**From Five Miscarriages to Unanswered Questions: My Journey Through Loss**

An insidious side effect occurs when no one can explain to you why you cannot stay pregnant . When miscarriage follows miscarriage – four in a row, in my case – your mind turns against you.

Without answers, all that frustration, your desperation to be a parent, and the need to not feel utterly powerless has to go somewhere. It’s easy – almost inevitable – to blame yourself for your body’s inability to nurture a baby; your apparent inhospitability.

I became obsessive about salmon, broccoli, and which herbal teas were “safe” (because it wasn’t enough to simply cut down on caffeine). I stressed myself out if I walked past someone smoking. I tried acupuncture, reflexology and increasingly expensive prenatal supplements.

Like most people who lose a pregnancy – especially when it happens in the first trimester, before 12 weeks – I was offered no medical explanation. The first time it happened, in 2017, much to my surprise no one actually bothered to look for one.

By my fourth miscarriage, two years later, and following a protracted round of investigations involving a battery of blood tests and internal scans of my womb and ovaries, the verdict was that everything was perfectly normal. It was a perversely devastating diagnosis, in the circumstances.

Modern medicine’s best, evidence-based answer for me? Try, try, try again.

This week, scientists at the University of Warwick and University Hospitals Coventry and Warwickshire NHS Trust have found that abnormal reactions in the womb lining could be an identifiable – and preventable – cause of miscarriage. It’s a rare beacon of hope in what can otherwise feel a bleak landscape.

The new research, published in the journal Science Advances , shows that in some women with a history of miscarriage, cells in the womb lining, which undergo a transformation each menstrual cycle to prepare to receive an embryo, don’t always adapt in the way they should. Either the cells don’t transform fully in time or they’re dysregulated, meaning that while the embryo still implants, a pregnancy cannot be supported, leading to bleeding and miscarriage.

A key piece of the miscarriage puzzle

Even more positively, based on their analysis of 1,500 biopsies from the womb linings of 1,300 women, the researchers were able to develop a new diagnostic test that can predict who may be more at risk of miscarriage as a result. Those women who are identified could then be given drug treatment to alter the way the cells in the womb lining behave, and prevent the loss of their baby.

The researchers, whose work is funded by the charity Tommy’s, described their findings as a “key piece of the miscarriage puzzle”.

As an estimated one in four will learn the hard way, a miscarriage before 12 weeks is almost always presumed to be random bad luck ­- the result of chromosomal abnormality that means a pregnancy could never survive. This means the rather fatalistic assumption that still underpins most miscarriage care today is that there’s simply nothing that can be done.

This is why you will not, currently, qualify for any sort of testing on the NHS until you have had at least three losses in a row. Even once you’ve crossed this threshold, specialist recurrent miscarriages clinics are few and far between ­- often with long waiting lists.

I have never had the lining of my womb tested – so the possibility that this new test could finally offer an explanation is undeniably tantalising.

Not all miscarriages are the same

But there’s another reason this new research feels so hopeful to me – and that’s because it attempts to distinguish between types of miscarriage: at its core there’s a recognition that not all miscarriages are the same and that they likely do not all have the same underlying cause.

This means that while some losses will, sadly, not be preventable – others will be.

As the lead researcher Dr Joanne Muter put it: “Many women are told they’ve just had ‘bad luck’, but our findings show that the womb itself may be setting the stage for pregnancy loss, even before conception takes place.”

Read Next: I had a miscarriage at 11 weeks – a baby loss certificate would have helped me

Something people like me, who go through miscarriage over and over, instinctively feel is that they must be having a particular “kind” of miscarriage, with their losses seeming to follow a pattern – a pattern that may be different to someone else who also loses pregnancies repeatedly.

In my case, the broad pattern has been that everything seems fine at six weeks, the earliest point at which you can have an ultrasound scan. My husband Dan and I have seen the flashing, flickering dot signifying a healthy heartbeat in three of my pregnancies that ended in a miscarriage.

However, again and again, we’ve then walked into a further scan, two weeks later, only to be told that that encouraging flash of light has been extinguished.

What no one can say yet ­- although this study perhaps takes us an inch closer – is what exactly such patterns may signify, or whether they are a clue as to the right treatment that will, ultimately, keep a pregnancy going.

Figuring out which drugs can most effectively improve the womb lining reaction will be the next phase of the Warwick research. One option is a repurposed diabetes drug called sitagliptin, which previous research has found can increase the number of stem cells in the womb lining and decrease inflammation, potentially making it more pregnancy “friendly”.

I now have a son – but at 39, do not feel ready to try again

While there are things that can and do help some people who have had multiple miscarriages, such as progesterone and various blood-thinning medications, a 2021 review published in the Lancet medical journal concluded there isn’t any treatment for preventing miscarriages that has high-quality evidence behind it.

Without the prospect of a treatment that might plausibly make a difference, it can be almost impossible to believe any subsequent pregnancies will end in anything but another loss. After multiple miscarriages, you experience pregnancy as merely waiting – waiting for blood, waiting anxiously for the next scan, waiting for more bad news.

In hindsight, I don’t think I truly let myself believe I would have a living, breathing baby, until the moment my son was born, in 2020. When I became pregnant that fifth time – in 2019 – my doctors agreed to let me try taking progesterone (a hormone known to be vital to pregnancy), which at the time was not standard practice. (The NICE guidance would later change in 2021, following new trial results – progesterone should now be prescribed for anyone who starts bleeding during pregnancy if they’ve had at least one previous miscarriage. It’s been estimated that this could lead to 8,450 more births each year.)

Unfortunately, when it came to trying for a sibling for our son, in 2023, when he’d just turned three, I had a further, fifth miscarriage. This was despite taking progesterone just as I had before in my one, successful pregnancy. I have not felt ready to give it another roll of the dice since.

And this is the final thing to say about promising new research like this: it can be bittersweet. Because, while NHS decision-makers are being urged to consider adopting the womb test nationwide based on the Warwick pilot trial, in all likelihood, it will be too late to make a difference to me.

Likewise, it may be years before a drug like sitagliptin is available as a mainstream treatment to prevent miscarriages.

I don’t have years. I will be 39 in a few months. A hard reality I am starting to accept is that I will probably never know the reason for my miscarriages.

Perhaps my solace will have to come from knowing that this latest research – and the further breakthroughs it inspires – may well mean a future generation will never have to know the intense uncertainty and self-recrimination that comes with living in a body that cannot be explained to you: a body that keeps rejecting the thing you want most. It’s almost enough – almost.

‘ Life, Almost: Miscarriage, misconceptions, and a search for answers from the brink of motherhood’, by Jennie Agg, published by Transworld, is out now