The global non-invasive prenatal testing (NIPT) market is expected to grow from $2.3 billion in 2018 to $6.1 billion by 2023, at a compound annual growth rate of 21.1%. NIPT is among the most widely used techniques for detecting genetic disorders in the fetal stage, and advancements in technology are a frequent occurrence as vendors are pushing new product launches, product approvals, and appeals to end-users.
Prenatal genetic tests such as Amniocentesis are both invasive and dangerous and are performed between the 15th and 20th week of pregnancy. Performing this test earlier may result in fetal injury. With ultrasound guidance, a needle is inserted into the abdomen at an angle through the muscle, into the uterus, and the amniotic cavity. Women who choose to have this test are usually at increased risk for genetic and chromosomal problems. The test is invasive and carries a risk of miscarriage. Amniocentesis can be used for prenatal sex discernment—meaning parents opting to abort if they don’t have a boy, which is why the procedure is legally restricted.
Recently, NIPT has been available in the first trimester. This genetic screening works by analyzing the small amount of cell-free DNA (cfDNA) from the fetus that can be found in the mother’s blood. This testing is accurate in detecting common chromosomal abnormalities and it is noninvasive. So, win-win?
Among the poskim, many are strict in prohibiting abortion even if it is discovered that the fetus suffers from a serious illness, and so many rule against performing any tests—invasive or otherwise—to find out the condition of the fetus, because even if it turns out that the fetus is genetically compromised, they do not permit abortion. And so, from their point of view, it would be better to trust God than to worry about problems that have no solution.
Rabbi Moshe Feinstein, for instance, rules (Igrot Moshe Choshen U’Mishpat, Chelek B, Siman 71) that “in general, one should know that the examination done by the doctors who will be determine based on their examination that the fetus is deformed is only an estimate and a hypothesis, and they are not reliable in these cases, because even if it is such a fetus it is forbidden to abort.” And here the ultimate Lithuanian posek Rav Moshe goes mystical, saying, “Generally, we should know that everything comes from Heaven and it is not acceptable to be clever to escape fate God forbid, through the inciting arguments of the doctors. Because God has many emissaries, which is why we should accept with love everything that God does, and then, thanks to this and our trust in Him and our pleas to Him, He will bless the woman who will give birth to a wholesome child who will remain healthy for many years.”
Interestingly, Rabbi Shlomo Aviner, who is not known as a liberal posek on many social issues, encourages a genetic examination when the doctors recommend it. In a psak Rabbi Aviner published in the Daat website (בדיקות טרום-לידה), he says: “It is a good idea to perform this test. After all, if the test result is negative, the pregnancy will continue in a state of relaxation and peace of mind for the benefit of the mother and perhaps also for the benefit of the fetus; and if, God forbid, the result is positive, it would be possible to ask a Rav if in such a case an abortion is allowed. If he rules that abortion is permitted, since there are cases in which abortions are permitted, and abortions are performed according to the rulings of substantial poskim, then the parents can consider their options responsibly and decide what they want. And should they decide to keep the fetus, it would be of their own free will and they would receive the child at birth with wholehearted love and raise it with wholehearted love.”
“As for man’s alleged intervention in God’s actions, there is no intervention here, and everything is the light of God that shines through the scientific mind of man, acting in the ways permitted by the word of God as it was revealed by Moses. Otherwise, all medicine and all science, in general, are wrong,” concluded Rabbi Aviner.
Rabbi Yuval Cherlow also supports Amniocentesis (בדיקת מי שפיר באור ההלכה), and so it stands to reason that he would also support non-invasive alternatives. He, too, recommends asking a Rabbi in case the results are positive, God forbid. In fact, some of the halachic publications, such as Hidabrut (בדיקת מי שפיר: מזהה פגמים או מייצרת אותם), oppose Amniocentesis citing cases when the test harmed the pregnancy when the fetuses were healthy. Arguably, they should not object to non-invasive methods of testing the genetic well-being of the fetus.
