Hello, my name is Dr. Andrea Vidali. I am the Medical Director & Master Endometriosis Excision Specialist here at BRI Reproductive Immunology & Endometriosis Surgical Center. You have most likely come to this website because you have been suffering from endometriosis, pelvic pain, 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 implantation.
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 cavity called 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 immunology.
If you feel you would like to speak to me, simply request a consultation by going to our Surgical Landing Page