New womb lining test can help women who have miscarriages, UK scientists say
They say the findings are set to pave the way for new treatments for some women who experience recurrent pregnancy loss.
Researchers said they discovered that miscarriage risk can be traced back to a problem with the womb lining before pregnancy, after previous studies mostly focused on the quality of the embryo, overlooking the role of the womb.
Around one in six pregnancies are lost, mostly before 12 weeks, and each miscarriage increases the risk of another pregnancy loss.
Pregnancy and baby charity Tommy's said the discoveries are set to provide explanations for pregnancy loss as well as treatments to prevent the 'trauma and devastation of recurrent miscarriage'.
Lead author Dr Joanne Muter said: 'This is about identifying preventable miscarriages. 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.'
The study – led by the University of Warwick and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust with funding from pregnancy charity Tommy's – was published in Science Advances on Thursday, after over 1,500 biopsies from more than 1,300 women were analysed.
The team found that an essential biological process called the 'decidual reaction', which prepares the womb lining for pregnancy each month, often does not progress properly in women with a history of miscarriage. This creates an unstable environment that, while still allowing embryos to implant, increases the risk of bleeding and early pregnancy loss.
The scientists have consequently developed a test that can measure the womb lining response, which is being piloted to support more than 1,000 patients at Tommy's National Centre for Miscarriage Research at UHCW.
Senior author Professor Jan Brosens said: 'It is well-established that chromosomal errors in embryos account for the rise in miscarriage rates in women older than 35 years. This study shows that each miscarriage increases the risk of an embryo implantation in an abnormal womb lining, regardless of age.
'Thus, the frequency of one of two events – abnormal embryo or abnormal decidual reaction – happening over hundreds of menstrual cycles determines the likelihood of miscarriage in each individual woman. Importantly, we now have the tools to screen for the risk of preventable miscarriage and to evaluate treatments that improve the womb lining before pregnancy.'
Holly Milikouris, who has had five miscarriages, described the new test as 'life changing'.
After it was revealed that her womb lining prepared abnormally for pregnancy, she underwent treatment and went on to have two healthy children, three-year-old George and 17-month-old Heidi, with her husband Chris.
Ms Milikouris, a civil servant from Cheshire, said: 'My miscarriages were all 'missed', which means there were no symptoms to let us know there was a problem. We found out when I went for a scan and a grew to dread having scans.
'We felt lost and were beginning to accept that I might never successfully carry a pregnancy. The treatments that typically can help women who have experienced miscarriages hadn't worked for us and each time we tried again we felt like we were rolling a dice with the baby's life.
'Being given the opportunity to take part in this trial was life changing. For the first time the results of my biopsy were normal, and we went on to have not one, but two successful pregnancies. We will never be able to thank Professor Brosens enough and are hopeful that the results of this groundbreaking study will help many other families.'
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