BS”D
Dear Friends,
As the month of connection and growth progresses, it is our privilege to share with you the latest discoveries and advancements at Tahareinu.
With gratitude to Hashem, we can report much progress and growth as well as tremendous feedback from our audience and clients.
Rabbi Melber has recently concluded our 10-week course for Tahara professionals, with close to 200 participants. The change they are bringing to their communities with their newfound arsenal of knowledge cannot be overstated.
We look forward to another year in which we serve you every day, researching and sharing the absolute best of women’s health and Tahara.
Kesiva V’chasima Tova!
Rabbi Yitzchok and Chaya Melber
Tahareinu Founders
Spotlight on RPL (Recurrent Pregnancy Loss):
At the recent conference focusing on RPL, Professor Howard Carp of Tel Hashomer Hospital stressed one take-home message:
Pregnancy loss is by no means a one-size-fits-all area of medicine. Although evidence-based treatment has its place, the importance of examining and treating couples on an individual basis is especially crucial here.
Rabbi Melber reports a recent case where a woman had suffered repeated miscarriages before reaching out to Tahareinu. Upon speaking to Rabbi Melber, she learned that her options had been limited by lack of knowledge.
The good news is that RPL often does not need to be treated by IVF. The challenge, of course, is charting the correct path for treatment.
Should we use IVF to avoid miscarriage?
The Pros: We can use PGTA genetic testing to choose the best cells, thereby allowing the greatest chance of a successful pregnancy.
The Cons: When the mother is younger than 35, most embryos will have the ability to self-correct, and we can leave it up to nature to do that and avoid the expense, discomfort, and inconvenience of IVF.
The resolution: Although official guidelines worldwide advise against going this route, most clinics, particularly in New York and New Jersey, will offer this option.
However, couples should be aware that IVF is not the go-to solution for preventing RPL. Each couple should have a complete workup done, and then a unique medical path charted, and only turn to IVF once other avenues have been exhausted. As always, we invite couples to reach out to Tahareinu hotline or schedule a private consultation with Rabbi Melber.
Testing a couple’s Karyotype
In some couples who have recurrent miscarriages, the problem may be some sort of chromosome abnormality in one or both partners. A genetic test called a karyotype can be used to confirm if this is the case.
In the case where one spouse has a Balanced Translocation, where one part of a chromosome breaks off and attaches to another location, 50-60% of their pregnancies will end in miscarriage. In that case, the couple can choose the IVF/PGTA route and save themselves the nail-biting uncertainty.
This also improves their emotional well-being, with the knowledge that the losses were not their fault and there is a solid genetic reason.
Coming soon – NIPT testing: Genetic testing of the fetus through a simple blood test!
Though it might sound like science-fiction, this incredible technology is likely coming around the bend, and soon. In about a year, experts are predicting the ability to test the genetics of a fetus by drawing blood from the mother during pregnancy. This will inform many decisions in the eventuality that the pregnancy is lost
Professor Simcha Yagel cracks the mystery:
Why do first pregnancies result in losses more often than subsequent ones?
A study by this award-winning Hadassah Medical Center Director of OB/GYN reveals that “natural killer cells,” renowned for being able to destroy tumors, also produce helpful proteins in the uterus.
In second pregnancies, these cells protect the embryo, ensure its development, and then remember this important role for the next pregnancy.
This is why after one initial loss couples are not advised to begin doing a workup; only after repeat losses.
Progesterone treatment for RPL: The controversy
Although progesterone treatment is obviously not a panacea for every woman suffering from RPL, it certainly can’t hurt.
In the past couple years, data has been published to indicate that women who only took progesterone without investigating other factors did have better outcomes.
A few ways to make this treatment more effective:
1. Timing: Some believe it is better to start as soon as the woman ovulates instead of waiting for pregnancy to occur.
2. Form: In the United States as well as other countries, the progesterone needs to be taken as a vaginal suppository called micronized progesterone. In some countries, it is better taken as a pill, so do your research.
3. Dosage: Some will only give 400 mg per day, but other believe that double that dosage will be more effective. It should be used for the first three months of pregnancy.
This is a safe and basic solution everyone can use for unexplained pregnancy loss.
New solution for women with PCOS:
In order to prevent RPL, these patients should be taking Metformin for at least the first trimester, and sometimes longer.
Other solutions: Hysteroscopy and 3D
Ultrasound
As new research evolves about the importance of the shape of the uterus and growths within it, women are encouraged to explore this avenue as well. Because endoscopic gynecology is so advanced, it is now simple to see treat issues such as polyps and septum, which can contribute to miscarriage.
Conference on
Menopause:
Takeaways
At this conference, Rabbi Melber heard from experts who shed light on several important aspects of this often mystifying stage of life.
PCS in women age
40-50:
Many women who had never suffered from PMS can suddenly find themselves with severe mood swings and worse. The accepted solution worldwide is a high dosage (20 mg) of Vitex Agnus Castus. Other solution would include SSRI medication or using hormonal contraception to regulate moods.
Remember: You don’t
have to “just live with it.”
Although menopause
symptoms hit over 60% of
women, over 90% will never go for help. And that’s regretful, because their symptoms can affect their own lives and those around them severely.
Many women in this age
bracket are at the peak of their family lives and careers, and their emotional and physical imbalance hampers their advancement. There are solutions out there; reach out and employ the best one for your needs.
MHT (Menopause Hormonal Treatment) – when it doesn’t
work anymore
Some women get frustrated when they use hormonal treatment and then
the effectiveness wears off.
Some points to consider:
- There are over 50 medications and various dosages; it will take time to find the
right match. - If it has been working and then stops, consider stopping for a month and restarting or continuing at a higher dose. If that doesn’t help, you many need to switch meds.
Sometimes, women experience unpleasant side effects from MHT. Since most women are ingesting a combination of esterogen and progesterone, but the main actor is the estrogen, she can experiment with different types of progesterone until she finds one that doesn’t bother her.
For women with medical conditions, it is important to research which combinations are safe on the American College of Cardiology website. However, always consult an expert even when the basic guidelines recommend against specific usages.
TAHAREINU NEWS HIGHLIGHTS:
This summer season has
been incredibly busy for the Tahareinu team. The number of calls to our hotline keeps increasing, and Baruch Hashem we were able to meet the demand efficiently and expertly.
For the first time, in the past couple of months most of our calls have been coming from the US. The American hotline is now the most popular of our 13 hotlines servicing the entire Jewish world
We’ve just concluded another cohort of our course for Tahara professionals. We now have over 500 trained experts in the US sending patients, students, and couples to Tahareinu with issues ranging from simple to complex.
Over 75% of our calls are related to Tahareinu’s #1 specialty, Taharas Hamishpacha struggles. We are pleased and proud to be the community’s address for this pivotal realm of Jewish life.
Tahareinu will be moving to our new and expanded offices next month, where our staff will be even more equipped to service your needs.
A new cohort of Tahareinu advisors is graduated to stage II of their training, where they will be observing experienced staff in the Tahareinu offices. With our hotline hitting 4k calls per month, we are looking forward to employing these additional 17 members shortly.
We hope you find this content informative, and as always, we
encourage you to reach out to us directly with any Taharas
Hamishpacha, women’s health, or infertility challenges.
That’s why we’re here!
Got a question about relieving tahara problems, infertility, reproductive health, pain or other related issues?
call the Tahareinu hotline
Call the Tahareinu Hotline!
For ongoing infertility, recurrent pregnancy loss, or reproductive genetic issues,
you and your spouse are warmly invited to schedule an in-person, phone or Zoom consultation with our founder and president, Rabbi Yitzchok Melber.
Please send an email to rabbimelber@tahareinu.com Include your first name and location, and briefly describe your issue.
Personal consultations are for more involved reproductive issues. Note the Israel
office has reopened for in-person consultations, in line with the country’s coronavirus status.
IMPORTANT
Most Tahareinu issues are addressed by our hotline advisors, 13 hours a day, 5 days a week. If you are unsure whether to schedule a consultation, call the hotline first.
