah[71] has shown that close rabbinic consultation with poskim who are experienced in these matters can solve halachic infertility problems for at least[72] 76% of the couples! By following well accepted leniencies (that they may not have been able to employ on their own without consultation), most couples were able to start counting the seven clean days earlier than usual and managed to make it to the mikveh before the ovulation. This way, the woman did not need to take hormones or go through any other kind of medical procedure.
So perhaps the solution is not to ignore the halacha, rather to accept it fully and to consult with halachic authorities who are familiar with the issue and can direct those with this problem properly.
Summary
To summarize, in order to understand the problems and solutions of halachic infertility, we first reviewed the basics of the menstrual cycle and ovulation. We also discussed the Torah level difference between a nidda and a zava, the decree of R. Yehuda HaNasi, the stringency of R. Zeira that incorporated all bleeding from the uterus as having the status of the zava, and the opinions regarding emitting semen, which all together prevent a woman from going to the mikveh until 11–12 days after the beginning of the bleeding.
We saw that the ovulation will occur after the woman was at the mikveh, but in two cases – a short menstrual cycle or a long bleeding phase – the ovulation might occur earlier, ergo halachic infertility.
We examined the medical solutions for this problem – mainly, hormones that will delay the ovulation time. We also discussed the halachic solutions – different ways of shortening the 5-day waiting period before the counting of the seven clean days but that this is only helpful when the bleeding phase is very short.
We touched upon the controversy regarding canceling the seven clean days and the opinion of nearly all rabbinic authorities that it cannot be done. Finally, we noted that the right rabbinic consultation can help solve the problem in many cases, though there are always some who will require engaging in the medical solution.
May we merit that the Torah’s[73] blessing will always be upon us: “You shall be blessed above all peoples: There will be no sterile male or barren female among you…”[74]
[1] According to Wikipedia (“עקרות הלכתית”), the first documented description of halachic infertility was in 1970. However, some responsa go back further. For instance, see Responsa Igrot Moshe, Y.D. 1:93 who began addressing this issue in 1948.
[2] Wikipedia, “Menstrual cycle”
[3] Ibid.
[4] Wikipedia, “Ovulation”
[5] Wikipedia, “Menstrual cycle”
[6] Vayikra 15:19
[7] Vayikra 15:25
[8] There is a difference between a woman who sees one or two days during this period – a zava ketana, who only needs to count one clean day before she goes to the mikveh – and a woman who bleeds for three or more days – a zava gedola, who must count seven clean days.
[9]E.g., Rashi, Erechin 8a s.v.”פתח”; Ramban, Hilchot Nidda 1:10-12; Rabbeinu Yona, Berachot 21b, s.v. “בנות”
[10] S.A., Y.D. 183:1 and Shach 4.
[11] Hilchot Issurei Bi’ah 6:4-6. Indeed, for many generations these were the two sides – the Rambam vs. all other Rishonim. See Beit Yosef, Y.D. 183. However, in recent years, more and more sources in line with the Rambam’s opinion have been discovered, mostly from the writings of the Geonim. See, for instance, the article of Rav Ben Tzion Uriel in HaMa’ayan (Tevet 5785), footnote 21.
[12] Head of the Sanhedrin and editor of the Mishna. He lived around the end of the second century CE.
[13] Nidda 66a.
[14] See footnote 8.
[15] Rashi, Nidda 66a, s.v. “בשדות”, “ששה והוא”.
[16] Rashi, ibid. and s.v. “שנים תשב ששה והן”; Rashba, Nidda 66a, s.v. “יש מי שגורס”; Ritva, Nidda 66a, s.v. “אמר רב יהודה”.
[17] See Nidda 19a that on a Torah level only five different colors of blood render a woman impure.
[18] See Nidda 20b and Bava Metzia 84b.
[19] See Rif, Shavuot 4a and Ran there; Rambam, Hilchot Issurei Bi’ah 11:3; Tosafot, Nidda 66a, s.v. “שנים”; Ramban, Nidda 66a, s.v. “ה”ג וכן”; and Rosh, Nidda 10:6. Most of these Rishonim mention both reasons for the decree, while Tosafot mention only the second.
[20] Nidda 66a
[21] In Responsa Shevet HaLevi (4:97), Rav Wosner explains that since this stringency may lead to hardships in conceiving, Chazal did not institute this decree themselves. Only after the women, who are not obliged to have children, accepted upon themselves to act in this matter did Chazal feel free to make it a formal decree.
However, this explanation is somewhat difficult, as the stringency of R. Zeira only added one day more than the decree of Rabbi Yehuda HaNasi (and also that only in cases of a very short period). Why was he not concerned about preventing pregnancies before making his decree? We will see later on that there is a disagreement regarding the status of this stringency as to whether it is in fact a rabbinic decree or perhaps something less.
[22] Even though bleeding on any day of the seven clean days requires a new count of seven days (and so it seems from the Ran, ibid.), both Rashi and the Ramban (mentioned in the next footnote) clearly state that the bleeding took place on the seventh day of the count. Perhaps they understood that bleeding during days 1-6 of the seven clean days does not add an additional seven days, as the woman was supposed to count a few more days even without bleeding. Only bleeding on the seventh day adds seven additional days.
[23] Rashi, Megilla 28b, s.v. “שהחמירו”; Ramban, Hilchot Nidda 1:18; Ran, ibid.; see further in Rashi in Megilla, ibid. and Ran, ibid., for other cases where a drop of blood forces a seven clean days count.
[24] This is the case at least as far as the amount of time that passes before going to the mikveh is concerned.
[25] The importance is because some have claimed that the seven clean days that women count nowadays is only a custom of “benot Yisrael” and can easily be ignored. We see here, though, that even if we say that Rabbi Zeira’s stringency is not fully binding, usually the seven clean days are in fact a proper rabbinic decree from Rabbi Yehuda HaNasi.
[26] Wikipedia, “Menstrual cycle.”
[27] Berachot 31a
[28] Rambam, Hilchot Issurei Bi’ah 11:3–4,10; Ramban, op. cit. 1:15–19; and Ritva, loc. cit., among others. The Rishonim were very strict about this matter. The Rambam writes that “one cannot deviate from this stringency for all eternity.” The Ramban also writes that “one should not take this matter lightly ever.” The Ritva writes that “no one has power to undo this decree or to be lenient regarding it at all.”
[29] S.A., Y.D. 183:1
[30] Shabbat 9:3
[31] Shemot 19:15.
[32] As the status of a man who emitted semen.
[33] Mikva’ot 8:3
[34] Shabbat 86a-b
[35] One can find a summary of the different opinions in an article by professor Dror Fixler, “מפולטת שכבת זרע עד המתנת חמישה ימים לפני ספירת הנקיים, published in Tzohar 4, pp. 63–67.
[36] Ra’avad, cited by Torat HaBayit Ha’aroch of the Rashba 7:5 (also found in other Rishonim). The Rashba writes that this seems to be the opinion of the Geonim and the Rif as well.
[37] Rambam, She’ar Avot HaTumah 5:11 and Issurei Bi’ah 6:16. There are different opinions regarding how to understand the Rambam, but this seems to be the most fitting.
[38] The semen causes impurity in the first three onot, defined as a unit of a day or night. The time is thus between 24 to 36 hours (during the equinox).
[39] Rambam, She’ar Avot HaTumah 5:13.
[40] Rosh, Nidda 4:1 and other Rishonim.
[41] Six onot. This will always be calculated as 72 hours.
It is interesting to note that the reasoning given for the “three day” period is that the semen can “survive” for three days in the woman and fertilize an egg (see Rashi, Shabbat 86a, s.v. “שהיא טמאה”, based on the Gemara Nidda 43a and 56a). However, modern science has determined that semen can cause fertilization for up to five days after relations took place. Does this mean that we should wait today 6–7 days (S.A./Rema) before starting the count of the seven clean days? The answer is no. One explanation may be that we could say that the five-day survival occurs only in the bodies of non-Jews – upon whom the scientific facts are likely based, while in Jewish woman the semen survives only three days, as we learn from the giving of the Torah. This is based on the Gemara (Shabbat 86b, Nidda 34b) that remains in doubt whether the semen can indeed survive for more than three days in non-Jewish women. In fact, the Chatam Sofer (Shabbat 86b, Responsa, 2:175, and 4:61 infers from this Gemara that one cannot rely on doctors in the matters of nidda (and other matters) as the science is based on experience with non-Jews, while Jewish bodies do not work the same way. However, this may be scientifically false and needs to be proven in a proper study on Jewish women. Another resolution (pointed out to me by my friend Rav Jeremy Koolyk) to the conflict between science and halacha here that explains why the five-day “surviving” period is not a factor is because this extended time is applicable around the time of ovulation. At that time, the cervical mucus is the most “semen friendly,” and therefore the semen can “survive” for longer. On the other hand, the halacha that emitting semen makes the woman impure for three days is true throughout the entire menstrual cycle – and when referring to the halachot of nidda, we are talking about the very end of the cycle – when the cervical mucus is less “semen friendly” and can therefore only “survive” for three days (although we rule that even for a ketem, a woman must wait five days (Rema 196:11), and a ketem may be seen even around the time that the semen can last for longer, we can say that since it is only a rabbinic decree, Chazal did not want to make things too complicated and therefore maintained the decree in the same fashion as menstrual bleeding. However, the question rises what would be the halacha in the future when we practice taharot once again – will emitting semen around the time of ovulation make the woman impure for five days after the relations? That will be up to the Sanhedrin to decide, along with other halacha “vs.” science questions that we have today).
[42] S.A., Y.D. 196:11
[43] S.A., Y.D. 196:11,13
[44] Based upon the Terumat HaDeshen 245. The fear is of relations taking place towards the end of a day and ending at night, while the woman may mistakenly think that they were completed while it was still day and therefore start the count too early.
[45] Based upon the Responsa of the Maharik 35.
[46] Most agree (Rashba, loc. cit., Rosh, loc. cit., and more) that cleaning the area of semen is sufficient, and the woman can start the count of the seven clean days right away. This is the ruling of the S.A., Y.D. 196:13, as well. There are those (Ramban, op. cit. 2:9) who rule that even simply walking suffices to all the semen at once, but others disagree (Rosh, loc. cit.), and this appears to depend upon differing versions of the text of the Gemara (Nidda 41b).
[47] Based upon the Semak, 293.
[48] Three days for the emission of semen if relations took place during the day/night before the bleeding started, plus seven clean days.
[49] This is the case even when no relations took place.
[50] This is aside from the methods mentioned in the beginning of the article.
[51] Some claim that in contrary to the argument (that was used by those who called for canceling the seven clean days – see later on in the article) that the stringencies cause less pregnancies among those who follow halacha, in fact they improve the rate by causing the time of immersion in the mikveh to be in close proximity to the ovulation. According to Torah law, a nidda goes to the mikveh around a week before ovulating, and this could cause relations to not take place at the correct time for conceiving.
[52] From Hebrew Wikipedia: “עקרות הלכתית”. The diagrams are according to the ruling of the Rema.
[53] In a 26-day cycle, the ovulation will occur after the mikveh only in a 5-day bleeding scenario.
[54] According to the Rema’s ruling of 12 days before going to the mikveh. According to the S.A., the cycle must be less than 24 days.
[55] Sometimes, a short period of time between menstruations is not due to early ovulation. There are cases where the ovulation takes place after the mikveh, but due to hormonal problems, the Luteal phase is short and the endometrium disintegrates early. This can be solved by taking medicine which supports the endometrium.
[56] From Hebrew Wikipedia: “עקרות הלכתית”.
[57] Ibid.
[58]Rav Dov Popper, “Early Ovulation,” on the Machon Puah website.
[59] Ibid.
[60] See responsa Tzitz Eliezer 9:51:6 who discusses this issue.
[61] For a list of those who permit, see Rav Dov Popper, op. cit., footnote 29.
[62] Hebrew Wikipedia: “עקרות הלכתית”, in the name of Rav Dr. Mordechai Halperin.
[63] Responsa Har Tzvi, Y.D. 157; Responsa Igrot Moshe, Y.D. 4:17; Responsa Minchat Shlomo Tinyana 72; Responsa Yabia Omer 7:13, and more.
[64] Responsa Da’at Kohen 84, Igrot Moshe, loc. cit. and Y.D. 2:84, Minchat Shlomo loc. cit., and Yabia Omer, loc.cit.
[65] See S.A., Y.D. 196:11 and Taz 8, Shach 22, and Pitchei Teshuva 16.
[66] Chut Shani, Nidda 196:11:12 (pg. 271); Responsa Ohr L’tzion, Y.D. 6. However, the Taharat HaBayit, Vol. 2, siman 13 (p. 425) disagrees since it is not appropriate for a rabbi to instruct a woman to lie to her husband.
[67] See S.A., Y.D. 185:3.
[68] Responsa Har Tzvi loc.cit., Responsa Minchat Yitzchak 3:85, and others. However, the Igrot Moshe, Y.D. 4:17 does not agree with this, since it is harsh to prevent a couple from having relations for more than a month.
[69] There is another halachic solution that was not mentioned above. According to the Minchat Shlomo, loc. cit., if the menstrual blood would flow out of the uterus using a tube of some sort, then the woman would not become impure and would be able to have relations at the time of the ovulation. This would also solve the problem of the second type of halachic infertility. However, this solution was not accepted by all, and due to its lack of practicality there is no written account (as far as I know) of it being used.
[70] Rav Benny and Noa Lau, op. cit.; Tirza Kelman, op. cit.; Rav Aryeh Katz, op. cit.; Rav Dov Popper, op. cit.
[71] See Rav Dov Popper, op. cit.
[72] In 16% of the cases the problem was not solved, and in 8% of the cases the problem was solved but it was unclear if it was due to the consultation or just by chance.
[73] Devarim 7:14
[74] Translation by Chabad.org.
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