Many thanks to all participants 🙌 and to @OmarRawi89 and his team for leading this great edition of the #ESHREjc

@OmarRawi89 Many thanks to our experts and author 🙌 #ESHREjc

@OmarRawi89 See you next time! #ESHREjc

November #ESHREjc is done and dusted thanks to our experts and authors for joining us! And kudos to our moderators! See you all in January 🌟

Summary of que 4⃣ moderated by @DKalaitzopoulos #ESHREjc

Summary of que 2️⃣ moderated by @juanjo_fraire #ESHREjc

Summary of que 1️⃣ moderated by @AttilioDGM7 #ESHREjc

@DKalaitzopoulos @ESHRE @OmarRawi89 @GLiperis @NoemiSalme30386 @juliauraji @AttilioDGM7 @FabrizzioHorta From the ACOG: “…any medication [paracetamol] taken during pregnancy should be used only as needed, in moderation, and after the pregnant patient has consulted with their doctor.” https://t.co/vAnughjmQ9 ACOG Response to Consensus Statement on Paracetamol Use During Pregnancy

@NoemiSalme30386 @ESHRE @juliauraji @OmarRawi89 @AttilioDGM7 @GLiperis @DKalaitzopoulos @Saara_riibeiro There is evidence pointing out that paracetamol (acetaminophen) has potential to produce a synergistic relaxing effect on uterine contractions #ESHREjc https://t.co/RUsXL9hZbV Synergistic relaxing effect of paracetamol and pyrilamine combination in isolated human myometrium

@DKalaitzopoulos @ESHRE @OmarRawi89 @GLiperis @juanjo_fraire @juliauraji @AttilioDGM7 @FabrizzioHorta Avoid over-restriction driven by possible confounding! If analgesia is clinically indicated, it should be used but always appropriately, not excessively. Offer safe alternatives, give timing guidance. Evidence-aware counseling is essential. #ESHREjc

@juanjo_fraire @ESHRE @juliauraji @OmarRawi89 @AttilioDGM7 @GLiperis @DKalaitzopoulos @Saara_riibeiro Acetaminophen? So far it looks uterine-neutral…but the truth is, we still can’t accurately measure uterine functionality in vivo. Low biological concern, interpreted with caution…! #ESHREjc

@AttilioDGM7 @DKalaitzopoulos @juanjo_fraire @catiamalinina @Kristensen8511 @OmarRawi89 @ESHRE @GLiperis @Saara_riibeiro @NoemiSalme30386 But also tricky - do you really tell people trying to get pregnant to take paracetamol for no reason? Ethical approval may be tricky. But yes the data would be very valuable #ESHREjc

@DKalaitzopoulos @juanjo_fraire @catiamalinina @Kristensen8511 @OmarRawi89 @ESHRE @AttilioDGM7 @GLiperis @Saara_riibeiro @NoemiSalme30386 Agreed, although data quality has to be top notch. Do all clinics track mild painkiller use? Or the reason for painkiller use as a confounding factor (eg fevers, illness, inflammation etc)… but it could tell us if there’s a clinical effect worth investigating #ESHREjc

@juanjo_fraire @catiamalinina @Kristensen8511 @OmarRawi89 @ESHRE @juliauraji @AttilioDGM7 @GLiperis @Saara_riibeiro @NoemiSalme30386 I believe that, from a design perspective, it should not be difficult to conduct a retrospective clinical study examining the effect of paracetamol exposure during ovarian stimulation or embryo transfer, in order to obtain clinical evidence.

@GLiperis @ESHRE @OmarRawi89 @juanjo_fraire @NoemiSalme30386 @juliauraji @AttilioDGM7 @FabrizzioHorta I totally agree with you @GLiperis. The problem is that the alternatives do not appear to be less harmful than paracetamol. I think the main rule for paracetamole should be "use the lowest effective dose in the shorter time" and for sure not prophylactic #ESHREjc

@juanjo_fraire @OmarRawi89 @DKalaitzopoulos @ESHRE @GLiperis @NoemiSalme30386 @AttilioDGM7 @FabrizzioHorta @catiamalinina Definitely a delicate balance. Also depends what the paracetamol is being taken for - is it a mild headache? Pain from oocyte retrieval? Or a high fever? I‘m sure 40°C is also not good for embryo development… #ESHREjc

@AttilioDGM7 @juanjo_fraire @OmarRawi89 @DKalaitzopoulos @ESHRE @GLiperis @NoemiSalme30386 @juliauraji @FabrizzioHorta That's true! A lot of women are getting scared thus resorting to either ignorance or unproven, dangerous strategies to prevent possible damage (e.g. non-proven herbal remedies for 40C fever)

@catiamalinina @GLiperis @DKalaitzopoulos @ESHRE @OmarRawi89 @NoemiSalme30386 @juliauraji @AttilioDGM7 @FabrizzioHorta @DKalaitzopoulos #ESHREjc

@GLiperis @juanjo_fraire @ESHRE @juliauraji @OmarRawi89 @AttilioDGM7 @DKalaitzopoulos @Saara_riibeiro @NoemiSalme30386 But is there a solid evidence of safety? Or is there just not enough data on the potential consequences due to ethical constraints for conducting the research?

Q2: #ESHREjc Nielsen et al, showed the molecular effect of APAP 💊 on early embryogenesis. However, we cannot exclude its systemic effect. Could APAP also affect endometrial tissue during implantation? Would its effects extend beyond the peri-implantation period? @ESHRE