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  What Do We Do?

Welcome to our website. Nora was founded in late 2003 by Dr. Darryl Carter, who recognized many years ago while on faculty at The Johns Hopkins School of Medicine that there was a large gap between what was known about the functioning of the immune system in pregnancy and what was being made available to patients who were suffering from recurrent miscarriage and In Vitro Fertilization (IVF) implantation failure. Under Dr. Carter's leadership, Nora conducts research and offers testing and treatment to patients suffering from immune-mediated recurrent miscarriage or repeated IVF implantation failure. We are attempting to create a medical environment where the most recent scientific and medical advances in the field of reproductive immunology are brought out of the laboratory and into the clinical arena.

Nora offers a very sophisticated testing panel that helps doctors and patients accurately evaluate the levels of Th1 and Th2 category cytokines in a woman's immune system. Proper balance and interplay between these cytokines is well known in the immunologic community to be integral to successful pregnancy. Doctors and patients interested in ordering our Cell Mediated Immunity Panel, should click on How Do I Start? Dr. Carter has also developed a treatment procedure that reconditions a woman's immune system in a fashion that is conducive to successful pregnancy. The treatment procedure is a modification of a widely used procedure that is well known to have a very favorable safety profile.

Nora is located in Baltimore, Maryland, and is run by Dr. Darryl Carter, formerly of the The Johns Hopkins Hospital and The Johns Hopkins School of Medicine. Dr. Carter has followed developments in reproductive immunology closely for the past decade. Over those years, he realized that there was a great deal of misunderstanding regarding miscarriage. He also realized that some of the more recent discoveries in the field of reproductive immunology could take many of the elements of chance out of the reproductive equation and that those advances were not being provided to the public at large.

If you have any questions or comments, contact us at any time. Please also feel free to sign up for our periodic emailed newsletter, which will address recent advances in the medical community's understanding of miscarriage and the immune system. Thanks for visiting.

Where Should I Go From Here?

Our website is purposefully replete with information regarding not only our own advances in the treatment of miscarriage but also information regarding other tests and treatments that couples might want to evaluate critically. We encourage you to take advantage of the information compiled here and to see if you might be someone who could benefit from our novel battery of tests and our treatment procedure.

The website is navigated primarily through the navigation bar at the top of the site. Here is a brief description of the content associated with each of the navigation choices:

  • About Us - Dr. Carter's background as well as Nora's commitment to changing the status quo in the testing and treatment of recurrent miscarriage and IVF implantation failure.
  • Reproductive Immunology - A brief description of the Th1/Th2 immunologic paradigm as it applies to recurrent miscarriage and IVF implantation failure.
  • Testing - This portion of the site is split into two sections. One section discusses Nora's testing panel (Cell Mediated Immunity Panel). The other section discusses critically many of the more common immunologic testing batteries.
  • Treatment - This portion of the site is also split into two sections. One section describes Nora's treatment procedure (The Carter Procedure). The other section assesses the positives and negatives of many of today's more common treatment protocols.
  • How Do I Start? - Instructions for ordering testing from Nora or for contacting Nora to discuss treatment alternatives.

Please also participate in our discussion board if you would like to share with and learn from other interested people.

An Overview of Recurrent Miscarriage

Over a million women aged 15-44 suffer from recurrent miscarriage in the United States alone. We estimate that every year slightly fewer than 10% of those women are actively engaged in trying to conceive and bear children without success. For these women, miscarriage is a frustrating and repetitive outcome of pregnancy. Recurrent miscarriage is defined formally by the American College of Obstetrics and Gynecology (ACOG) as three or more miscarriages within the first 20 weeks of gestation, and not necessarily consecutive. The risk of miscarriage after two miscarriages is statistically very high; therefore ACOG recommends testing to determine the cause of the miscarriages after the second one, especially if the mother is over 35 years of age.

The standard testing battery includes an examination of the parents' chromosomes because abnormalities of parental or maternal chromosomes can be inherited by the baby and can result in fatal genetic abnormalities in the embryo/fetus (the baby is referred to as an embryo through the 8th week of gestation, after which time the baby is called a fetus). The standard battery will also generally include imaging studies to assess the anatomy of the uterus and fallopian tubes and will assess whether the mother's body provides the proper hormonal environment to support a pregnancy, which usually involves an endometrial biopsy during the luteal phase of the menstrual cycle. A thorough standard testing battery should also include blood tests for thyroid function and blood clotting. Unfortunately, this standard test battery establishes a specific cause of recurrent miscarriage in far less than half of all cases.

For over two decades, some problem with immune system has been suspected to be responsible for many cases of recurrent miscarriage. Recent research indicates that those suspicions were correct. It appears now that many cases of recurrent miscarriage are due to an imbalance in the mother's immune system. Fortunately, recent advances in testing technology and in our ability to rebalance the immune system are available today. It is on the basis of these recent advances that Nora tests and treats its patients.


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