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Av 5782 / August 2022

Av 5782 / August 2022

Dear Friends, 

As we revel in the summer sun, we look optimistically at a future full of innovation and renewal. 

In this newsletter, we bring you good news for the Lakewood community and indeed the entire tri-state area. 

We are also including eye-opening updates from several conferences that created a stir in the OB/GYN arena. 

As always, we encourage you to reach out with any comments, questions, or requests. 

Wishing you a happy and healthy summer, 

Yitzchok Melber

WE ARE HONORED TO ANNOUNCE:

The opening of a new fertility clinic is always a reason for hope and excitement. But never have we been as delighted as we are now – with the launch of Conceive NJ, a state-of-the-art fertility center in the heart of Lakewood, NJ under the helm of our dear friend Dr. Isaac Glatstein. 

Dr. Glatstein has spent 22 years as the director of the IVF Center at Harvard University, overseeing the births of 70,000 babies, and has always been a visionary in the field. Now, he brings his expertise, sensitivity, and uniquely caring nature to the Orthodox community of Lakewood and beyond.

Rabbi and Mrs. Melber were privileged to meet with Dr. Glatstein and have only the most effusive praise. This is an incredible new revolution for the couples in our community facing infertility. 

Conceive NJ will offer the full workup and treatments to the community with cutting-edge treatments & procedures. 

Dr. Glatstein traveled the world in the last few years going to seminars and conferences bringing the latest innovations in treatments, processes and procedures, bringing these services in-house. 

Rabbi Melber’s warm and hearty relationship with Dr. Glatstein has been cemented throughout their mutual attendance at many medical conferences, and they continued to be in touch at every juncture throughout the planning and building stages of this unique facility. 

The care is personalized and culturally sensitive, which are both so essential to couples in this vulnerable state. 

We extend a warm and heartfelt Bracha to this incredible doctor and his dedicated team – may they see Hatzlacha in their hallowed endeavor and be Zoche to see many more Neshamos enter the world through their incredible care. 

Dr. Glatstein has a long-standing relationship with Tahareinu and the Lakewood community, speaking at the annual Tahareinu conference for Rabbonim and Kallah Teachers in Lakewood multiple times over the past few years.

Appointments can be made by calling the office at 732-806-1613, visiting their website conceivenj.com, or emailing info@conceivenj.com.

RABBI MELBER ATTENDS RCOG CONFERENCE

The Royal College of Gynecology conference in England takes place only once in 3 years – and is always a hotbed of innovation. 

Professor Joop Laven M.D PH.D. announced new guidelines for PCOS. Until now, in order to diagnose PCOS, a patient had to have 2 out of the 3 main symptoms: Acne, irregular cycles, and an ultrasound showing (many) undeveloped follicles.  

The updated recommendation (in addition to the above symptoms) for diagnosing PCOS has changed to include a simple AMH blood test. The benefits include easier access and greater clarity, as well as determining POI issues simultaneously. 

In the States and the UK this test is covered; in Israel it is still private. 

Dr. Scott Nelson delivered a lecture on role of AMH in fertility preservations and beyond. Whenever the question of whether to freeze eggs or not arises, either because someone is approaching age 30, has endometriosis, or, is undergoing chemo – how do we determine the protocol? 

Usually AMH can give us the info regarding the ovarian reserve in order to provide the answer. 

Oncology patients should undergo egg-freezing before starting chemotherapy treatments, and perform the test before and after chemotherapy. Girls who have not begun menstruating by their late teens, or, who have not had a period for a full year should take this test and repeat it every year that their AMH is showing low.

AMH has a wealth of additional uses that are now beginning to be fully realized. 

At Tahareinu, we recommend this test often when we see the need.

Dr. Ippokratis Sarris, Director and Consultant in Reproductive Medicine at King’s Fertility delivered another lecture focusing on two reasons for failed IVF: Thrombophilia (clotting) and immunology. He recommended that after RIF or 3 or more failed IVF cycles these 2 factors should be investigated. 

Professor Adam Balen, Professor of Reproductive Medicine at Leeds Hospital in the UK and member of FIGO, released a new classification of disorders of ovulation (#1 cause of female infertility) – known as the HyPOP classification: Hypothalamic Pituitary Ovarian PCOS. 

This tool is another major advancement that puts the whole field of infertility into a new phase of progress allowing for greater investigation and treatment.

Another lecture, “The Forgotten Father – Male Factors in Miscarriage” was delivered by Dr. Stephen Gordon of the Center of Reproductive Immunology and Pregnancy. Dr. Gordon brought the guidelines from the American Urology Association, or AUA, in 2021: In couples with failed ART cycles or RPL, the male partner should be evaluated with a focus on sperm DNA. The European Association of Urology, or EAU, in 2020 states that couples with RPL and men with unexplained male infertility indicate that sperm DNA may be damaged. The new 6th Edition WHO recommends testing DFI (DNA Fragmentation Indix) as a cause for infertility and/or miscarriages. 

Dr. Sarah Robertson delivered a lecture on the topic of immunotherapy. Dr. Robertson posited that a healthy immune response helps pregnancy success, and focused on the importance of immune response in helping healthy implantation and placental development. In Dr. Robertson’s opinion, poor immune response raises the risk of pregnancy loss, specifically with first pregnancy or RIF.

In order to improve immune response, one should first incorporate lifestyle changes: increase vegetable and protein in one’s diet, and exercise, considering that people with obesity have weaker immune profiles. 

The next step would be medications: Intra-lipid, IVIG, and others, which in some cases would be beneficial and recommended for immune disorders.

UTERINE TRANSPLANTS: THE WAVE OF THE FUTURE

At a recent Israeli conference, Rabbi Melber was fortunate to meet Dr.  Ben-Shachar, who is developing a method for uterine transplants which has already been approved by the Israeli government. This procedure will be free for Israelis – with the same high level treatment as in the US, where it costs roughly $300,000!

In general, it is often worthwhile for couples to come to Israel for fertility treatments, which are considerably more affordable even when paying privately.

TAHAREINU LIVE SHIURIM – COMING TO YOUR COMMUNITY!

Tahareinu had the honor hosting 6 shiurim around Yerushalaim during the past 4 weeks. Four shiurim were given to Rabbonim in Ramat Eshkol, Romemma, Bircas Moshe and Ganei Geulah, and two shiurim for women in the Sanhedria/Ramat Eshkol neighborhoods. Tahareinu will I”H be hosting shiurim in Melbourne, AU during the month of Tammuz, along with multiple shiurim in the Arze Habira neighborhood of Yerushalaim. 

If you would like Tahareinu to come to your community please reach out to tzvi.goldman@tahareinu.com.

In the past 8 weeks we’ve hosted shiurim in:

  • Lakewood
  • Boro Park
  • Chicago (4 different neighborhoods)
  • Yerushalayim (5 different neighborhoods)

TAHAREINU PROFESSIONAL COURSE – LAST CHANCE!

Our English course is sold out and underway, with close to 100 Rabbanim, Kallah teachers, and professionals from around the world enrolled. (The course is recorded, for information pertaining to the course/recordings please email tzvi.goldman@tahareinu.com

The Yiddish course is starting this Monday, July 4! To enroll, please email tzvi.goldman@tahareinu.com

Tammuz 5782 / July 2022

Tammuz 5782 / July 2022

Dear Friends, 

As we revel in the summer sun, we look optimistically at a future full of innovation and renewal. 

In this newsletter, we bring you good news for the Lakewood community and indeed the entire tri-state area. 

We are also including eye-opening updates from several conferences that created a stir in the OB/GYN arena. 

As always, we encourage you to reach out with any comments, questions, or requests. 

Wishing you a happy and healthy summer, 

Yitzchok Melber

WE ARE HONORED TO ANNOUNCE:

The opening of a new fertility clinic is always a reason for hope and excitement. But never have we been as delighted as we are now – with the launch of Conceive NJ, a state-of-the-art fertility center in the heart of Lakewood, NJ under the helm of our dear friend Dr. Isaac Glatstein. 

Dr. Glatstein has spent 22 years as the director of the IVF Center at Harvard University, overseeing the births of 70,000 babies, and has always been a visionary in the field. Now, he brings his expertise, sensitivity, and uniquely caring nature to the Orthodox community of Lakewood and beyond.

Rabbi and Mrs. Melber were privileged to meet with Dr. Glatstein and have only the most effusive praise. This is an incredible new revolution for the couples in our community facing infertility. 

Conceive NJ will offer the full workup and treatments to the community with cutting-edge treatments & procedures. 

Dr. Glatstein traveled the world in the last few years going to seminars and conferences bringing the latest innovations in treatments, processes and procedures, bringing these services in-house. 

Rabbi Melber’s warm and hearty relationship with Dr. Glatstein has been cemented throughout their mutual attendance at many medical conferences, and they continued to be in touch at every juncture throughout the planning and building stages of this unique facility. 

The care is personalized and culturally sensitive, which are both so essential to couples in this vulnerable state. 

We extend a warm and heartfelt Bracha to this incredible doctor and his dedicated team – may they see Hatzlacha in their hallowed endeavor and be Zoche to see many more Neshamos enter the world through their incredible care. 

Dr. Glatstein has a long-standing relationship with Tahareinu and the Lakewood community, speaking at the annual Tahareinu conference for Rabbonim and Kallah Teachers in Lakewood multiple times over the past few years.

Appointments can be made by calling the office at 732-806-1613, visiting their website conceivenj.com, or emailing info@conceivenj.com.

RABBI MELBER ATTENDS RCOG CONFERENCE

The Royal College of Gynecology conference in England takes place only once in 3 years – and is always a hotbed of innovation. 

Professor Joop Laven M.D PH.D. announced new guidelines for PCOS. Until now, in order to diagnose PCOS, a patient had to have 2 out of the 3 main symptoms: Acne, irregular cycles, and an ultrasound showing (many) undeveloped follicles.  

The updated recommendation (in addition to the above symptoms) for diagnosing PCOS has changed to include a simple AMH blood test. The benefits include easier access and greater clarity, as well as determining POI issues simultaneously. 

In the States and the UK this test is covered; in Israel it is still private. 

Dr. Scott Nelson delivered a lecture on role of AMH in fertility preservations and beyond. Whenever the question of whether to freeze eggs or not arises, either because someone is approaching age 30, has endometriosis, or, is undergoing chemo – how do we determine the protocol? 

Usually AMH can give us the info regarding the ovarian reserve in order to provide the answer. 

Oncology patients should undergo egg-freezing before starting chemotherapy treatments, and perform the test before and after chemotherapy. Girls who have not begun menstruating by their late teens, or, who have not had a period for a full year should take this test and repeat it every year that their AMH is showing low.

AMH has a wealth of additional uses that are now beginning to be fully realized. 

At Tahareinu, we recommend this test often when we see the need.

Dr. Ippokratis Sarris, Director and Consultant in Reproductive Medicine at King’s Fertility delivered another lecture focusing on two reasons for failed IVF: Thrombophilia (clotting) and immunology. He recommended that after RIF or 3 or more failed IVF cycles these 2 factors should be investigated. 

Professor Adam Balen, Professor of Reproductive Medicine at Leeds Hospital in the UK and member of FIGO, released a new classification of disorders of ovulation (#1 cause of female infertility) – known as the HyPOP classification: Hypothalamic Pituitary Ovarian PCOS. 

This tool is another major advancement that puts the whole field of infertility into a new phase of progress allowing for greater investigation and treatment.

Another lecture, “The Forgotten Father – Male Factors in Miscarriage” was delivered by Dr. Stephen Gordon of the Center of Reproductive Immunology and Pregnancy. Dr. Gordon brought the guidelines from the American Urology Association, or AUA, in 2021: In couples with failed ART cycles or RPL, the male partner should be evaluated with a focus on sperm DNA. The European Association of Urology, or EAU, in 2020 states that couples with RPL and men with unexplained male infertility indicate that sperm DNA may be damaged. The new 6th Edition WHO recommends testing DFI (DNA Fragmentation Indix) as a cause for infertility and/or miscarriages. 

Dr. Sarah Robertson delivered a lecture on the topic of immunotherapy. Dr. Robertson posited that a healthy immune response helps pregnancy success, and focused on the importance of immune response in helping healthy implantation and placental development. In Dr. Robertson’s opinion, poor immune response raises the risk of pregnancy loss, specifically with first pregnancy or RIF.

In order to improve immune response, one should first incorporate lifestyle changes: increase vegetable and protein in one’s diet, and exercise, considering that people with obesity have weaker immune profiles. 

The next step would be medications: Intra-lipid, IVIG, and others, which in some cases would be beneficial and recommended for immune disorders.

UTERINE TRANSPLANTS: THE WAVE OF THE FUTURE

At a recent Israeli conference, Rabbi Melber was fortunate to meet Dr.  Ben-Shachar, who is developing a method for uterine transplants which has already been approved by the Israeli government. This procedure will be free for Israelis – with the same high level treatment as in the US, where it costs roughly $300,000!

In general, it is often worthwhile for couples to come to Israel for fertility treatments, which are considerably more affordable even when paying privately.

TAHAREINU LIVE SHIURIM – COMING TO YOUR COMMUNITY!

Tahareinu had the honor hosting 6 shiurim around Yerushalaim during the past 4 weeks. Four shiurim were given to Rabbonim in Ramat Eshkol, Romemma, Bircas Moshe and Ganei Geulah, and two shiurim for women in the Sanhedria/Ramat Eshkol neighborhoods. Tahareinu will I”H be hosting shiurim in Melbourne, AU during the month of Tammuz, along with multiple shiurim in the Arze Habira neighborhood of Yerushalaim. 

If you would like Tahareinu to come to your community please reach out to tzvi.goldman@tahareinu.com.

In the past 8 weeks we’ve hosted shiurim in:

  • Lakewood
  • Boro Park
  • Chicago (4 different neighborhoods)
  • Yerushalayim (5 different neighborhoods)

TAHAREINU PROFESSIONAL COURSE – LAST CHANCE!

Our English course is sold out and underway, with close to 100 Rabbanim, Kallah teachers, and professionals from around the world enrolled. (The course is recorded, for information pertaining to the course/recordings please email tzvi.goldman@tahareinu.com

The Yiddish course is starting this Monday, July 4! To enroll, please email tzvi.goldman@tahareinu.com

Sivan 5782 / June 2022

Sivan 5782 / June 2022

ds,

As we anticipate the celebration of Kabalas Hatorah, we join you in wishing all of Klal Yisroel a wonderful Yom Tov. 

Here at Tahareinu, we remain committed to our mission of spreading awareness about the latest innovations in women’s health and fertility. 

To that end, we share within this edition fascinating new insights gleaned from conferences we’ve attended around the world. 

Read and gain insight! 

Also, look out in your inboxes for details about the well-regarded Tahareinu course for professionals, starting after Shavuos.

Thank you, 

Yitzchok Melber

RABBI AND MRS. MELBER ATTEND ACOG CONFERENCE IN SAN DIEGO

As the only Jewish people in attendance at the American Conference of Gynecology (ACOG) in San Diego, Rabbi and Mrs. Melber represented our community and gained tremendous insight regarding the absolute latest updates in the field.

One presentation focused on Abnormal Uterine Bleeding (AUB), a topic about which there is increasing awareness throughout the medical world. 

Of course, the PALM COEIN model was presented, and the recommendations were very much in line with Tahareinu’s advice. 

The buildup for treatment goes as follows: 

NSAID (Non-steroidal anti-inflammatory drugs) such as Ibuprofen

Hormonal treatment: Lysteda

Progesterone

Combination treatment (if patient is not looking to conceive)

HTRS: TECHNOLOGY REVOLUTION IN HYSTEROSCOPY

Professor Chaimovitz, head of OB/GYN in Laniado Hospital, presented this innovation.

HTRS, or hysteroscopic tissue removal systems, are set to replace D&C throughout the medical world. 

The facts are:

With blind D&C, only 50% of the uterine cavity is viewed in 60% of cases. 

With blind D&C, only 40% of placental remains are removed. 

This technology combines a hysteroscopy with a new machine that can remove not only polyps, fibroids, and adhesions, but products of conception much more effectively as well. 

The conclusion? This should be the new standard of care and completely replace blind D&C.

RABBI AND MRS. MELBER IN CHICAGO, LAKEWOOD, BROOKLYN & YERUSHALAYIM

Following the ACOG, Rabbi and Mrs. Melber flew to Chicago. 

Rabbi Melber presented an extremely comprehensive two-day seminar to Rabbanim, and Mrs. Melber presented to the Kallah teachers. 

They also met with couples and individually with local professionals. 

In Brooklyn and Lakewood, Rabbi Melber presented at the Tahareinu yearly conference with over 120 Rabbanim in attendance. 

One topic that was highlighted was Progesterone. 

On the one hand, progesterone is notorious for causing trouble such as AUB, irregular cycles, and staining. 

However, when administered properly – in the correct time, form, and dose – it is extremely effective and is in fact the solution to many common challenges. 

Many women naturally have low progesterone, and common symptoms include spotting, infertility, and miscarriages. 

Each case and scenario must be evaluated carefully and the right guidance must be given. We were pleased to present this crucial information to the Rabbanim so they can in turn be of help to their communities. 

Of course, guidance must be double checked with one’s doctor for clarity. 

Progesterone for 5 stages of life: A handy guide

  1. Kallah: Aygestin should be used to control a woman’s cycle. The standard dose in the US is 2 pills a day, or 10 mg. In Europe, most countries use 15 mg a day, so if a woman has staining while taking 10 mg she should discuss using 15 with her doctor. This is for Kallahs or anyone who wants to reschedule their period, but not as contraception. It is generally used after ovulation, and is safe to use even if she may be pregnant.
  2. Provera should be used when women are not allowed to use Aygestin, for example those with a tendency for clotting or women over 45.
  3. Micronized progesterone is used for preventing miscarriages. Pregnant women shouldn’t use Aygestin for this; they neeed the micronized version created int eh US or Dydrogesterone/Duphaston in Europe of Israel. For stopping staining and preventing miscarriages it must also be the right method – given as a suppository; even if she gets the pill she must insert it as a suppository. The dosage must be 400 per day for the US, though the European and Israeli versions are assumed to be more effective. 
  4. Mini-pills: Most cause staining and breakthrough bleeding, so it is important to take the best on, the Slynd. It is now available in the States and most countries in Europe. Because it has a higher dosage it has a 90% success rate, and in Tahareinu we prefer it also for emotional wellbeing. 
  5. IUD, such as Kyleena/Mirena: Try to avoid using it if possible, as they often cause issues. These should only be used if there is no other option or for long-term use for older women.

OTHER UPDATES:

  • As we’ve mentioned before, the first line treatment for overweight PCOS patients is to lose just 5% of their body weight, which can have overall positive effects on their fertility. 
  • The 6th version of semen analysis was recently released, which includes an expanded investigation and a particular focus on DFI (DNA Fragmentation Index). All labs should be including this option soon, and it is Halachically preferable as it will only require one sample vs. an additional sample for DFI.
  • Dr. Bar-Tuv, Dr. Barak and Dr. Peretz of Israel published research for the success rate of the Microscopic testicular sperm extraction (microTESE) procedure when combined with the IMS method. The research shows a greater success rate when these techniques are combined. This is currently only performed in Israel, and couples do travel to Israel to have this treatment. 
  • When Rabbi Melber presented in Boro Park along with fertility expert Dr. Michael Werner, he recommended TRT (testosterone replacement therapy) for males with under 300 units in order to boost fertility. He recommended under 300 units should be treated

See below for information on our upcoming webinar!

Iyar 5782 / May 2022

Iyar 5782 / May 2022

BS"DDear 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...

Nissan 5782 / April 2022

Nissan 5782 / April 2022

BS"D Dear Friends, Pesach prep is in full swing throughout every Jewish community – and we hope this joyous season finds you healthy and happy.At Tahareinu, every season finds us exploring the latest innovations in women’s health and fertility – at conferences,...

Articles

Featured in Dosiz: Tahareinu Certification Course.

There is no import/export tax on knowledge, but its appreciation value is immeasurable.

“That one phone call was the turning point they longed for: they received guidance no one else had known to give them.”

Tahareinu overview:

“One woman said she was suffering for years until she picked up our flyer.”

Refuah b’Halacha:

Dayanim and Rabbanim gain insights at Toras HaMishpacha/Tahareinu conference. (London)

“I cannot imagine how London would be today without the Tahareinu hotline.” – Rabbi Yisroel Meir Greenberg, shlita, Rav of Golders Green Beis Hamidrash, London

Thousands of women attend a Tahareinu fertility symposium, featuring Hadassah Hospital and renowned Rabbanim and Rebbetzins. (Jerusalem)

Mikveh.org’s Kallah Teacher Training features Tahareinu-led lectures.  (New York)

Tahareinu runs seminar for Rebbetzins working with kallahs and married women. (London)

Columnist Yonoson Rosenblum on a Tahareinu symposium:

“Such an evening of chizuk needed no justification beyond itself.”

A day in the life of Tahareinu, featuring Founder & President Rabbi Melber.

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