Elul 5735/September 2024

Dear friends, 

Elul always heralds a feeling of hope and renewal, and never has that wish hit stronger than this year. 

Here at Tahareinu, we are always in a season of renewal, curating the latest insights and innovations in the medical world to better serve you. 

Recently, Rabbi Melber attended the ESHRE (European Society of Human Reproduction and Embryology) conference, which was replete with cutting edge updates that were both eye-opening and beneficial. 

Here, we bring those updates to your inbox. 
Feel free to be in touch with any questions on this content, or if we can help in any other way. 

Rabbi Yitzchok Melber

ESHRE Conference: Tips and Takeaways

1. PCOS and GLP-1 (Glucagon-like peptide-1) Medications

In recent years, GLP-1 medications like Ozempic have emerged as valuable tools in treating infertility associated with Polycystic Ovary Syndrome (PCOS). These medications, originally developed for diabetes management, have shown promise in improving fertility outcomes for women with PCOS. A groundbreaking study presented at the conference addressed a crucial concern: the safety of these medications during early pregnancy.
Researchers from Denmark conducted a comprehensive study on the topic. The results were reassuring, showing no significant association between GLP-1 use and increased pregnancy complications when compared to a control group. Until now, doctors typically recommended discontinuing these medications 4-6 months before pregnancy, which often resulted in weight regain, causing frustration and deterring women from using the drug. 
Now, they are still generally recommending a 2-month hiatus between GLP-1 and pregnancy, but it is encouraging to note that there is no danger to the fetus

2. Endometritis and Recurrent Pregnancy Loss

Dana McQueen, Reproductive Endocrinologist from RMA of Northern CA, shared research that indicates that approximately 30% of women who experience miscarriages have underlying endometritis.
The good news is that 94% of cases can be successfully treated with first-line antibiotics, and nearly 100% can be resolved with second-line treatments. This high success rate translates to improved live birth rates for affected women.

3. Vitamin D and Miscarriage Risk

Professor Siobhan Quenby from the UK’s Tommy’s Clinic presented compelling research on the relationship between Vitamin D deficiency and miscarriage risk. The study found that women with low Vitamin D levels are at a significantly increased risk of miscarriage. Conversely, women with a history of recurrent pregnancy loss (RPL) were more likely to have successful pregnancies if they had sufficient Vitamin D levels.The recommendation now is to check Vitamin D levels even after a single miscarriage, rather than waiting for recurrent losses. 

4. Novel Approaches to Preventing Miscarriage

Researchers in Denmark are exploring an innovative approach to preventing miscarriages, particularly in high-risk IVF pregnancies. They are investigating the combined use of intravenous immunoglobulin (IVIG) and Prednisone as a preventive measure. Some clinicians are recommending this combination for women who have experienced miscarriage following IVF. It’s worth noting that this approach is not universally accepted within the IVF community, highlighting the need for more robust clinical trials.

5. Advancements in Fertility Preservation

Fertility preservation techniques continue to evolve, offering hope to many individuals facing devastating diagnoses and potential fertility challenges. A collaborative study between Belgian and American researchers focused on ovarian tissue freezing, a technique that allows for the preservation of thousands of eggs. The study conclusively demonstrated that the freezing process does not cause damage to the ovarian tissue, alleviating concerns about potential long-term effects on a woman’s reproductive health.

6. DNA Fragmentation and Unexplained Pregnancy Loss

A significant breakthrough was presented regarding unexplained pregnancy loss and its association with high sperm DNA fragmentation. This finding provides a potential explanation for many cases of recurrent pregnancy loss that were previously categorized as unexplained.

Several interventions were discussed to address this issue.

7. Update on Premature Ovarian Insufficiency (POI)

The following points regarding POI were brought to light at the conference: 

• Diagnosis of POI should be based on the presence of irregular cycles for at least four months, along with elevated FSH and low AMH levels.
• Women diagnosed with POI should be informed about the substantially reduced chances of natural conception.
• Fertility preservation should be considered for women at risk of POI, ideally before the condition fully manifests.
• Currently, there are no interventions that have been reliably shown to improve natural conception rates in women with POI.

NOTE: Interventions on the above-mentioned conditions may have Halachic implications, and consultation with a rabbi is advised before pursuing any fertility-related protocol.