Sandy Robertson had six miscarriages in three years before she eventually gave birth to her now 7-year-old daughter.
As the trauma repeated itself -- three miscarriages after in vitro fertilization, including losing a set of twins, and three more after conceiving on her own -- she was nearly defeated by the emotional turmoil.
"Once you are pregnant, you go through what the baby will look like and how you will do up the nursery, and then, boom, it's gone," said Robertson, now a 52-year-old college professor from Golden, Colo.
"The first time, usually everyone knows about it and sends flowers," said Robertson. "But what do you do after the third or fourth?"
Just this week 25-year-old British pop singer Lily Allen had her second loss in three years after suffering a viral infection at six months into her pregnancy.
Technically, because it occurred after the 20th week, Allen's second loss was a pre-term delivery. Her first miscarriage was at four months in 2008.
Allen and her boyfriend, decorator Sam Cooper, were expecting a boy. Friends said the couple was grief-stricken by their loss.
"Lily and Sam are both devastated," a friend reportedly told Britain's Daily Mail newspaper. "She had kept quiet for three months until she had the scan and doctors told her everything was okay. She was understandably so nervous after having had a miscarriage before."
"This is a nightmare for her and Sam," said the friend. "It's too early to say how she will be able to cope with this. They are both heartbroken."
Emma Bunton, another British pop star, revealed her second pregnancy today on " target="external">Twitter, saying her thoughts were with Allen.
Of the nearly 6 million pregnancies each year in the United States, approximately 15 percent end in miscarriage, according to the Centers for Disease Control and Prevention.
In about half the cases, a cause cannot be determined. Among the conditions usually linked to miscarriage are a woman's age, chromosomal abnormalities, structural problems, infections, autoimmune disorders or a condition that causes the blood to clot in the placenta, known as thrombophilia.
"I never got an explanation," said Robertson, who turned to natural methods for getting pregnant and later wrote about it in the book, "Get Pregnant Over 40, Naturally."
She also started a Web site by the same name which gives advice to those who don't understand the pain of miscarriage: "The best thing to do is just say, "I am sorry and not try to fix it. We get a lot of unwanted advice."
"Your self-esteem takes a beating," she said. "You see all the people with kids and think, 'What do they have that I don't have? Why can they and I can't?'"
Only about 2-to-5 percent of all pregnant women will experience a second miscarriage, according to Dr. Wendy Chang, director of research and patient education at Southern California Reproductive Center and an assistant professor at UCLA Geffen School of Medicine.
"It's still very rare," said Chang, but that risk increases as the number of miscarriages increases.
"The odds are greater," she said. "After one miscarriage, the chances of a live birth are 90 percent. At two, the chances are still low -- a 35 percent chance of another miscarriage. But it does go up linearly."
And so does the stress.
"Many of them are doing their own tests at home and if they see a positive pregnancy, that begins a whole cycle of anxiety again -- whether the test will go away and not be positive anymore or how long they will be able to hold on to the pregnancy," she said.
Once they are pregnant again, these women, "literally are holding their breath trying to make sure with sonograms that this baby is going to make it further than the next," said Chang.
Celebrities Who Had Repeat Miscarriages
Celebrities, from Marilyn Monroe to modern actresses Courtney Cox Arquette and Christy Brinkley have had repeat miscarriages.
Brinkley was 31 when she had her daughter Alexa Ray with Billy Joel, and 41 at the birth of her son Jack from real estate developer Rick Taubman. But in her fourth marriage to Peter Cook, she had three miscarriages, before giving birth to daughter Sailor Lee in 1998.
Olympic skater Nancy Kerrigan had six miscarriages in the eight years between her first and second child.
New research published recently in the British Medical Journal reveals that women who try to get pregnant again soon after a miscarriage may be more successful than those who delay conception, but fertility doctors say that doesn't eliminate the anxiety and trepidation.
"We don't tell people to stop trying just based on the numbers of miscarriages they've had," said Chang. "We give advice on the results of their testing. If they have chromosomal abnormalities, we have them consider going to an egg donor. If this is something autoimmune or clot-related or a septum, pregnancy rates can be improved, sometimes surgically. It depends on many factors."
Doctors also recommend counseling, because facing another pregnancy can take a "huge toll" on patients' emotions and even their marriages, she said.
As for Lily Allen, "I hope she knows to see a reproductive endocrinologist to get an evaluation," said Chang.
But the psychological impact of repeat miscarriages is incalculable, say many experts.
Television actress Kirstie Alley confessed in 2005 that her big weight gain began after she miscarried her only pregnancy a decade earlier.
"When the baby was gone, I just didn't really get over it. Neither did my body. I so thoroughly convinced my body that it was still pregnant after nine months that I had milk coming from my breasts," she told People magazine. "I was still fat, I was still grieving, and I had just been told it was very possible I would never be able to have children."
Society Doesn't Recognize Miscarriage Grief
Ellen DuBois, 44, of Massachusetts said she felt alone when she had a miscarriage when she was 25. Her son would have been 19 today on years old this Thanksgiving.
"I have not had any children and quite honestly, am saddened by it -- I've been afraid of pregnancy since my miscarriage," said DuBois, author of the 2006 book, "I Never Held You: Miscarriage, Grief, Healing and Recovery" and creator of the Web site Miscarriage Help.
"I wrote about my miscarriage and shared tools for healing because I wanted to prevent another woman from feeling as alone as I did after mine," she said. "It seemed like every bookstore was filled to the brim on how to have a baby, raise a baby, get pregnant. There was nothing that spoke to the woman who just lost her baby. Not back then. If it existed, I couldn't find it. Many times I left a bookstore in tears -- or waited until I got to my car."
"For years I have seen women come into the emergency room late a night having a miscarriage," she said. "My heart goes out to them. This is not something medicine does well, meaning we have a good way to assess and evaluate and work up patients, but what we don't care for the whole person."
"There is a norm in the culture to dismiss the loss very quickly," she said. "The most common response from family and friends is, 'Oh well, it's probably a blessing. There was probably something wrong with the pregnancy.' That might be true, but it's not an acknowledgement of the loss."
Grief can be as great with the loss of an early pregnancy as with the loss of a child, according to Gaudet.
"It's compounded exponentially if it's a second or more loss," she said. "It hooks into the fear, 'Is there something wrong with me? Will I be able to have a baby?' We don't support women in processing that."
Even women who didn't intend to become pregnant are "confused and distressed" by miscarriage.
"It's ... very primal and deep-seated," she said. "We are genetically programmed to procreate, and even if we choose not to, it's life-affirming for a woman to know she has the capacity to create life and give birth. When that is threatened, that's a loss, compounded by fear."
Despite research that suggests women should try to get pregnant quickly after a miscarriage, Gaudet advises waiting until that grief -- "whatever it looks likes" -- has been resolved.
"When they are feeling horrible and depressed and crying, it's not best to get pregnant," she said. "They need to honor and walk through the mourning process and they well know internally when they are ready to step into this again."