From Publishers Weekly
Frustrated by wildly differing explanations for his wife's four lost pregnancies, award-winning science writer Cohen (Shots in the Dark: The Wayward Search for an AIDS Vaccine) set out to understand miscarriage, a subject fraught with misunderstanding, controversy and emotional pain. Writing in an impressively sensitive and balanced tone, Cohen describes the dynamics of human female egg production, the signs of an impaired fetus, the impact of odd numbers of chromosomes, the relevance of a woman's age and the efficacy of a range of medical interventions designed to help women carry a baby to term. Integrated into this highly readable narrative are the moving stories of numerous couples whose hopes for a child have been repeatedly thwarted by miscarriage. Cohen also gets candid scientific opinions from leading researchers in the field and provides intelligently skeptical and illuminating guidance on some of the more controversial treatments, from lymphocyte immune therapy to the use of progesterone to treat luteal phase deficiency. Looking back, he draws cautionary lessons from the popular miscarriage treatment of the 1950s, diethylstilbestrol (DES), a synthetic estrogen now known to cause cancer in female offspring. This enlightening and comprehensive study is a must read for any woman battling the emotional roller coaster of miscarriage and for all those interested in an underexplored area of pregnancy and women's health. Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From Booklist
After Cohen and his wife suffered multiple miscarriages, he decided to research miscarriage, a topic about which little is commonly known. He found that the medical community offers surprisingly scanty information about what causes what is also called spontaneous abortion. He spoke with more than 100 women, interviewed dozens of medical and scientific experts, and pored over pages of data. What he learned, as presented in this sensitively written, reader-friendly book, is both frustrating and encouraging. Despite hundreds of so-called miracle treatments and tricks, for which hopeful couples pay dearly, experts confess that no one can say with any certainty what causes and, more important, what might prevent most miscarriages. Hence, Cohen cautions against accepting the unsubstantiated claims of well-meaning practitioners. On the other hand, statistics show, he says, that the odds of a woman who has suffered several miscarriages carrying a fetus to term inexplicably increase with each miscarriage. A valuable resource. Donna Chavez
Copyright © American Library Association. All rights reserved

Review
"Impressively sensitive and balanced . . . This enlightening and comprehensive study is a must read."

Book Description
After his wife lost four pregnancies, Jon Cohen set out to gather the most comprehensive and accurate information on miscarriage – a topic shrouded in myth, hype, and uncertainty. The result of his mission is a uniquely revealing and inspirational book for every woman who has lost at least one pregnancy – and for her partner, family, and close friends. Approaching the topic from a reporter's perspective, Cohen takes us on a surprising journey into the laboratories and clinics of researchers at the front, weaving together their cutting-edge findings with intimate portraits of a dozen families who have had difficulty bringing a baby to term. Couples who seek medical help for miscarriage often encounter conflicting information about the causes of pregnancy loss and ways to prevent it. Cohen's investigation synthesizes the latest scientific findings and unearths some surprising facts. We learn, for example, that nearly seven out of ten women who have had three or more miscarriages can still carry a child to term without medical intervention. Cohen also scrutinizes the full array of treatments, showing readers how to distinguish promising new options from the useless or even dangerous ones. Coming to Term is the first book to turn a journalistic spotlight on a subject that has remained largely in the shadows. With an unrelenting eye and the compassion that comes from personal experience, Jon Cohen offers a message that is both enlightening and surprisingly hopeful.

Excerpt. © Reprinted by permission. All rights reserved.
Chapter 1Not ViableOn a brilliant, warm San Diego saturday in the spring of 1996, my wife, Shannon, had her first miscarriage.Our baffling, heartbreaking journey into the world of what doctorscall "spontaneous abortion" began with a phone call. We were having alazy brunch with my parents on our front porch, pine trees shading us,the Pacific Ocean visible in the distance. Our daughter, Erin, nearly six,was chattering with her dolls in the pine needles. Paging my way throughthe newspaper, I struggled to dodge conversation with my folks, whowere visiting for the weekend and would rather talk than read. Then thephone rang, and Shannon excused herself to answer it.Shannon is close to my parents, but had grown weary, as had I, of mymother"s well-meaning but insensitive probing about our reproductivestatus. Any luck? my mother would ask, month after month, noting that acousin of mine recently had succeeded with in vitro fertilization. You reallyshouldn"t wait. You really should have started earlier. Maybe you should see aspecialist. Maybe there"s something wrong with your sperm. Maybe you should do IVF. I"ll help you pay for it. You two should have another. It"s a shame. For Erin"s sake. She shouldn"t grow up alone. My kids always had each other to play with.There must be something you can do.So it was with great delight that a week earlier, we had Erin phone mymother and tell her that Shannon, then thirty-seven, was pregnant. Shewas only four weeks along, too early to see anything with an ultrasoundscan, but a blood test already had confirmed the positive urine test we haddone at home. We even had a due date. My mother squealed, reallysquealed, with joy. She advised us not to tell anyone else until the baby wasthree months along, but at every opportunity she exclaimed, "Finally!"A few days after sharing the news, we drove to Los Angeles forPassover dinner at my aunt and uncle"s house. Erin had already leakedthe news to her cousins, and because Shannon"s pregnancy with Erin hadgone so smoothly, we ignored my mother"s warning, celebrating ourgood fortune with all fifty of my relatives. Shannon also confided to myuncle, a doctor, that she had been spotting blood, but that her obstetricianhad said it was common and usually means nothing. My uncleagreed. "Everything is probably going to be fine," he said.Shannon"s spotting continued, and we read everything we could findto help us understand first-trimester bleeding, which doctors often referto by the frightening phrase "threatened abortion." Sometimes, when theembryo implants itself in the uterus it causes bright red bleeding for afew days. But this blood was brown and had continued staining Shannon"sunderwear for several days. Sometimes, bleeding occurs after intercoursebecause hormonal changes make a pregnant woman"s cervixmore exposed and delicate. Some women spot throughout their pregnanciesfor no known reason and without any harm to the child or themother. Depending on whom you believe, 15 percent or 25 percent or 35percent of women spot during their pregnancies and 25 percent or 35percent or 50 percent of these women miscarry.Obstetricians sometimes prescribe bed rest to prevent miscarriages,but most often they do nothing. In part, the reluctance to intervene comesfrom the diethylstilbestrol fiasco that surfaced in the 1970s. More commonlyknown as DES, this synthetic form of the hormone estrogen waswidely used as a miscarriage treatment in the 1940s and 1950s. Reportsbegan to surface in the 1950s that questioned whether DES might actuallyincrease miscarriage rates, but the drug remained popular into the1960s. In 1971, following a report that linked DES to a rare vaginal cancerin female offspring of mothers who took the drug, a bulletin from theU.S. Food and Drug Administration urged doctors to stop prescribingDES to pregnant women. Subsequent studies have found that DES causedinfertility in exposed female children, genital abnormalities (of uncertainconsequence) in both males and females, and may also have increasedbreast cancer in treated mothers. Recently, concerns have surfaced aboutthe health of DES grandchildren.The day we returned from Los Angeles, Shannon saw her obstetrician,who took a blood test. A six-week-old embryo should secrete increasinglevels of the hormone human chorionic gonadotropin, or hCG.Home pregnancy tests turn positive when a woman"s urine contains ahigh enough concentration of hCG. The hCG keeps a pregnancy viableby telling the body to keep producing two other hormones, progesteroneand estrogen, which help prepare the wall of the uterus for implantationand prevent menstruation. The doctor told Shannon that if the embryowas healthy, hCG levels should double every two to three days.The phone call that Saturday morning was the doctor. "I"m reallysorry to tell you this, but your numbers have plateaued," the doctor toldShannon. "It"s not viable. You"re going to miscarry within twenty-fourhours."An ashen Shannon returned to the porch, and pulled me aside. Shewhispered through suppressed tears, "Ask your parents to leave." Shannonthen went inside and fell on the sofa, forming a ball.That afternoon, the intense cramps of labor walloped Shannon. Byevening came the heavy, seemingly endless flow of blood that marks afirst-trimester miscarriage.Human beings are notoriously inefficient baby makers. A woman who istrying to become pregnant will succeed, on average, one out of every fourmenstrual cycles. According to a landmark study published in 1988, 31percent of pregnancies end in miscarriage. So for each menstrual cycle,a sexually active woman not using birth control has less than a 10 percentchance of carrying to term. It is a wonder that we have an overpopulationproblem.Shannon and I had never thought much about fertility. We quit usingbirth control when Shannon was thirty-one (I"m five months younger),and she became pregnant in her first cycle. I announced our good newsat my office, stupidly joking about how all I had to do was look at Shannonand she became pregnant. A woman I worked with excused herself.Later, she told me that she and her husband were having fertility prob-lems. I learned fertility lesson number 1: your good news is not necessarilygood news to others.Shannon"s first pregnancy progressed precisely as described in thestack of new books cluttering our coffee table. We marveled at each ultrasound scan, thrilling at the window into the womb and each discerniblehuman feature of our creation. When the doctor put a microphoneon Shannon"s belly, we delighted to the sound of our baby"sresonant heartbeat. At the baby store we bought not just a crib but, in ajoyous moment that underscored how certain we were that everythingwould be fine, a beach chair for a one-year-old.Everything was fine. Erin was born in Washington, D.C, at ColumbiaHospital for Women, with ten toes, ten fingers, and no complicationswhatsoever. When we wanted another child, we figured, we would stopusing birth control again.We didn"t want another child right away. We both had demanding careers,and we also wanted to return to our roots in California beforeadding to our family. And four or five years between kids seemed like theright spread, a chance for each child to enjoy our full attention.In 1994, back in California, we rented a house with an extra bedroomand abandoned birth control again. A few months went by, but no pregnancy.The ob-gyn said not to worry: Given that Shannon was five yearsolder, the odds of becoming pregnant in a single menstrual cycle haddropped from 25 percent to 10 percent. In a year"s time, then, she shouldbe pregnant.But after a year, we began to suspect that something was wrong.Maybe it was me. I take a steroid, from time to time, to treat ulcerativecolitis. Or maybe it was Shannon. She takes strong drugs for her migraines.Or Shannon"s eggs. Or my sperm. Maybe we should see a fertilityspecialist. Maybe we should listen to my mother and try in vitrofertilization. Weighing these possibilities wore us down. Each of us feltguilty for secretly hoping that the other person"s body had caused theproblem. We worried that seeing a specialist would open a floodgate ofexpensive, painful, and often futile interventions. Yet as the monthspassed, I found myself lobbying for that option.All that friction disappeared of course in the spring of 1996. Reliefwashed over us when Shannon tested positive. But the miscarriage thatfollowed mocked us, illustrating how naïve and overconfident we hadbeen about our fecundity.Six months later, more frustrated still, Shannon agreed to see a specialistpraised by a friend. At our first meeting, this likable doctor expresseddismay about what she saw as our casual approach to thepregnancy dance. "You"re subfertile," she said. A woman"s "fertility window"begins to shrink dramatically at thirty-five, she explained. Wethought our odds would plummet after we turned forty, not thirty-five. The"subfertile" label chagrined us. I, in particular, wanted to read the scientific evidence behind the doctor"s claims, which seemed to annoy her.At the specialist"s suggestion, Shannon started taking Clomid (clomiphenecitrate), a fertility drug that stimulates an egg to mature andmove to the surface of an ovary, the process known as ovulation. And onthe doctor"s advice, I had my sperm checked. Normal count, the lab said,but their swimming skills, daintily referred to as "motility," did not impress.After a few cycles on Clomid with no success, we upped the antewith intrauterine insemination.On the carefully chosen day based on Shannon"s ovulatory cycle, shedrove Erin to school in the morning, providing me with a few minutes todeposit my seed into a sterile container before our doctor"s appointment.But shortly after Shannon left, a magazine editor phoned me with deadlinequestions about one of my stories. When Shannon returned, the containersat empty. She was livid. "I can"t believe this," she said. "I have toput my body through torture, and you can"t even do the one thing youhave to do. You"ll do it on the way.""I can"t do that," I said."Get in the car," she fumed.So as we drove along the freeway, I tried to do my thing, but, well, it"snot easy when your wife is giggling at you and you"re cruising down theinterstate, a pea coat over your lap, in clear sight of other morning commuterssipping their coffee. As we exited the freeway fifteen minuteslater, I still hadn"t made much progress."Damn it, do it!" barked Shannon. Somehow, I did, and just as I did,I noticed a guy riding a bike staring at me.We dropped off the container at the clinic and went out for breakfastwhile the lab prepared my sperm for the procedure. When we returned,Shannon changed into a flimsy hospital gown and lay down on the examiningroom table. The doctors drew my sperm into a syringe and coupledit to a catheter. A team of nurses and I watched as a doctor wiggledthe catheter up to Shannon"s cervix and pushed the syringe plunger,sending my sperm on the journey to find one of her eggs. This isn"t makinglove, I thought. It"s making babies. The insemination failed. I was notsurprised.We tried intrauterine insemination again at the peak of Shannon"snext cycle, which fell on Christmas Eve. There was holiday magic in theair. Wouldn"t it be wild? Again, no luck.The side effects of Clomid limit the number of cycles during which awoman can safely take the drug. By spring, Shannon had reached hersixth and final cycle on the ovary stimulant. Rather than try intrauterineinsemination one more time, we opted for the natural approach--well,seminatural, given the Clomid--and, lo and behold, her period was late.But we did not rush to buy a $15 home pregnancy kit. Buying the kit atfirst suspicion, we had learned, needlessly unleashes demons. A late periodhas an ambiguity to it that a pee stick does not. Too many times wesuccumbed to the delusional drama of the pee stick, watching the secondhand on the watch in frantic hopes that the test would turn positive. Toomany times had we felt completely deflated both by the result and by ourfoolish willingness to, once again, embrace odds-defying optimism. Toomany times we ended up feeling like Lotto players holding a losing ticket,cursing ourselves for having dumped money on a dream.Our resolve gave way five days later, while vacationing in Mexico. Wefinally found a urine test in a dust-covered box in a little-trafficked pharmacy.We bought it anyway, and anxiously waited for Shannon"s pee tohighlight the enthralling "plus" symbol on the blank white stick. Thestick soon showed a minus sign, but, in our delusion, we convinced ourselvesthat it was really a minus sign with faint traces of the plus sign pokingout--if, that is, you held it in just the right light.Were we winners or losers? On the plane home, Shannon started tospot. Her period soon followed. Her doctor later concluded that she hadhad her second miscarriage.• • •Several months passed, and fertility and miscarriage faded into the background--at least I thought it had. One evening, Shannon asked me, hereyes wet, mascara streaking down her cheek, whether I knew what day itwas. Had I missed our anniversary? "Our baby would have been duetoday," she said, referring to the first miscarriage. I held her as she criedand then wailed, with the particular grief that accompanies the death ofsomeone you love.I suffered no lasting depression about that miscarriage. In my Cro-Magnon way, I puzzled that she grieved so over a pregnancy that hadlasted a few weeks. Men and women do--must--have different reactionsto miscarriage, which adds yet another twist to an emotional rope that alreadyhas many knots in it. I know more intimately than anyone else whatmiscarriage meant to Shannon. But from another vantage, any womanwho has miscarried has a more precise understanding of Shannon"ssense of loss. A woman lives through a miscarriage. A man, no matterhow devoted, only observes it. So Shannon"s reaction to an unborn baby"sbirthday, a symbol that had little meaning to me at first, taught me somethingabout what miscarriage means to a woman.Miscarriage for Shannon did not approach the most feared tragedy thatany parent can imagine: the loss of a child who actually breathes air, snuggles into your neck, and looks into your eyes. But for me, the miscarriedembryo was an embryo. For Shannon, it was a son or a daughter, who, hadfate been more kind, would at that moment have fed from her breast forthe first time. It was that mercilessly real, and, though the pain eventuallydid recede, I am certain that for her it will never entirely disappear.In the fall of 1997, Shannon and I drove to Los Angeles for a concert byJackson Browne, whose music served as the soundtrack for our courtshipwhen we met in 1980. The next morning, I would leave on a three-weektrip to Congo, which was in the midst of a civil war. Our fears, mixed withromance, created a mystical, fated mood.I returned from Congo unharmed, and Shannon told me she was late.Had we made a baby on a most perfect night? Was it simply a matter ofall the forces in the universe aligning themselves? I do not believe in anysuch hooey, but for more than a moment I did. Shannon waited until mybirthday to take a pee test, and this one came out strongly positive."Happy birthday!" she announced, waving the stick in the air.Shannon took her positive pregnancy stick to the doctor. "We lovewhen this happens," the nurse told Shannon before taking a confirmatorysample of urine. After handing the nurse her sample, Shannon hada consultation with her doctor, which the nurse interrupted. "I"m afraidit"s negative," she said.The doctor added another phrase to our ever growing fertility playbook."You had a chemical miscarriage," said the obstetrician, explainingthat the advent of biochemically triggered pee sticks has allowedmany women to see pregnancies that otherwise would have gone by unnoticed.The doctor suggested that given Shannon"s age and her reproductivehistory, she had roughly a 3 percent chance of becoming pregnantand carrying to term.With those grave odds and three miscarriages in two years, Shannonconcluded that enough was enough. "Life is good," she told me. "I"mabout to turn forty. We have a family. Let"s just leave it at that." I still clungto hope, but agreed with her that we should quit actively trying to havesomething that nature, clearly, did not want to give us.There surely are bigger tragedies in life than not being able to have asecond child, and I soon accepted my lot in life, coming up with somewhattortured rationales for why I was happy that things had worked outthe way they had. If we really, really wanted another child, surely wewould have pursued adoption, which neither of us ever gave seriousthought. Although Erin was now only eight, it occurred to me that shewas almost halfway done with living under our roofwhich meant a returnto freedom for us. Whenever I was near babies, I suddenly recalledhow much work they required, and how much sleep they stole from theirparents. And if we had another child, our two-bedroom, one-bath housewould no longer work, requiring us to invest heavily in a remodel or anew home.Why then did I feel elated when Shannon suggested that we see onemore specialist? Because hope does not go quietly into the good night.It lies on its cot, suitcase packed and ready to join us anytime we inviteit along.Shannon"s change of heart came about after she spoke with an oldfriend who had had success with the most renowned fertility doctor intown. "We should at least hear him out," Shannon suggested.Entering the specialist"s office, we noticed the requisite bounty ofbaby pictures overflowing from his bulletin board. He met with us aftera forty-five-minute wait, guaranteeing us a 28 percent success rate if wewent with in vitro fertilization. I told him a 28 percent guarantee of successequals a 72 percent guarantee of failure, and that our problem wasn"tgetting pregnant, it was carrying babies to term.Yes, he understood that, but Shannon was forty, and IVF would buyus precious time by increasing the odds of a pregnancy per cycleforabout $10,000 a pop. Before investing that sort of money, we agreed ona set of tests to determine if either of us had any underlying reproductiveproblems. The first order of business was a sperm sample from me.This clinic required that I produce the sample on location. On an appointedday, I joined a few other men in a special waiting room at the rearof the doctor"s office. We avoided eye contact. When my name was called,a nurse ushered me into a media-equipped bathroom and showed me themagazines (including a tattered seventies-era Hustler), a TV-VCR, and astack of porn videos. "Take as long as you"d like," she said. Right.At our next consultation, the doctor said that because my sperm appearednormal he wanted to perform a hysterosalpingogram on Shannon.Neither of us had ever heard of this procedure, and the very soundof it, reasonably enough, frightened Shannon. The doctor explained thatthe test involved sliding a catheter into the uterine cavity, in the same waythat they did for intrauterine insemination. He then would inject a dyeinto her uterus that would fill the fallopian tubes, allowing an X-ray to revealwhether her tubes were clear. It would cause some cramping, he said,but would not be painful.We went downstairs for coffee while the doctor prepared a room forthe procedure. Shannon had a meltdown, crying inconsolably. "I don"twant to do this," she said. "We"re done," I said, "that"s it." When we toldthe doctor, he tried to convince us that we were making a mistake, and,unrelenting, he encouraged us to reschedule. "This isn"t what we wantto do," I explained. His office later phoned again to reschedule. Then hesent us a Christmas Card with babies on it.In June 1999, Shannon and I attended the Matanzas Creek Winery"s annualDay of Wine and Lavender in Sonoma. The winery cultivates twoacres of lavender, the aromatic, glorious herb that many cultures have celebrated for its healing properties. I put more faith in the healing powersof wine. Booking a cabin in the nearby hills and renting a convertible, wereveled in a kid-free, romantic weekend. Making a baby wasn"t on theagenda.Whether it was the wine, the lavender, the combination, or the phaseof the moon, Shannon became pregnant that weekend. Urine tests are 99percent accurate, but when she tested positive this time, we bought a secondpee stick and did it again. A blood test at the doctor"s office showedpositive, too, and though it was too early to see the heartbeat on the ultrasound, the obstetrician--a twenty-something man we called "the Kid"--said he saw a "life form" on the machine. "Congratulations," he said, craninghis neck around the machine to see Shannon"s face. "You"re pregnant."Despite our history, we started to tell people. It was such great newsthat we just could not help ourselves. This time, we assured each other,we would be spared the need to untell. This time, everything would workout fine.Two weeks later, Shannon returned for another ultrasound test. Wewell knew the drill now: If they found a heartbeat on this scan, there wasa 95 percent chance that Shannon would carry a healthy baby to term. Iwas out of town on a business trip, and Shannon phoned me from thestairwell at the clinic. She was in a panic. "They couldn"t find it," shewailed. "He said, "It"s not viable.""Please don"t be true, we bargained with fate. It can"t be true. The Kid didn"tknow what he was doing. This baby was just too perfect, conceived underperfect circumstances after we quit trying. Shannon was forty-one. Thissurely was our last chance. It had to be viable. It had to.Shannon did not miscarry, and her breasts continued to grow. We returnedto the Kid for a confirmatory ultrasound. He turned it on, and dida double take. "I don"t know what this is," he said, pointing to a blob onthe screen, "but you better go downstairs to the bigger machine." Thefancier ultrasound revealed what looked like two embryos. But there wasno heartbeat. Still, we asked him to have his superior look over the filmsthat they saved from the scan. An elderly obstetrician phoned that afternoonand confirmed the Kid"s diagnosis. They both said Shannon wouldneed a D and Ca dilation and curettage, in which the doctor dilates thecervix and then uses a surgical spoon called a curette to scrape out theuterus.Shannon wanted nothing to do with the D and C, and vowed to waitout the miscarriage. At twelve weeks, on Labor Day weekend of all things,she finally started to feel nauseated, had cramps, and miscarried. She wasgrateful.Two months later, in December 1999, Shannon again was late. We didnot bother to buy a pregnancy test. A few weeks went by, and our resolvecrumbled. The pee stick quickly turned positive. We did not even tell Erin,nor did Shannon go see her doctor. After four consecutive miscarriages,we assumed that the fifth was a given. It was just a matter of time.Miscarriage, no matter how much we had accepted it, represented afailure. A failure of my body or Shannon"s or of our joint biochemistry, itdidn"t really matter: try as we might, we could not make an embryo thatwould attach to a uterine wall for nine months. That sense of failure Ithink explains why adoption held little attraction for us. We did not simplywant another child. We wanted to beat what seemed a curse, to defythe experts, to, in short, succeed. But after four miscarriages, failure hadthoroughly thrashed us, so much so that we both had a detached senseabout this fifth pregnancy, a hardened stance that said, in effect, if we donot get our hopes up, failure will not be part of the equation. Call it denial.Call it pragmatism. We were determined not to board the emotionalbarnstormer, with all the nauseous loop-the-loops and barrel rolls, again.But this pregnancy, unlike every preceding miscarriage, kept advanc-ing just as Erin"s had, just as the books described. Shannon"s breasts became tender and started to swell. She did not spot at all. She had morningsickness. We bought two more pee sticks. Both turned positive nearlyinstantaneously. At the first doctor"s visit, Shannon already was nineweeks along, and we intensely studied a monitor as a nurse performedan ultrasound scan. We had become skilled at reading the foggy sonogramimages, but neither of us saw what we were looking for. The nursedid. "There it is," she said, pointing to the fetus"s pulsating heart.With a heartbeat and a positive pregnancy test, the clinic shuffled usto their obstetrician who handled high-risk cases. He performed his ownscan. "This one"s good from the get-go," he said.On August 6, 2000, Shannon gave birth to our son, Ryan YisraelCohen.Ryan"s birth ended our personal battle with miscarriage, but the subjectstill gripped me, especially given how much nonsense we had heard. I decided to write the book that I wish had existed when miscarriage had usin its throes.Early in my research, I uncovered a fact that astonished me: when "recurrentspontaneous aborters"--women like Shannon, veterans of threeor more miscarriages in a row--become pregnant again, they will, withno treatment, carry to term nearly 70 percent of the time. Not only hadno one ever mentioned this major detail to us, but the underlying biologybaffled me. I studied miscarriage more intensively than I had during ourentire odyssey with this medical malady. I wanted to separate the manymyths that surround this most common event from the scientific studiesthat carefully have attempted to illuminate one of the greatest mysteriesthat exists about our bodies.Investigating the causes of miscarriage drew me into the wonders ofreproduction, tracking each step of the journey: from sperm and egg unitinginto an embryo, to implantation, to viable fetus. Other species boastmuch higher success rates. Reproductive biologists, in particular theones at the forefront of cloning, have begun to tease out more and moreclues about what it takes to carry a baby to term.Scientific studies prove that abnormal chromosomes account for halfof miscarried fetuses. Research also clearly has established that eggsmore frequently present sperm with abnormal chromosomes as a womanages, which powerfully affects the increasing number of women whonow attempt to have children in their late thirties and forties. I sought outboth the researchers behind these studies and the couples participatingin them to better understand chromosomal problems and their intersectionwith female aging, the single most common explanation for miscarriagetoday.I became intrigued, too, by the many theories that tie miscarriages toaberrant immune responses. Still other studies implicate everything fromcoffee to Advil to alcohol. Where did the truth lie? And what role did hormonesplay, misshapen uteri, and infections?As I delved deeper and deeper into the science of miscarriage, I wasastonished that so little is known. The dearth of solid answers helps explainwhy so many unproven treatments have won wide acclaimandremained popular even when evidence surfaces that they do not work.Scientists first raised questions about DES in the 1950s, two decadesbefore its ban. Today, a wild, wild West mentality still exists in the miscarriage field, an oft-ignored branch of medicine. Consider some of thesupposed "leading" clinicians who encourage recurrent spontaneousaborters to inject themselves with their male partner"s white blood cells.A large, well-done study recently concluded that this experimental treatmentresults in higher miscarriage rates than among subjects receivinga placebo. Yet the treatment still is offered in some places. How couldthis be?While Shannon and other women who repeatedly miscarry and seekhelp typically end up at fertility clinics, a dozen clinics devoted to recurrentpregnancy loss now exist around the world and provide much moreappropriate care. As I spoke with the clinicians who run these clinicsand read their many scientific publications, I became intrigued by theircutting-edge view of a problem that so many of their colleagues (manyof whom make oodles of money with fertility clinics) ignore. I quicklysaw, too, that recurrent loss plays the starring role in most miscarriagestudies.Recurrent miscarriage plays a starring role in this book, too. Womenwho have two, three, or, as befell one woman I met, seventeen, miscarriagesoffer insights for others. Although most women who miscarry willnever have the experience again, as I discovered to my astonishment, recurrent miscarriage hardly represents a rare event, as researchers longhave contended. As I will explain in some detail, modern miscarriage detection techniques have uncovered this statistic: 50 percent of conceptionsfail, which means that at least half of all pregnancies fail, 25 percentof women who attempt to become pregnant likely will have two miscarriages,and 12.5 percent will have three. My intense focus on this groupreflects both this new reality and the fact that for the scientists unravelingthe mysteries of miscarriage, these women may hold answers that, ifidentified, may help the population at large.Finally, I began to pay attention to the networks of people who offeremotional support for others who have suffered miscarriages, mostlythrough chat groups on the Internet. Some have tragic tales of unrelentingdespair, while others, like us, have happy endings. Most everyonereaches a tone of honesty and clarity that death, uniquely, ushers in.Disease binds people. Look at the coalitions that have formed aroundAIDS, breast cancer, and diabetes. But miscarriage, as common as it is,does not qualify as a disease. It is not even a medical condition. That orphanstatus, mixed with the taboo of discussing miscarriage and themany scientific unknowns, feeds the loneliness and confusion that manyof us feel when we are in the throes of such a sad experience. I hope thisbook will encourage people to talk more openly about their own miscarriages,and that it also provides an accurate assessment of what scienceunderstands, and what, as of yet, it does not.The book weaves together personal stories with the most authoritativescientific research that I could unearth, which I have divided intothree parts. After explaining my personal history and impetus for writingthe book, the first part, "Mother Nature," examines the fundamental biologyof reproduction, with close attention paid to the genetics, the singlemost important driver of miscarriage. Part Two, "Mysteries," looksclosely at several leading theories about what causes miscarriages of genetically normal embryos and fetuses, exploring in depth the various interventions that attempt to prevent them. I first look at immune causesof miscarriage and treatments, which range from the theoretical to theproven to the disproved. Hormonal problems follow, again with a criticaleye cast toward the many experimental interventions now available,and leading to a sobering look at how DES, a synthetic version of estrogen,became a popular miscarriage drug. DES caused anatomical abnormalities,but many others occur naturally, and I focus on their effects andattempts to correct them. Part Three, "Hope," opens with an examinationof the long list of environmental and lifestyle factors that miscarriageresearchers have dragged down to the station house and put under theharsh light. I then profile three clinics, each in a different country, thatspecialize in miscarriage, describing what state-of-the-art care looks like,as well as a myriad of patients who have many of the problems describedin earlier chapters. The book closes with a few of the most extraordinarymiscarriage stories I came across.People repeatedly have asked me why women would want to read abook about miscarriage written by a man. Well, why wouldn"t they? Andwhy wouldn"t men? If my book aimed to explain how it felt physically andemotionally to miscarry, and how to handle the grief, I think a womanwriter who had experienced a miscarriage inevitably would offer unique,powerful insights. But the questions that interest me most evade specialclaim because neither gender knows more when it comes to puzzling outhow the human body works and devising strategies to help it when somethingmalfunctions. Why do miscarriages happen? Which interventionswork, which ones might, and which ones do not? Women and men alikestruggle mightily to unravel these mysteries. If one or the other has anedge, I have not seen it.I well recognize that Ryan is a gift, even a miracle, and that a happyending eludes many couples who struggle with miscarriage. Still, for coupleswho have had miscarriages and still hold out hope, this book makesthe case that their prospects might not be as bleak as they seem. And regardless of whether couples who badly want a child ever realize theirdreams, this book ultimately concludes that we all must come to termswith our reproductive fates, which, try as humans might, we have lesscontrol of than we would like.Copyright © 2004 by Jon Cohen. Reprinted by permission of Houghton Mifflin Company.

FROM THE PUBLISHER

"After his wife lost four pregnancies, Jon Cohen set out to gather the most comprehensive and accurate information on miscarriage - a topic shrouded in myth, hype, and uncertainty. The result of his mission is a uniquely revealing and inspirational book for every woman who has lost at least one pregnancy - and for her partner, family, and close friends." "Approaching the topic from a reporter's perspective, Cohen takes us on a journey into the laboratories and clinics of researchers at the front, weaving together their cutting-edge findings with intimate portraits of a dozen families who have had difficulty bringing a baby to term." Couples who seek medical help for miscarriage often encounter conflicting information about the causes of pregnancy loss and ways to prevent it. Cohen's investigation synthesizes the latest scientific findings and unearths some surprising facts. We learn, for example, that nearly seven out of ten women who have had three or more miscarriages can still carry a child to term without medical intervention. Cohen also scrutinizes the full array of treatments, showing readers how to distinguish promising new options from the useless or even dangerous ones.

FROM THE CRITICS

Publishers Weekly

Frustrated by wildly differing explanations for his wife's four lost pregnancies, award-winning science writer Cohen (Shots in the Dark: The Wayward Search for an AIDS Vaccine) set out to understand miscarriage, a subject fraught with misunderstanding, controversy and emotional pain. Writing in an impressively sensitive and balanced tone, Cohen describes the dynamics of human female egg production, the signs of an impaired fetus, the impact of odd numbers of chromosomes, the relevance of a woman's age and the efficacy of a range of medical interventions designed to help women carry a baby to term. Integrated into this highly readable narrative are the moving stories of numerous couples whose hopes for a child have been repeatedly thwarted by miscarriage. Cohen also gets candid scientific opinions from leading researchers in the field and provides intelligently skeptical and illuminating guidance on some of the more controversial treatments, from lymphocyte immune therapy to the use of progesterone to treat luteal phase deficiency. Looking back, he draws cautionary lessons from the popular miscarriage treatment of the 1950s, diethylstilbestrol (DES), a synthetic estrogen now known to cause cancer in female offspring. This enlightening and comprehensive study is a must read for any woman battling the emotional roller coaster of miscarriage and for all those interested in an underexplored area of pregnancy and women's health. Agent, Gail Ross. (Jan 11) Copyright 2004 Reed Business Information.

Library Journal

After his wife suffered four miscarriages before achieving a successful birth, award-winning science writer Cohen (Shots in the Dark) decided to delve into the mysterious causes of this reproductive problem. Relying on clinical data, medical interviews, research papers, and case studies of couples who had endured numerous miscarriages, he found little evidence available to pinpoint the exact cause of this disorder. Numbers show that almost seven out of ten women with three or more miscarriages still manage to carry a baby to term without medical intervention. Besides evaluating the science of miscarriage, Cohen also deeply probes its human element, revealing how this reproductive failure affects the emotions, decisions, and lives of typical couples. While some of the research reports are fairly technical for the average reader, Cohen's chronicle will interest couples who have suffered the anguish of miscarriage, if only to learn that this malady is more common than thought and that remedies are almost nonexistent. Suitable for public and academic libraries. [See Prepub Alert, LJ 9/15/04.]-Rita Hoots, Woodland Coll. Lib., CA Copyright 2004 Reed Business Information.

Kirkus Reviews