Shvat 5782 / January 2022

Jan 4, 2022 | new newsletters | 0 comments

BS”D

Dear Friend,

Though the trees are bare and the gusty winds blow, here at Tahareinu we feel warmth, connection, and hope.

Coming off a positively electric annual campaign, we are inspired by your participation, your encouragement, and your championship of the Tahareinu camp.

With your help and the help of Hashem, we reached and exceeded our goal of $1.5 million, which will go directly to expand Tahareinu’s services and bring even more couples closer to their goals of unity and fertility.

To that end, stay tuned for exciting developments – and as always, we are here for you with support, guidance, and the absolute latest information on all things OB/GYN, Tahara, and fertility.

Wishing you a safe, warm, and healthy winter,

Yitzchok Melber

look back at 2021: Medical updates and highlights

In recent weeks, Rabbi Melber has delivered a lecture on the key medicaldevelopments of 2021 in fertility, recurrent pregnancy loss, Tahara,contraception, and pregnancy/postpartum in seven different places, both inperson and virtually.

Key Updates & Innovations in 2021:

1.  PCOS Medications – The Old, the New and the Recommended:

For women that are overweight and have irregular cycles, (not ovulating), the first line of medical advice is to reduce body weight by 5%. This reduction in weight will help with natural ovulation and enhance the efficacy of PCOS medications.

For a long time, the go-to medication for PCOS, as well as diabetes & weight loss has been Metformin (pill), though Metformin did not prove (that) successful for many people. In the last year an effective but relatively expensive drug effective in treating PCOS in overweight women, called Wegovee, was approved by the FDA. Wegovee, while effective at both controlling weight-loss and more effectively producing regular cycles, is considerably more expensive (then Metformin), and is not available globally.

I would like to recommend Ozempic, a diabetes related medication that has proven effective at managing weight-loss and producing regular ovulation. Ozempic is globally approved, more affordable, and more readily available than Wegovee.

Both of these drugs are a weekly injection; there is an additional option, Saxenda, which is a daily injection, readily available (and is completely covered in Israel).

2. AMH (Anti-Müllerian Hormone) indicator for PCOS/POI

PRP treatment used successfully to improve AMH

As we’ve mentioned in the past, Platelet-Rich Plasma (PRP) has been shown to improve Anti-müllerian Hormone (AMH), which in turn greatly enhances fertilization. It has been used successfully in the RMA New Jersey clinic, and more recently in Nahariya, Israel.

3. Focus on DNA Fragmentation Index (DFI) as cause for miscarriages

Although a certain percentage of miscarriages will inevitably be classified as unexplained, the goal in the fertility community is obviously to keep that number at the lowest fraction possible. One major development in this area has been testing the DFI of the father, which has been found to be a fairly common genetic   cause   of   miscarriages   and   even   stillbirths.

4. Contraception: Slynd is the mini-pill of Choice

Tahareinu has been recommending the Slynd mini-pill across the board as the best option, whether a mini-pill is being used because the woman is nursing or because she cannot tolerate estrogen. This brand is ideal for postpartum women for both Tahara and emotional reasons. Firstly, there is much less staining on the Slynd as opposed to other mini-pills because of the high progesterone content.

In addition, the specific type of progesterone is similar to the Yaz combination pill, which has been proven to improve emotional well-being. Other mini-pills are known to cause anxiety or even depression, but the Slynd can be a life changer for those suffering from PPD or even borderline depression, especially those who are reluctant to use psychiatric medications. The Slynd can even be prescribed by a general practitioner, and is a great first-line option.

5.  New medication for Hyperemesis Gravidarum (HG):

A new drug for hyperemesis gravidarum (HG) approved in Israel, Bonjesta has been available in the US for two years, and has now been brought to Israel. Similar to the original Diclectin, this is a slow-release drug that can be taken once a day to stave off nausea symptoms.

6. IVG vs. IVF

In a development that is taking the infertility universe by a storm, IVG (in vitro gametogenesis) is set to be trialed and approved for widespread use within the next few years. This innovation is both unique in its method as well as its application, and will have mammoth ramifications on the entire infertility landscape. It promises to be a more cost-effective and more successful approach than IVF.

7. Contraception: Phexxi gel

This innovative non-hormonal contraception is a gel that is inserted into the vagina before intercourse, but is not a Halachically problematic spermicide.

Shovavim Spotlight:

Five practical Tahara pointers every couple should know

If a woman is staining at the end of a cycle or in middle of the seven clean days, there are several solutions:

First-line solutions:

1.Bioflavanoids

She should take3000 mg a dayfrom the first dayof the cycle untilafter she goes to the Mikvah.

2.Advil/Ibuprofen

There is official research- based  evidence  by  the  CDC that taking 200 mg of Ibuprofen 3 times a day will decrease the blood flow. She should start on day 2 of the cycle and continue for five days.

3.Lysteda

For heavy periods (not only light staining) that continue past the initial 5 days, she should take this prescription drug for 5 days, 2 doses 3 times a day.

Medical interventions:

  1. Hysteroscopy

In addition to using vitamins andbasic medications, if the problempersists it’s prudent to investigatefurther, particularly after birth ormiscarriage or for women over 30who have a higher likelihood ofpolyps and fibroids. Ahysteroscopy is relatively simpleprocedure that can both detectand treat minor issuesimmediately.

2. PALM-COEIN

Consistent irregular bleeding or staining can be the result of over 25 medical causes, and should not simply be chalked up to a Makka/wound in the vagina or cervix. Abnormal uterine bleeding (AUB) is a medically recognized condition, and the PALM-COEIN  classification  is  used  to determine the severity and treatment plan.

Of course, we are available at Tahareinu to explain the intricacies of this system if the need arises.

THANK YOU FOR A SUCCESSFUL CAMPAIGN!

Coming off our incredibly successful Kinderlach campaign, we are both humbled and inspired by your avid participation and support!

We especially want to extend our heartfelt thank you to:

OUR RAISERS:

Over 500 dedicated individuals took ambitious goals upon themselves, and worked tirelessly to reach them! Many of you mentioned your appreciation for this newsletter. From professionals to laymen, from Australia to Los Angeles, you rallied for our cause and we are so touched by your kinship

OUR CAMPAIGN ACTIVISTS:

Our campaign managers and activists (you know who you are!)worked for months to ensure a successful campaign. Throughout theworld, these leaders raised awareness, spread the word aboutTahareinu’s impact, and created a force of unity and kindness in KlalYisroel.  Kudos!

OUR DONORS:

Of course, the real heroes – to the tune of 9,000 donors! On behalf ofevery grateful couple and every relieved woman, we thank you toeach one of you.

Please encourage your friends, family, and contacts to sign up to this enlightening newsletter! We currently have almost 20,000 subscribers, and we hope to double that number in 2022.

Copy this link and spread the word!

Other Tahareinu news:

Tahareinu  advisors  met for our monthly  training,  and were treated to a lecture by Dr. Yaakov Bentov of Hadassa fertility clinic, an endocrinologist and fertility specialist who recently made Aliyah from Toronto.

He focused on the advantages of Letrozole vs. Clomid to increase a woman’s ovulation. He was involved in the development of Letrozole, a more recently introduced drug, in Canada, and it is now approved by the FDA as well. It is preferable, he explained, because it doesn’t cause a thinning of the uterine lining like Clomid does, which can prevent implantation even if ovulation occurs.

Rabbi  and  Mrs.  Melber were in America  this month  for the duration of the campaign, and used the time to both extend their medical network and meet with more couples in person.

In Monroe, they met with Yoel Mittelman of Ezras Cholim Medical Center, and discussed ways in which they can work together to serve the Monroe community better.

Rabbi Melber also met with community leaders in the Five Towns and Queens to expand Tahareinu’s services in those cities.

Many new couples have been added to the Tahareinu case management roster, and we look forward to sharing in their good news in the near future!


Got a question about relieving tahara problems, infertility, reproductive health, pain or other related issues?

call the Tahareinu hotline

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.



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