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AGAIN, just because I'm posting about something does not mean it has anything to do with me!

Anyway, I get MedPage Today updates, sort of by accident, but I never turned it off because there's some good links in there pretty consistently. Today's link of interest was a long form piece on Mosaic that was absolutely not worth my time. The Medpage Today link promised science, and the first half was first person narrative of agonizing emotional experience. Then the next bit was the same-old-same-old on there isn't much to do about multiple miscarriages except in rare circumstances. And then _finally_ a few short paragraphs on the actual science. An unfulfilling tease!

But it did give me names to google and THIS summary is worth reading.

https://www2.warwick.ac.uk/fac/med/research/tsm/bru/miscarriageandmolecularsignals/

The basic idea is that we've recently discovered that nearly all fetuses have some kind of genetic "abnormality". So ... maybe it's not the fetus. Brosens and Quenby (those are some awesome names right there!!!) went looking at the lining, and discovered that women who have multiple miscarriages have uterine lining that is very receptive to implantation. Maybe a little _too_ receptive to implantation.

"Put differently, to be successful, the lining of the womb (endometrium) must be ‘receptive’ to implanting embryo but also ‘selective’. In RPL women, the lining of the womb appears excessively receptive (‘super-receptivity’) but insufficiently selective. Hence, many of our patients report that they find it very easy to become pregnant (‘super-fertile’) but then fail to hold onto the pregnancy."

So far, so good -- matches one of the folk theories of miscarriage okay.

"we showed that IL-33/ST2 activation is both prolonged and disordered in endometrial cells from RPL patient. As aforementioned, exposure of mice uteri to these signals prolonged the implantation window in these animals, allowing out-of-phase implantation and resulting in early pregnancy loss."

So they've identified some of the biochemistry of the dance of implantation, and identified at least one major issue with it in women who have repeated miscarriages. AND THEY CAN DO THIS TEST BEFORE YOU EVER GET PREGNANT AT ALL. Which is pretty amazing, right there. " it is possible to develop tests that predict prior to conception the likelihood of pregnancy complications."

The future holds wonderful prospects! They are hoping their work on the womb's side of the pregnancy developmental process might also lead to insights into fetal growth restriction and preeclampsia. That might be a little optimistic, but I'm so happy that smart people are tackling another component of this complicated and super important area of research.

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