Dear Tahareinu friends,
As the heat of the summer comes to an end, our efforts to continue bringing you the latest innovations in women’s health burn strong as well. It’s been a whirlwind couple months since we were last in touch, and we look forward to summarizing a lot of valuable information in this month’s newsletter.
As always, we are waiting to hear from you with any feedback or questions you may have.
Until next month – wishing you all a happy and healthy summer!
Rabbi Yitzchok Melber
ROYAL CONFERENCE OF GYNECOLOGY (RCOG), UK
Rabbi Melber was privileged to join over 3,000 doctors in the UK once again for this cutting-edge conference. He learned of the absolute latest innovations in the field of women’s health and fertility, and is excited to share the highlights with you here. And of course, the new medications, new treatments, new procedures, new guidelines, and new research will now be incorporated into Tahareinu’s new repertoire to help as many people as we possibly can.
In addition, Rabbi Melber attended in person in order to forge and strengthen valuable connections in the medical world, and was successful in doing so.
Please note that although the conference is based in the UK, the content was largely relevant worldwide because of the solid research and wide reach.
The 3 main topics covered at the conference were infertility, miscarriages, and gynecology.
9 TOP TAKEAWAYS:
1. INFERTILITY
For years, medical professionals have been trying to answer the million dollar questions: How can we help patients with unexplained infertility get help without aggressive intervention?
The answer, of course, is to do any possible test to minimize the number of cases of unexplained infertility.
One new idea presented was regarding the the diagnostic test Hysterosalpingography (HSG), originally used to see if fallopian tubes are open and the uterine cavity is normal. The test is performed via dye inserted through tubes into the uterus and taking pictures using x-ray.
This is part of the standard evaluation, because if there are blockages in the tubes, they prevent the sperm from reaching the egg, and abnormalities in the uterine cavity can cause infertility.
Now there is a new idea: HSG can now be used as a treatment, especially for unexplained infertility. The number of successful outcomes in the research was significant.
Flushing the tubes and the uterus during the procedure increases the chances for fertilization and implantation. This can be done using either oil or water, and the research showed that oil is more effective.
Utilizing every available solution before pursuing aggressive infertility treatment has 5 benefits: physical, emotional, mental, financial, and Halachic.
A couple should give this treatment a 2-3 month chance to see improvement before proceeding with conventional treatments.
2. POOR OVARIAN RESPONSE
When a woman undergoes IUI/IVF, we need to increase her eggs in order to retrieve successfully, but women with low AMH have poor ovarian response; therefore, it’s difficult to make enough eggs for the treatment to succeed. Here, they presented strong research conducted in a double blind randomized trial that 600 mg of the CoQ10 vitamin can help the ovarian response and embryo quality even with low AMH, such as POI patients. This is for young women with decreased ovarian response. We at Tahareinu now recommend using it.
3. MISCARRIAGES
Reproductive Immunology was mentioned; there is emerging evidence that this is effective. If a patient has several miscarriages, they should examine their immune profile and be treated if necessary.
They also recommended a very high dose of micronized progesterone: 400 mg twice daily for a total of 800 mg (based on the NICE guidelines).
This can actually prevent a lot of miscarriages!
This is still in debate and in the US there are no official guidelines on this, but they presented new research from the UK to strongly recommend it.
If someone had a previous miscarriage and now has a threatened miscarriage with bleeding, they should definitely pursue this.
Based on our conversations with experts, we also recommend it for anyone who has first trimester vaginal bleeding to use it for the first 12 weeks. They should also perform an ultrasound to rule out ectopic pregnancy.
4. HYPEREMESIS GRAVIDARUM (HG)
They focused on timely and effective treatment; if a patient waits until the condition is fully developed it is much harder to treat. They only treatment currently available to prevent this is Bonjesta In the UK, known as Xonvea elsewhere. This is to prevent and manage HG.
There is no indication from the millions of people who have used it of side effects on the fetus.
This is just one medication out of many, and if it’s not effective enough there are others that can be prescribed.
5. TRANEXAMIC ACID
This is very important for treating AUB, as proven in a randomized double blind trial – it is available everywhere and a safe medication. This is the strongest medication for someone who has bleeding for too long on a monthly basis.
If someone cannot make a Hefsek Tahara because they bleed for 7-10 days or stain extensively, we recommend to start with Bioflavanoid vitamins and Advil 3 times a day for 5 days, but if those don’t work we recommend this medication.
In the US this is called Lysteeda.
6. RYEQO
This is a medication available in Europe and the US for HMB (heavy menstrual bleeding) and has significantly reduced the bleeding, especially for women with fibroids. Over the age of 40 many women develop fibroids, so this is a good option to be aware of, as it often replaces the need for medical procedures.
It contains relugolix, estrogen, progesterone.
7. NHS RESEARCH SAVING BABIES’ LIVES, VERSION 3
A focus on monitoring fetal growth has proven to reduce stillbirths in England. In many cases, if the fetus stops growing properly it can be delivered by week 34 and prevent a stillbirth.
They are now developing different tools to track fetal growth after seeing how effective this is.
8. COMPARISON OF 3 TREATMENTS FOR MISCARRIAGES AND PRE-TERM BIRTH
In a multi-center randomized controlled trial, 3 options for women with short cervixes were tested:
1. Cervical cerclage
2. Cervical pessary
3. Vaginal progesterone
Their research demonstrated that they are all very effective. At Tahareinu, we recommend a combination of cervical cerclage and vaginal progesterone if it’s not too late; otherwise replace the cerclage with the pessary.
9. CRYOPRESERVATION VS. PRESERVATION OF OVARIAN TISSUE
This is relevant for various groups of people, specifically those undergoing cancer treatment.
Ovarian Tissue Cryopreservation (OTC) has been established as a treatment and is well past the research stage (in the US as well).
TAHAREINU IN TORONTO:
A Mutual Success Story
As is well known, Rabbi Yitzchok Melber, founder and director of Tahareinu, makes his way across the globe to attend medical conferences in all areas of women’s health and fertility. As the impact of Tahareinu grows worldwide, he has also made it his mission to visit communities and spread knowledge and hope to their environs.
Last week was Toronto’s turn.
Rabbi Melber’s astounding breadth of knowledge in all areas of women’s health both impressed and inspired the many who stood to gain from it.
Numerous local Rabbanim, askanim, medical professionals and couples eagerly anticipated the visit and were gratified that Rabbi Melber dedicated such a significant portion of his demanding schedule to focus on the community’s specific needs.
The impact is felt throughout the Toronto Kehila and will continue to reverberate with many Simchos, with Hashem’s help.
Rabbi Melber delivered a very well-received lecture to approximately 25 Rabbanim, with Rabbi Shlomo Miller Shlita and Rabbi Yaakov Felder Shlita at their helm. He discussed the latest innovations in both the Tahara and fertility realms, providing illuminating insight into these complex topics.
He also met with doctors and other professionals, outlining a joint vision for the future of women’s health in the community. He was met with enthusiastic support and made a strong impression with his tireless devotion and unique level of expertise. Tahareinu is grateful to the devoted doctors who were instrumental in facilitating both this visit and developments for the future.
A successful parlor meeting was held at the home of Mr. and Mrs. David Stein, who share Tahareinu’s mission in bringing the latest innovations in Tahara and women’s health to every Jewish family. Every dollar raised will go directly to promoting innovation that directly improves the lives of fellow Jews.
Lastly but perhaps most importantly, Rabbi Melber provided personal consultations with nearly 20 couples to review their specific fertility circumstances and delve deeper into possible solutions. As always, Tahareinu is available for in-depth case management, often resulting in the final Yeshua, B’Ezras Hashem.
This whirlwind trip was a meaningful and memorable one, and both the community leaders and Tahareinu’s leaders look forward to further cementing this special relationship.
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 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.
