Hello, my name is Dr. Jeffrey Braverman. I am the Director of the Department of
Reproductive Immunology at White Grove Hospital in Brooklyn, New York and the Director here at
Braverman IVF & Reproductive Immunology. You have most likely come
to this website because you have been suffering from recurrent miscarriages,
chemical pregnancies, multiple
failed IVF cycles and these might have happened even after you have had successful pregnancies.
You might have had a late pregnancy complication such as toxemia, fetal
abruption, intrauterine growth retardation, gestational diabetes or even
still births. You may have an autoimmune disease and found no explanation
for your inability to conceive and successfully hold a pregnancy. We refer
to these problems as "Failure to Initiate and Successfully Complete
a Pregnancy" – pronounced FISCP – and it seems that all
the above issues have a common thread: a failure to achieve proper embryo
Poor implantation leads to early and late pregnancy complications. My practice
is devoted to the science of the implantation process. I have been diagnosing
and safely treating patients from around the world with these problems
now for over twenty years. I not only help my patients conceive through
our IVF and our IUI programs but I also follow this high-risk group of
patients through until their deliveries, giving me the most unique prospective
on FISCP that you won't find at conventional infertility centers.
During these last twenty years, I have seen our ability to diagnose and
treat all the potential causes of these problems expand exponentially.
In order to maintain our success over the years, it was important to not
only be abreast on all the most current
treatments for FISCP but we also had to keep up with every article that was being
published and the most explosive area of research into FISCP – this
was reproductive immunology.
Much of this literature was dispersed in
immunology journals from around the world where a significant amount of this research
is being performed. Our volumes of clinical experience over the last twenty
years are now being prepared for publication as well. I am usually the
last stop for any of my patients and they count on me to always think
outside the box. I always like to feel that my work is never outside of
the box, just that I work within the framework of a much larger box.
It is also critical for me to always to be able to justify my thinking
based on good clinical research that was being done, carefully analyze
it and extrapolate it to current clinical practice. With our current level
of knowledge and experience, we firmly believe there is no longer a need
to tell a patient "I can't give you an explanation for your losses"
and we are eliminating the need for the diagnosis of
unexplained infertility. We are confident that we can always give our patients an answer.
There is a great deal of technical content on this website that I have
written and it is constantly updated from my review and interpretation
of the current literature on reproductive immunology; although we treat
every single disorder that is related to recurrent pregnancy loss and
FISCP, I want to just take a brief overview for those of you who may find
it difficult to get through the reproductive immunology information posted
on this website.
Immune tolerance is the key word in reproductive immunology and it is what
the embryo must initiate to survive; this tolerance is also necessary
for the successful completion of the pregnancy. It seems the first step
that we have discovered is that special white blood cells in the uterine
dendritic cells sample the genes from the invading embryo and take this information to
the mother's lymph nodes where other cells are waiting for instructions.
If all the mechanisms are working correctly, then a group of special cells
called T regulator cells are produced in the lymph node and sent to the
uterine lining to protect the embryo from cells that would normally attack, such as
natural killer cells. These T regulator cells actually help to turn off most of the immune
response against the embryo, but if the dendritic cells present the genetic
information about the embryo to the lymph nodes in an inflammatory manner,
there are no T regulator cells produced. Instead, the inflammatory T cells
are sent to the uterine lining from the lymph nodes to assist in the attack
against the embryo.
There are many other mechanisms in this whole process of immune tolerance
that either help to achieve tolerance or to prevent tolerance from occurring
and hence lead to FISCP. Our extensive custom designed immune panel that
we developed here at Braverman IVF & Reproductive Immunology looks
at all of the immune cells involved in this process – not just a
cursory few. This is what gives us the depth of insight that we offer
to our patients to help them diagnose the problem and to offer treatments.
Our knowledge of the mechanisms behind immune tolerance has grown significantly
every year. The idea that one single cell alone, such as a natural killer
cell, can be analyzed to assess the risk for immune rejection is now outdated
and the recommendations for treatment must be based on the entire immune
panel that we provide. It is just as important to know who not to treat
at is to know whom to treat. Because of the enormity of the information
that is required to treat
immune complications, these treatments and managements should only be done at specialized centers
where the doctors have a strong background in the field of reproductive
Our website will keep you posted on all the latest developments in the
field of reproductive immunology. You can learn about what is on the horizon
through my monthly interviews with researchers in the field that we posted
on our reproductive immunology blog, where you will also find my continuously
updated review of our current knowledge in reproductive immunology. If
you feel you would like to speak to me, feel free to print out the consultation
form on the website then fax it to us or just call our office to schedule
a consultation. My reputation has always been based on two very important
principals that I adhere to strongly – always knowing the right
thing to do and always being willing to do it. I look forward to meeting you.