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Multiple miscarriage research

Jan Brosens is Professor of Obstetrics & Gynaecology at Warwick Medical School and University Hospitals Coventry and Warwickshire NHS Trust. His research focuses on the role of steroid hormone signalling in the human endometrium, especially in the context of prevalent reproductive disorders such as infertility, endometriosis and endometrial cancer. His major translational interest is focused on improving the management of miscarriage. We caught up with Jan to find out more about his work and what he enjoys most about it.

How did you come to work at Warwick and set up the Biomedical Research Unit in Reproductive Health?

Previously I worked as Professor of Reproductive Medicine at Imperial College London, with my research focusing on the lining of the womb and providing care for patients who had experienced multiple miscarriages.

In 2011, I was an external assessor on the interview panel for Professor Siobhan Quenby at Warwick. She was doing very similar work to me, but more focused on the clinical side of things. I thought this could be a great opportunity to work together and make progress in miscarriage research. Fortunately, I was given the opportunity of joining Warwick as well and in 2012 we were able to set up the Biomedical Research Unit in Reproductive Health, focused on helping women suffering from repeat miscarriages.

How common are miscarriages?

Miscarriage is the most common complication of pregnancy. One in seven recognised pregnancies end in miscarriage during the first trimester and 1-2% fail between 13 and 24 weeks gestation. When taking into account very early (unrecognised) losses, the true incidence of miscarriage is between 50-60% of all pregnancies. Repeat Pregnancy Loss (RPL) is a particularly distressing disorder that affects between 1 and 2% of couples trying for a baby. It’s these patients that our work is focused on.

How do you help these patients?

Our work focuses on researching the womb and understanding how endometrial cells affect the chances of a woman becoming pregnant and suffering from miscarriages. We routinely culture endometrial cells from individual patients, study these cells and conduct trials based on our research findings.

Our research has shown that in order to have a successful pregnancy, the lining of the womb must be ‘receptive’ to implanting the embryo but also ‘selective’. In women suffering from repeat pregnancy loss, the lining of the womb appears excessively receptive but insufficiently selective. This means many of our patients report that they find it very easy to become pregnant but then fail to hold onto the pregnancy.

The cause of miscarriage, especially in repeat pregnancy loss, therefore appears to lie in the preparation of the womb before pregnancy. Our work aims to develop tests to predict the likelihood of problems in a pregnancy before a woman becomes pregnant, and treatments to help those affected.

What do you enjoy most about your work?

It’s a highly rewarding career. I love being able to combine cutting-edge science with helping people. We see about 600 couples per year and given that we’ve been running our research unit for five years now, we must have seen around 3,000 couples since we launched. Of course not all of these couples will end up with a successful pregnancy, unfortunately, but I’d say we have been able to help the majority. We represent an important part of their journey to having a baby, and that’s a wonderful thought.

What do you think the future holds for your area of research?

I’m very excited about what the future holds. In 2016 we became part of the Tommy’s Centre for Miscarriage Research, bringing together different expertise from across the country and I’m confident that by working closely together with these colleagues, and making the most of new technologies, we’ll make significant progress.

Siobhan and I have built an exceptional team of talented and caring researchers, clinical fellows, midwifes and support staff. Working at Warwick has also enabled me to collaborate with researchers in other departments - such as Dr Sasha Ott in Computer Science, an expert in complex data analysis – meaning I can progress my research further than I was able to before. Through our collaboration with Professor Theo Arvanitis from the Institute of Digital Healthcare at Warwick, we are working hard to improve clinical care for miscarriage patients.

I’m looking forward to continuing these collaborations and hopefully, one day, reaching a stage where the vast majority of women affected by multiple pregnancy loss are able to go on and achieve a successful pregnancy. Women wishing to take part in our research should email Kerri Geraghty, the Secretary of the Biomedical Research Unit in Reproductive Health at University Hospital Coventry and Warwickshire NHS Trust.