BS”D
Dear Friends,
The beautiful spring weather speaks of renewal and rejuvenation, and at Tahareinu we are constantly in a state of innovation as well.
At this month’s conferences, new information was unveiled by expert from across the globe, and we are pleased to share them with you below.
We are also very excited to announce the opening of another cohort of our acclaimed Tahareinu course for professionals! Stay tuned for details, or reach out with any questions.
Thank you,
Yitzchok Melber
SAVE THE DATES FOR THESE UPCOMING EVENTS!
Monday: Brooklyn (men only)
Time: 7:45 – 9:00 PM – R’ Melber will be speaking (English)
8:45 – 9:30 PM Dr. Michael Werner, Urologist & Intimacy/Fertility Specialist (English)
9:45 – 10:45 PM R’ Melber will be speaking (Yiddish)
Where: Beis Medrash Bircas Avraham – 1319 50th Street, Brooklyn, NY
Light refreshments will be served
Tuesday: Lakewood (men only)
Time: 12:00 – 1:30
Rabbi Melber will be speaking
Where: Esther Gerber Hall – 590 Madison Ave, Lakewood, NJ 08701
Lunch will be served
If you are interested in a recording, please email office@tahareinu.com
RABBI MELBER ATTENDS ASPIRE CONFERENCE
This several-day conference offered an intense gamut of updates in several key areas of reproduction:
1. Miscarriages:
Siobhan Quenby, Professor of Obstetrics at University of Warwick in the UK, shared an impressive new workup for recurrent pregnancy loss.
At Tahareinu, we were very gratified to see that the workup we have been developing is right in line with her vision.
The core differentiator in this workup is to divide it into several models, with each being applied after an increasing number of pregnancy losses. The first is the public model, or what the government will cover, and includes only the most basic testing. Model 2 is the graded model, which ideally should be applied after just one loss. After more than one loss, model 3 should be applied, which includes more intensive investigation such as thyroid testing.
Of course, because there are so many multi-factured causes involved in miscarriages, each case should be individually evaluated. (Of course, our team at Tahareinu can help with that.) Location is also a factor, because in Israel, for example, almost all testing is covered whereas in the States and UK the testing can run about 10,000 dollars or pounds!
But the minimal investigation that the government recommends should definitely not be the yardstick by which medical societies should perform.
As Professor Quenby concluded, “The future is personalized.”
2. Another point this professor stressed,
which we have been positing for a long time, is that progesterone prevents miscarriage. In England, they were big fighters against it for all the years, publishing numerous studies showing that it doesn’t help. Now Professor Quenby strongly recommended that everyone should take it, explaining that the data in her country’s studies wasn’t proper.
She suggested taking 400 mg of micronized progesterone 400 mg from ovulation until 16 weeks of pregnancy. In general, we recommend until 12 weeks, but people should know there is research to prove it’s recommended until 16, with some even giving it until week 22 or 25 depending on the number of miscarriages and the existence of bleeding.
Research shows that progesterone prevents miscarriage in 15% of cases.
3. Preservation
Professor Richard Anderson, Professor of Clinical Reproductive Science at University of Edinburgh in UK shared several conclusions on this topic. Preservation should be considered in young patients, including women and girls who don’t yet have eggs, or are ill and have no time to get regular preservation. The solution is to freeze a piece of or a whole ovary, and then put it back later in life. The ESHRE has already released guidelines for this procedure, so it is no longer considered experimental. It is important to note that often the number of eggs a woman has can be misleading, since unfortunately most eggs will not lead to a live birth. On average, one needs eleven eggs per child, with that number increasing
with a woman’s age.
This solution applies to non-cancer causes as well, such as POI or Turner’s Syndrome, a genetic issue which causes a girl to lose all her eggs by the age of 18.
The professor cited a paper that showed successful live births are this form of cryopreservation.
4. Genetic issues in sperm:
Professor Thomas Masterson of University of Miami, spoke about the idea of checking genetic problems with sperm after miscarriage. We’ve mentioned several times the importance of testing DFI (DNA Fragmentation Index), but most men don’t check for genetic problems in the sperm.
This testing reveals the advent of aneuploidy (the occurrence of one or more extra or missing chromosomes leading to an unbalanced chromosome complement).
When do we suspect this abnormality? After persistent RPL or IVF failure.
Although there are not so many treatments for this issue, it can be managed via IVF with PGT.
5. Eran Kassif, Director of Ultrasound in Sheba
Medical Center,
raised the debate surrounding TKUC (True Knot of Umbilical Cord), which occurs in 1% of pregnancies.
He strongly opined that this must be checked and corrected, because it increases the risk of stillbirth tenfold. Because this only becomes a danger after 37 weeks, if it is discovered earlier (between weeks 18-22) the baby can simply be delivered before 37 weeks.
RABBI MELBER ATTENDS ISRAELI CONFERENCE OF GYNECOLOGY
One important update at this conference concerned egg banking for healthy unmarried girls at the age of 30. Assuming most girls and women want at least 2 live births, depending on their age, this is the recommended route.
Professor Frank Loewen also presented on obesity in pregnancy, showing how it changes the whole pregnancy.
RABBI MELBER ATTENDS FIFTH ONLINE IVF
CONFERENCE
This international conference attracts over 10,000 doctors worldwide.
In most clinics, they offer PGTA with any IVF package – and push it. They present is as part of the protocol, and tell couples they will lose out if they don’t do it.
Professor Norbert Glycher, Founder & Medical Director at Center for Human Reproduction in New York, recommended against it. He cited an example of a transfer he performed with allegedly damaged genetics, which then developed into a healthy child. This proves the concept of self-correction, or possibly false test results.
Another topic covered by Professor Kyle Orwig of Pittsburg was the removal of male tissue, which is later replaced and successfully produces sperm. In fact, Hadassa Hospital in Israel has sent boys to Professor Orwig for this procedure.
Professor Amander Clark is the #1 expert in the US on the upcoming much anticipated IVG innovation. This will allow males without sperm and females without eggs to produce them from skin or other cells. She presented on updates in this area, while making it clear that this treatment is still in the experimental stages.
EXCITING NEWS!
Our course for professionals will be opening again soon! If you are a Kallah teacher, Chosson Rebbe, doctor, Rav, or other professional, look out for updates coming to your inbox!
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.