Myths abound as to why women experience recurrent miscarriages. Often factors like stress, too much exercise, being too thin or too fat, exposure to environmental toxins, and bad habits like smoking or drinking too much coffee are the common issues to blame. Affected couples, often desperate for a solution, sometimes grasp at unproven or useless remedies. What they need instead is factual information, emotional support and, if possible, treatment based on a medically established cause.
However, a report released by the American College of Obstetricians and Gynecologists (ACOG) shows that although a common concern of patients, environmental factors rarely have been linked to sporadic pregnancy loss, and no associations between environmental factors and recurrent pregnancy loss have been established.
“Miscarriages are not uncommon and are believed to occur with as many as 1 out of every 4 pregnancies,” says Dr. Jeffrey Braverman, Reproductive Immunologist & IVF Specialist and Founder of Braverman Reproductive Immunology in New York. “Often the woman will miscarry very early in pregnancy, sometimes even before she knows that she has conceived.” According to Dr. Braverman, although many women experience one or two losses, most are able to conceive a child that is carried in a healthy pregnancy to term. However, in cases of recurrent pregnancy losses women continue to miscarry over and over again with each pregnancy.
Although genetic abnormalities of the embryo are identified as the cause for 60 percent of these cases, it’s not necessarily true once the heartbeat is detected. Dr. Braverman advises patients who have not gotten pregnant with high quality embryos, those who have experienced miscarriage of a genetically normal fetus or have suffered a loss after the heart beat has been detected, and those with a family history of auto-immune diseases and miscarriage to seek a consultation with a reproductive immunologist, or fertility doctor who specializes in immunologic causes of infertility.
“Patients usually come to our center after multiple miscarriages and unsuccessful treatment elsewhere,” says Dr. Braverman. An internationally known and respected physician, Dr. Braverman specializes in the treatment of recurrent miscarriages and reproductive immunology. “There are different types of miscarriage, different treatments for each, and different statistics for what your chances are of having one. Most miscarriages occur during the first 13 weeks of pregnancy. Pregnancy can be such an exciting time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed about the causes and treatments of recurrent miscarriages.” For more than 20 years, Dr. Braverman has been treating patients with all complications related to Recurrent Pregnancy Loss and has become one of the world’s leading authorities in the field Reproductive Immunology.
Dr. Braverman adds, “Today, we know a great deal about the exact workings of the immune system and how it affects a pregnancy. In fact, the mother’s immune system plays a critical role in the acceptance of an embryo. At Braverman Reproductive Immunology, we evaluate patients for immune related miscarriages as well as all other possible causes of miscarriages.”
Immune Disorders & Recurrent Miscarriages
Immune disorders are a hot topic in reproductive medicine these days. Your immune system is made up of a large network of cells, tissues, and organs working together to fight off germs and infections and respond to allergens in the environment. But the immune system doesn’t always work the way it should.
In some immune system disorders, the immune system can't fight off infections. In other disorders, it incorrectly identifies parts of the body as a threat and attacks the body’s cells the same way it would attack an invading germ. Allergic reactions fall to one side of this spectrum, with life-threatening diseases like lupus and multiple sclerosis at the other end of the scale. What happens in all of these disorders is that the immune system loses its ability to discriminate between “safe” and “harmful.”
Some couples trying to conceive may be diagnosed with immunologic incompatibility, or allogeneic issues, which are detrimental to their fertility. Genes from both of the parents that are passed on to their growing embryo may not properly communicate to the mother’s immune system and her body may mistake the embryo as a foreign invader. As a result, the embryo may not implant or may miscarry.
“Many doctors assume the cause of miscarriages is genetic or chromosomal abnormalities dismissing all other possible causes and in many cases putting the mother through unnecessary repeated episodes of pregnancy loss,” says Dr. Braverman.
According to Dr. Braverman, identifying the root cause is the crucial starting point in miscarriage prevention. “If we know that immune disorders are causing a woman to miscarry, there are preventive measures we can take. It’s precisely when an embryo is chromosomally normal that we need to look at the maternal immune system. Her immune system needs to be investigated as a cause.”
Diagnosing Immunologic Infertility
A number of factors can impact a woman’s ability to carry a healthy pregnancy. Predisposition to immunologic abnormalities such as autoimmune disease, abnormal development of ‘inflammatory’ cytokines in the mother’s blood, elevation of activated immune cells, immune response to proteins in sperm, or failure to generate protective cells that a mother makes when pregnant can be associated with improper immune tolerance in the mother for the embryo. Celiac disease, Crohn’s disease, Multiple Sclerosis, Polycystic Ovarian Syndrome (PCOS), Endometriosis and Lupus are all examples of conditions that can lead to rejection of an embryo if not properly treated. Stress and dietary factors may also play a role in the mother’s immune tolerance of the pregnancy.
Preventing Immune Disorder Related Pregnancy Loss
Dr. Braverman says patients who suffer from recurrent miscarriages should first be sure there are no genetic causes of the miscarriage. “By identifying the likely source of the problem, treatments can be given that help to correct them. The goal is trying as much as possible to assist in the immune tolerance that must be created. Most important is that we have ruled out genetic issues as the only cause for the failures and miscarriages. Once this is done we can focus on the immune system as one of the most likely causes of the failures or losses,” says Dr. Braverman. Without generating immune tolerance in these patients, the immune system will attack the embryo much like an organ transplant patient who suffers rejection of the organ and this can occur at any time during the pregnancy.
About Dr. Jeffrey Braverman and BRAVERMAN Reproductive Immunology
Dr. Braverman is the founder and Medical Director at Braverman Reproductive Immunology with offices in Long Island and Manhattan. An internationally known and respected physician, Dr. Braverman specializes in the treatment of recurrent miscarriages and reproductive immunology.
Dr. Braverman was honored as the youngest graduate at New York University where he was accepted at the age of 14. He went on to attend Medical School at The Mount Sinai Medical Center in Manhattan and completed his internship and residency at the Albert Einstein School of Medicine in New York.
After completing his residency Dr. Braverman established a private medical practice in Long Island New York. For more than 20 years, Dr. Braverman has been treating patients with all complications related to Recurrent Pregnancy Loss and has become one of the nation's leading authorities in the field Reproductive Immunology. He has managed thousands of cycles of IUI and IVF with a large majority of his patients suffering from Recurrent Pregnancy Loss and Failure to initiate and Successfully Complete a Pregnancy (RPL and FISCP). He has consistently maintained one of the highest success rates in New York despite the complexity of his caseload. For the last three years in a row, his practice was voted the Best Infertility Practice on Long Island in an independent poll conducted by the Long Island Press.
Dr. Braverman has published articles in the field of high risk obstetrics related to IUGR, Gestational Diabetes, and Fetal Distress and has gained unequaled experience managing as well as delivering this High Risk group of patients. In fact Dr. Braverman has delivered well over 5000 babies in his career. He has been featured with his RPL autoimmune patients on Discovery Channels Baby Story, local TV news stations, and has hosted numerous radio shows on reproductive immunology and fertility.
He assists and consults with patients from around the world with problems related to RPL and FISCP. He has designed the most complete panel for the diagnosis and management of immune related pregnancy complications, as well as one of the most comprehensive thrombophilia (blood clotting) panels available. He is currently assisting in designing a computer chip that will test DNA for most of the known genetic defects (hundreds) associated with RPL. He assisted in the Fertility Project for the development of nutritional supplements now used for the treatment of RPL and FISCP.
His current office staff has all been part of this practice for at least 20 years and most, longer than that. This has also been one of the most important elements in maintaining our consistency. You will always get someone knowledgeable when you call the office. Dr. Braverman performs all his own consults and sonograms. You will never get a "fill in "when you call for a consult or come in for a visit. He manages every case from start to finish. Most have is cell phone number and email and feel free to contact him with any questions. Many of Dr. Braverman's patients from around the country learn about him in numerous immunology and fertility chat rooms on the Internet, where he has developed a loyal following.
Dr. Braverman is a member in good standing with the American Society of Reproductive Immunology, the American Society of Reproductive Medicine, the European Society of Reproductive Immunology, the American College of Obstetrics and Gynecology, the New York State Medical Society, the Nassau County Medical Society and is actively Board Certified from the American Board of Obstetrics and Gynecology.