I've kept my infertility struggles and IUI pregnancy secret as an Orthodox Jewish woman. Here's why.

• An Orthodox Jewish woman has three children conceived with medical intervention.
• She and her husband consulted their rabbi before doing an insemination.

This as-told-to essay is based on a conversation with an Orthodox Jewish mother who asked to remain anonymous to respect her family's privacy. It has been edited for length and clarity.

My husband and I essentially had an arranged marriage. When we were considering, with our families, whether we would be a good fit I had to tell my husband about a chronic health condition that I have. He had to decide whether or not he wanted to take that on.

While I was upfront about one health condition I kept my diagnosis of polycystic ovarian syndrome (PCOS) a secret. I figured it was a woman's issue, and I was sure I'd still be able to have kids one day, so I didn't feel like I had to disclose.

We got married at 21 and at first I was on birth control. But when we started trying to conceive I noticed that I had irregular periods. I figured there was no sense waiting around to see if we would conceive — I knew we'd likely need help. But that was complicated by the fact that we are Orthodox Jews.

I looked for a doctor who was familiar with Orthodox patients

I wanted a doctor who could treat infertility while also honoring our religious customs. So, I reached out to an organization that gives referrals for doctors who are familiar with the Orthodox community. I connected with Dr. Ilana Ressler, a reproductive endocrinologist who is Jewish herself and is familiar with Orthodox culture.

I started on fertility medications to stimulate ovulation. Since I don't like needles, taking shots was difficult, especially because I wasn't talking about my health with any friends or family. Luckily, we got pregnant on our third cycle of timed intercourse. I was 23.

Looking back, I had it easy the first time. When my child was about a year old I started thinking about another. I knew I wanted to have my kids close together. We went back to Dr. Ressler, but right away we could tell that the medications weren't working as well this time. She suggested we move on to an IUI, or intrauterine insemination.

That presented a challenge. In our understanding of Jewish law, a man is only supposed to ejaculate inside his wife. Giving a sperm sample for insemination might break our religious laws, we worried.

Dr. Ressler was very understanding. She told us we could continue to try timed intercourse. She also gave us the number of a rabbi who could discuss the implications of an IUI. Ultimately, we spoke with our own rabbi, who told us to go ahead with the procedure. I got pregnant with twins.

The decision to keep quiet is about privacy, not shame

The Orthodox community is incredibly small. Everyone knows everyone and all the nitty-gritty details of their lives. That's part of the reason that my husband and I decided not to tell anyone we used assisted reproduction. I'm not ashamed, but we felt that this was our private information.

My husband was also worried that our kids might face a stigma because they were conceived with the help of a doctor. He worried that when it was time for them to marry, people might worry about their own fertility. I thought that was nonsense, but I honored his concern.

And so, we've kept quiet. Even my mom asked if the twins were conceived naturally. I told her yes.

I realize this might be hard for outsiders to understand

I see the Orthodox community in all its complexity: the good, the bad, and the ugly. If I were deciding on my own, I would likely speak out about using assisted reproduction. In fact, that's part of the reason I did this interview. I've always been a bit of a rebel.

But I also understand why people in my community choose to keep secrets. Often, I think that decision is more based on privacy, not shame. We're a community that values modesty, so talking openly about reproduction can be tricky. Despite the secrecy, I don't think that the Orthodox community has a taboo about assisted reproduction — we just tend to keep quiet about it.

Ultimately what matters is that I have my children. I don't want people to look at them and think about what their father and I had to go through to get them here. I want them to look at my three beautiful children and think "what a blessing." Because that's exactly what they are.