As the chill sets in and we get ready to hunker down for the winter ahead, we are excited to share where we’ve been, what we are doing, and what lies ahead.
As always, there is so much happening simultaneously at Tahareinu: Travels, discoveries, new connections formed and existing ones cemented.
Thank you for your interest and support!
Wishing you a happy and healthy winter,
Rabbi Yitzchok Melber
Inaugural Visit, Innovative Solutions:
Tahareinu in LA
In October, the LA community was privileged to welcome Rabbi Melber for what proved to be a tremendously beneficial visit.
Rabbi Melber flew to California to attend the ASRM (American Society of Reproductive Medicine) Conference, and then made himself accessible for hours each day for the Jewish community.
A dozen couples availed themselves of the valuable opportunity to meet with Rabbi Melber in-person. These consultations lead to expert continuous case management, with Tahareinu advising them at every juncture.
He also cemented connections with the local doctors, including Dr. Michael Feinman of HRC Fertility Clinic and Dr. Peyman Banooni, a specialist in OB/GYN, fertility, and endoscopic gynecology.
Rabbi Melber was grateful to meet with Harav Gershon Bess Shlita to discuss medical updates in various areas of women’s health, as well as present Shailos in the Halachos of Refuah. In the Pico neighborhood, he had the opportunity to meet Rabbi Yitzchok Summers Shlita, who thanked Rabbi Melber profusely for his intensive efforts to benefit his Kehilla and the entire LA community.
This visit achieved its purpose of spreading awareness and solutions particularly in the areas of infertility, miscarriage, and genetics. It was a Zechus for both Tahareinu and the LA community to initiate this rapport, and with Hashem’s help it marks the beginning of an auspicious relationship with the local families and medical providers.
ASRM Conference: Focus on genetic innovation
At this year’s ASRM (American Society of Reproductive Medicine) Conference, there was substantial discussion about the evolution of the fascinating field of genetics.
This has understandably become a huge area in reproductive medicine, and has earned its place as part of both workup and treatments.
In the future, this research promises to help eradicate fertility challenges with successful gene editing. This is a uniquely dynamic field, with continuously increased knowledge as well as increasingly modern technology. Though it can seem overwhelming and foreign to many, it is incredibly valuable and worthy of investment.
GENETIC TESTING OF PARENTS AND RPL
This lecture by Dr. Mak from Houston focused on full thrombophilia (clotting).
In the official guidelines of ASRM, we only need to check for a basic level of clotting, but not delve into genetics. He claims that this is outdated; we should change common practice in order to prevent miscarriages by checking for genetic thrombophilia. He presented data from the States and around the world to support his position.
Some people assume they checked basic genetic testing before the wedding. Genetics is a huge field; Dor Yesharim does not cover these areas.
3 Names of genes we should check for:
Protein S deficiency
Patients will need a referral from their doctor for genetic testing. They should know in advance that some doctors will resist it as it is not in the official guidelines, but Tahareinu does recommend it.
PGT: Unpacking the variations
Preimplantation genetic testing (PGT) is a screening test that can be performed on embryos created via in vitro fertilization (IVF) to genetically analyze the embryos prior to transfer. They take a gene from the embryo to test whether it’s healthy.
There are currently 4 kinds of PGT:
- PGT-A, preimplantation genetic testing for aneuploidies, is a genetic test performed on embryos created through IVF to screen for chromosomal abnormalities. The most common is PGT-A is testing for the health of the chromosomes
The purpose of this test is to avoid initiating a pregnancy that will not succeed.
This is under major debate, as there is evidence that pregnancies do not necessarily succeed in larger percentages when using this test. The guidelines are against it.
But we must factor in the age of the woman and the instance of RPL.
If each time a woman miscarried they tested the chromosomes and they are damaged, they should perform this test before the next pregnancy.
Also, on the emotional side, people who have had several miscarriages cannot endure another one. They would rather wait a bit longer and only have a healthy embryo.
It is true that if they will undergo IVF/PGT-A they will have fewer miscarriages. However, at times it will take longer to actually see a pregnancy.
General guidance from Tahareinu: Don’t do PGTA unless absolutely necessary.
2. PGT-M is a genetic test performed on embryos created through in vitro fertilization (IVF) that is designed for individuals who know they are at an increased risk of having a child with a specific genetic disorder.
It is a recommended treatment, as over 200 conditions can be diagnosed and treated with it.
- PGT-SR, preimplantation genetic testing for structural chromosomal rearrangements, is a genetic test performed on embryos created through IVF to screen for chromosomal structural rearrangements normally caused by balanced translocations and inversions.
This can be corrected through IVF/PGT-SR. It must be discussed with Rabbanim, but is recommended. The other option is to keep trying as most of these people can have children without IVF.
4. PGT-P is the newest member of this group, and can rule out long-term health conditions. People who need to do IVF can now avail themselves of this technique where they can check their embryos for these conditions – such as diabetes, heart conditions, and cancer.
There is a heated debate surrounding this concept, as it can be taken too far. Is it ethically correct to “choose our babies” for relatively innocuous conditions? The answer will often depend on the severity of the condition. There is no precedent to this, so it must be discussed.
IS CRISPR READY FOR PRIME TIME?
Should we already use gene editing for more areas?
This debate grew heated at the ASRM. The ones who are for it argue, understandably, that this is a game-changer in both male and female infertility.
The ones who are against argue that it can be taken too far.
Although it hasn’t been approved anywhere in the world, many groups presented their research on it, and it seems that it will benefit women with POI as well as males with azoospermia.
Dr. David Keefe, Chair of OB/GYN at NYU Langone Medical Center, opined that “gene editing is not ready for prime time.”
But the vast majority are pushing for this very strongly.
ARE YOU CAMPAIGN READY?
A personal request from Rabbi Melber:
We are once again launching our annual campaign, and invite you to be part of the success.
Last year, with the help of supporters like you, we exceeded our goal!
I believe that every couple deserves to build their family in the healthiest and happiest way. That’s why I founded Tahareinu – and we have since been Zoche to help thousands upon thousands of people.
If you are on the same page, create your page!
UPCOMING TRIP TO AUSTRALIA
It is so gratifying to return to the land down under once more – to reconnect and strengthen ties with the community, as well as meet more couples for in-person consultations.
Call the Tahareinu Hotline!
Got a question about relieving tahara problems, infertility, reproductive health, pain or other related issues?
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 firstname.lastname@example.org 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.
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.