The season of Simcha is in full swing at Tahareinu and throughout Klal Yisrael…
We welcome you once again to our environs, where innovation and education are the hallmarks of our work.
Please enjoy these updates on our recent whirlwind trip to the New York area, as well as several key highlights on the vital topic of RPL (recurrent pregnancy loss).
A Freilichen Purim to our 20,000 loyal readers!
May we only know Simcha and Shalom the world over.
IN-HOUSE TAHAREINU CONFERENCE ON RPL
In addition to the many conferences Rabbi Melber attends, we also hold periodic in-house trainings for our 60 Tahareinu advisors with experts on various topics of women’s health.
Professor Asher Bashiri, head of International Society of RPL and professor at Soroka Medical Center in Israel, presented these new updates:
The Israeli Society of Gynecology recently published guidelines for a workup for RPL, which are very much in line with those of ESHRE in Europe and ASRM in the US.
In the past, RPL was not a sufficiently explored topic, and every doctor would use his/her own discretion in treating it. Now, more and more countries create a standard protocol for both testing and treatment of RPL.
Rabbi Melber specifically asked the professor about his approach to DFI (DNA Fragmentation Index) in relation to RPL. His response was that since the first-line treatment for DFI is vitamins, he recommends that every male take the vitamins outlined below while doing the full workup for the female.
Because of the sensitivity in Halacha for the DFI test, especially after only two miscarriages, this approach is simpler. Of course, if the case emerges as more complicated, a Rav should be asked whether the DFI can be checked.
Daily Vitamin regiment for DFI:
Vitamin C: 500 mg
Vitamin E: 400 units
Q10: 100 mg
Zinc: 50 mg
Omega 3: 1 capsule
Professor Bashiri has also been approved by the government of Israel to research a new treatment for RPL involving the combination of Prednisone with HCQ.
Other important RPL highlights:
- It is crucial to investigate RPL with a dedicated RPL clinic, or at the minimum a sub-specialist in RPL. People often grapple with the question: which doctor should they see after several losses? Now that the awareness of RPL is thankfully becoming more widespread, hospitals should have a sub-unit devoted to RPL, not under the general OB/GYN specialty. Just as it is widely understood that one doesn’t see a standard OB/GYN for genetic issues, a similar concept applies to RPL. That said, although in Israel, Canada, and the UK, excellent RPL clinics are available, the same cannot be said for the US (other than in Illinois and California.) In New York for example, the only clinic would be Columbia, and it can take between 6 and 12 months to get an appointment! Therefore, Tahareinu recommends for people in the tristate area to educate themselves about the standard workup and try to reach out to local experts; often, they can perform the testing protocol which is a solid starting point.
- IVF is often not the correct go-to solution. In fact, in too many cases that Rabbi Melber has investigated, IVF would not even be effective due to the factors causing the RPL! Because many couples go directly to fertility specialists, they are being coaxed to try IVF without the proper workup beforehand (see below.)
- We can now reach 60%-90% explained RPL with the proper workup. Once the cause is determined, there are often several resources (such as medication or procedures) that don’t involve IVF in 95% of cases! Obviously, it is preferable to avoid this expensive and aggressive treatment whenever possible.
- Chemical pregnancies should be also included in the tally of RPL. Although some doctors have published other opinions, Professor Bashiri feels that a chemical pregnancy is counted in the 2-3 pregnancy minimum for RPL.
- Even couples who have several children should perform the workup. Since many of these factors are dynamic, a couple that wants a larger family but is experiencing losses should follow the protocol to investigate potential issues.
- The entire workup should be done in a parallel fashion, so multiple issues can be detected simultaneously. If one test is done at a time, one issue may be remedied while another lies undetected. Tahareinu also recommends that after a few miscarriages without children, a couple should obtain a heter to check out the male. But even if that is denied, the female should do the entire workup at once.
Areas of investigation for RPL workup:
- Lifestyle: If the patient is overweight, a healthier diet should be implemented. Even a slight improvement in BMI can enhance pregnancy quality significantly.
- Vitamin D: A deficiency is fairly common and easily remedied.
- Genetics of couple and genetics of products of conception
- Hormonal/Genetics: Such as thyroid disorders, TSH Prolactin, HbA1C. An example would be a TSH (thyroid stimulating hormone) of 3.5, which an endocrinologist would consider acceptable in general, but from a miscarriage perspective could potentially be harmful, and should ideally be brought down to can already cause miscarriage, need to bring down to 2.5.
- Coagulation/clotting issues: Until a decade ago, doctors would recommend treating everyone for clotting problems (via injections or medication) on the chance that they are present. Today we know that that can actually cause harm. Instead, we do a detailed workup in this area.
- Anatomy: It is vital to check for abnormal growths (fibroids, polyps, adhesions), malformations of the uterus, and blockages.
- Infections such as chronic endometritis can cause RPL.
- Male factor causes such as DFI should be tested for as mentioned above.
- An additional area that, although not included in the general guidelines, should be investigated after 3 or more miscarriages, is auto-immune testing.
TREATMENT FOR RPL:
The treatment for recurrent (more than two) miscarriages is both complex and very individual. Couples are welcome to call the Tahareinu hotline for details, or reach out directly to Rabbi Melber to schedule an individual consultation.
Rabbi Melber questioned Professor Bashiri whether there is any research to support alternative healing options as an effective course of treatment for RPL, to which he responded in the negative.
If a woman finds that an alternative treatment (i.e. acupuncture) lowers her stress level, that can positively impact her outcomes. But these should never be considered a viable replacement for medical treatment.
It is truly a shame to find couples spending enormous sums of money on vitamins and alternative treatments that have no proven record of success.
Tahareinu is here to help you explore the proper medical paths to a successful outcome with Hashem’s help.
RABBI MELBER VISITS THE NEW YORK AREA, FOCUSES ON CASE MANAGEMENT
Last week, Rabbi Melber visited the New York area, and for the first time, the trip focused solely on meeting couples – no doctors, education, or fundraising. The entire week was spent meeting couples, from morning until night. Meeting with tens of couples struggling with infertility and miscarriages, in the Five Towns, Monsey, Monroe, Williamsburg, and Boro Park.
Now, Rabbi Melber continues his close monitoring of each of these cases, procuring additional information and making new recommendations where necessary. Baruch Hashem, the positive feedback and gratitude has been tremendous.
In the wake of our successful Kinderlach campaign, meeting couples around the world in person has become a renewed focus at Tahareinu. We have been to London and New York, with more trips in the offing. Rabbi Melber very much values the ability to provide the latest medical innovations along with the emotional support and requisite Halachic guidance.
Couples who would like an individual consultation and case management should reach out directly to Rabbi
They can leave a message and he will happily return
Again, we wish you only Simcha in this joyous season! A Freilichen Purim from the Tahareinu family to yours!
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