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of procreation8, it does not say that a person is obligated to make
special effort and undertake sperm fortification in order to have an
additional child. He who refrains from such measures is not classed
among those who are enjoined “do not desist” since he is not aban-
doning the natural manner of procreation but is simply not exerting
special effort.

Similarly, a person who abstains from fulfilling the mitzvah of
procreation at an advanced age because he is concerned that his wife
might give birth to a child with Down syndrome is not transgressing
the mitzvah of “in the evening do not desist” since he is afraid, and
nowadays this is something that people fear. Granted, had he not yet
fulfilled the mitzvah of procreation he would be obligated to do so
despite concerns about the birth of a child with Down syndrome but
when they have already fulfilled this mitzvah but are concerned about
fulfilling the mitzvah of “in the evening do not desist,” since people are
generally nervous and fearful of having handicapped children at this
age one cannot compel them to have children.

See also the Igros Moshe (Even Ha’ezer, 1, 73,3) who discusses the
case of a couple who had fulfilled the mitzvah of procreation by hav-
ing one son and one daughter and they wanted to have more children.
Their question was should they seek medical advice?

He responded: Unless they know that either one of them suffers
from some disease which causes infertility, they can assume that they
are not sick, rather Hakadosh baruch Hu does not desire to give
them more children and has given them sufficient offspring for them
to fulfill the mitzvah of procreation and no more. Infertility is not a
punishment. Just as there are people to whom Hakadosh baruch Hu
has given just enough money for their needs and no more, so it is
with children. However, they ought to pray to Hashem yisbarach that
He bestow additional sons and daughters on them. Although one
perhaps ought not to pray for more money, when it comes to praying
for more sons and daughters, who are created naturally through the

8. See earlier, siman 226 for the ruling that arises from this in regard to ‘Fitting a
Diaphragm for Contraception without the Husband’s Knowledge.’

Avoidance of Genetic Disease through In Vitro Fertilization 2 89