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Here, we show that the sequential functions of the decidual reaction\u2014implantation and decidualization\u2014pivot on the time-sensitive loss of progesterone-resistant\n                    <jats:italic>DIO2<\/jats:italic>\n                    <jats:sup>+<\/jats:sup>\n                    stromal cells that form a specialized implantation niche and reciprocal expansion of progesterone-dependent\n                    <jats:italic>PLA2G2A<\/jats:italic>\n                    <jats:sup>+<\/jats:sup>\n                    predecidual cells. Simultaneously, uterine natural killer (uNK) cell proliferation results in the accumulation of immunotolerant subsets. Examination of endometrial biopsies from 924 women revealed that the recurrence risk of miscarriage closely aligns with the incidence of a weakened or stalled decidual reaction, more so than poor uNK cell expansion. Analysis of paired biopsies obtained in different cycles and modeling in assembloids intimated that prior miscarriages disrupt intercycle endometrial homeostasis and calibration of the decidual reaction. Our findings show that erosion of the decidual reaction following a miscarriage drives the recurrence risk irrespective of maternal age.\n                  <\/jats:p>","DOI":"10.1126\/sciadv.adv1988","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T13:58:34Z","timestamp":1750859914000},"update-policy":"https:\/\/doi.org\/10.34133\/aaas_crossmark","source":"Crossref","is-referenced-by-count":19,"title":["Stalling of the endometrial decidual reaction determines the recurrence risk of miscarriage"],"prefix":"10.1126","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6194-0165","authenticated-orcid":true,"given":"Joanne","family":"Muter","sequence":"first","affiliation":[{"name":"Warwick Medical School, Division of Biomedical Sciences, University of Warwick, CV4 7AL Coventry, UK."},{"name":"Tommy\u2019s National Centre for Miscarriage Research, University Hospitals Coventry &amp; Warwickshire National Health Service Trust, CV2 2DX 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