FOR more than a century, medical researchers have known that miscarriage is rarely preventable and is instead usually due to chromosomal abnormalities in an embryo. In recent decades, it has also become clear that miscarriage is very common: as many as one in five known pregnancies ends this way. That figure goes up as we get ever better at detecting pregnancy from its very first stages. It is now estimated that, among women in their early 20s, half of pregnancies end in miscarriage. This proportion rises with age.
No small effort has been made by medical organisations and advocacy groups to raise awareness and improve education around early pregnancy, but the notion that miscarriage is rare – or is somehow the woman’s fault – still widely persists. Not only do surveys consistently show that many women blame themselves for a pregnancy loss, but some societies heap blame upon them as well. That only exacerbates the intense grief and trauma that women and their partners can feel after a pregnancy loss.
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However, conveying to women – let alone society more broadly – how misplaced this notion of blame truly is hasn’t been easy, or straightforward. That is partly because, until recently, studying the very earliest stages of pregnancy, to better understand what is happening down at the molecular level, was physically complicated and ethically fraught.
“Advances in fertility medicine reveal that miscarriage has actually served a fundamental role in our evolution”
Now, thanks to advances in fertility medicine, we are getting a more detailed understanding of how a developing embryo sends and responds to signals from the lining of the uterus, as well as learning more about the intensive vetting process that each embryo must go through (see “The real reasons miscarriage exists – and why it’s so misunderstood”).
These insights reveal that miscarriage has actually served a fundamental role in our evolution – and even indicate that, surprisingly, women who experience multiple miscarriages may actually have optimal maternal fitness.
This revolution in our understanding of miscarriage has implications for the options available not only for those people trying to conceive, but also those coping with a loss.
