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

George Liperis Juanjo Fraire-Zamora ESHRE Julia Uraji Omar Ammar Attilio Anastasi Kalaitzopoulos Dimitrios Rafail Sara Noemi Salmeri 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?

Catia is biohacking for fertility George Liperis Kalaitzopoulos Dimitrios Rafail ESHRE Omar Ammar Noemi Salmeri Julia Uraji Attilio Anastasi Dr Fabrizzio Horta Kalaitzopoulos Dimitrios Rafail #ESHREjc

Attilio Anastasi Juanjo Fraire-Zamora Omar Ammar Kalaitzopoulos Dimitrios Rafail ESHRE George Liperis Noemi Salmeri Julia Uraji Dr Fabrizzio Horta 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)

Juanjo Fraire-Zamora Omar Ammar Kalaitzopoulos Dimitrios Rafail ESHRE George Liperis Noemi Salmeri Attilio Anastasi Dr Fabrizzio Horta Catia is biohacking for fertility 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

George Liperis ESHRE Omar Ammar Juanjo Fraire-Zamora Noemi Salmeri Julia Uraji Attilio Anastasi Dr Fabrizzio Horta I totally agree with you George Liperis. 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-Zamora Catia is biohacking for fertility David M Kristensen Omar Ammar ESHRE Julia Uraji Attilio Anastasi George Liperis Sara Noemi Salmeri 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.

Kalaitzopoulos Dimitrios Rafail Juanjo Fraire-Zamora Catia is biohacking for fertility David M Kristensen Omar Ammar ESHRE Attilio Anastasi George Liperis Sara Noemi Salmeri 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

Attilio Anastasi Kalaitzopoulos Dimitrios Rafail Juanjo Fraire-Zamora Catia is biohacking for fertility David M Kristensen Omar Ammar ESHRE George Liperis Sara Noemi Salmeri 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

Kalaitzopoulos Dimitrios Rafail ESHRE Omar Ammar George Liperis Juanjo Fraire-Zamora Julia Uraji Attilio Anastasi Dr Fabrizzio Horta 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-Zamora ESHRE Julia Uraji Omar Ammar Attilio Anastasi George Liperis Kalaitzopoulos Dimitrios Rafail Sara 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

Noemi Salmeri ESHRE Julia Uraji Omar Ammar Attilio Anastasi George Liperis Kalaitzopoulos Dimitrios Rafail Sara There is evidence pointing out that paracetamol (acetaminophen) has potential to produce a synergistic relaxing effect on uterine contractions #ESHREjc sciencedirect.com:5037/science/articl… Synergistic relaxing effect of paracetamol and pyrilamine combination in isolated human myometrium

Kalaitzopoulos Dimitrios Rafail ESHRE Omar Ammar George Liperis Noemi Salmeri Julia Uraji Attilio Anastasi Dr Fabrizzio Horta 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.” acog.org/news/news-arti… ACOG Response to Consensus Statement on Paracetamol Use During Pregnancy

Summary of que 4⃣ moderated by Kalaitzopoulos Dimitrios Rafail #ESHREjc

Summary of que 2️⃣ moderated by Juanjo Fraire-Zamora #ESHREjc

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

Omar Ammar Many thanks to our experts and author 🙌 #ESHREjc

Omar Ammar 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 🌟