Busyness, Stress and Anxiety Affecting Fertility & Pregnancy Outcomes

Posted on July 29, 2020July 29, 2020 by Andrew Orr

It is now known that modern day busyness, stress, anxiety and depression can significantly impact a couples chances of conceiving. When helping couples with fertility and achieving a pregnancy, one of the biggest issues I see overlooked is a couple’s emotional health. During the assessment of anyone’s fertility, depression, anxiety and stress scores (DASS) should be taken into consideration. Other assessment methods to look at anxiety and heightened adrenalin should also be utilised. It is so important to touch base on the topic of emotional health and make couples (or those who are single) aware of emotional factors that may be affecting their chances of conceiving.

I always recommend seeing a counsellor/psychologist

I always recommend that everyone should check in regularly with a counsellor/psychologist, but less than 10% of people do. What many do not realise is that their underlying stress, anxiety and other emotional concerns are actually a big part of them not being able to conceive, and that looking after our emotional health is just as important as looking after our physical health. There is research to suggest that a parent’s emotional state can be passed onto a child via the sperm, eggs and the parental mode of inheritance. Everything we put in our body, physically and emotionally, can be passed on to the unborn child. This is crucial to understand before considering having children because at the end of the day, it could affect them greatly.

Identifying the impacts of busyness, stress and anxiety

Another common observation I see when people are trying to conceive is they are adamant that they are not stressed, yet their mood/stress scores say otherwise. Many people have normalised their busyness and running on high levels of adrenaline to the point where they do not equate their heightened emotional states as being stress or anxiety. From an outside perspective, I can physically see how anxious and stressed some people are, but it is often hard for people to self-reflect and understand their emotional state.

Control issues exacerbating anxiety and stress levels

Statistically speaking, women have a higher likelihood of being the driving force behind wanting a baby/family so it is easy to see why they may be more focussed or driven in this regard. This also means that they carry a lot of the stress that comes with that. Unfortunately it is becoming more common to see said people struggle with letting go of control and feeling out of control which leads to underlying stress and anxiety. Occasionally this too leads to stress and instability in their relationships, especially if their partner isn’t stepping up.

The one thing I try to explain to all couples is that when it comes to IVF or assisted reproduction, nobody is in control. Everything is timed and controlled by hormones and medications and nobody can control that. Trying to control everything leads to high stress levels, activated adrenalin, heightened anxiety, and a vicious cycle of feeling like more control is needed. The only thing people can control is what they put in their mouths (food, medications, and supplements), how much they exercise, and how well they care for their emotional health. That is it.

Making the changes you need to do now

So many people try to justify their actions and behaviours with statements such as, “I will slow down and make time for myself once I am pregnant, or once I have the baby.” Any parent will tell you that once a child is born, there is hardly any time for yourself and things get a lot busier. The reality is that you need to work on yourself now, while you have the chance. It is not only important for you, but also for your child.

One of the things I say to future parents is this: “If I gave you your baby right now, what would you have to do to ensure its survival and yours? What changes in your life would you have to make?”

I then let them sit and think carefully about it because in reality, it would mean many changes to one’s life. The honest truth is that despite change often being uncomfortable, changing your life is exactly what you have to do right now to create the baby as well. I also tell parents that if you don’t have time for yourself, to do self-care, or to work on yourself, then you really need to question if you have time to have a child too. I don’t mean this in a bad way. I say it with absolute care and understanding of how demanding life gets when one is a parent.

Counselling needs to be mandatory

This is why it is so important to do counselling whether you are going through IVF or trying to conceive naturally. It is my personal belief that for the benefit of the parent/s and the child, counselling should be mandatory as many issues of not falling pregnant actually stem from high stress levels, anxiety, adrenaline, and an inability to slow down. It all stems back to control, and then lack of control, which then creates anxiety and stress. There can also be relationship dynamic issues that need to be addressed prior to having a baby. All this and more is not a good recipe to make a baby, or achieve a successful pregnancy outcome.

Stress animals don’t conceive and it applies to humans as well

The one thing we know from basic biology is that stressed animals do not conceive or will not carry a pregnancy. Many of our breakthroughs in fertility medicine actually come from vet science, where animals have undergone IVF or forms of assisted reproduction. We often forget as humans, that we too really are just animals.

Numerous studies have indicated how anxiety, stress and heightened adrenaline (common states of existence for many people) have a detrimental effect on egg quality, sperm quality, embryo quality, implantation, and overall pregnancy rates.

How busyness, stress and anxiety affect fertility and pregnancy outcomes

Going through IVF, or just trying to fall pregnant, is often described as the most stressful event in the lives of some couples. This is even more heightened if there are difficulties in achieving a pregnancy. There is increasing evidence that psychological factors, such as busy lifestyle, stress, anxiety and depression, have a negative impact on IVF and pregnancy outcomes.

Research studies have shown that the high levels of stress, anxiety and depression are significantly related to the treatment outcome in IVF and also achieving a natural pregnancy (Expert Review of Obstetrics & Gynaecology.2008- See diagram for how stress affects pregnancy outcomes).

The autonomic nervous system is affected by busyness, stress, anxiety and depression. This also leads to increased neuroepinephrine and increased epinephrine, which then leads to vasoconstriction and decreased blood flow into the uterus. It can also lead to increased stress within the uterus itself.

The immune system is also affected by increased Tumour Necrosis Factor (TNF), which is a cell signalling protein (cytokine) involved in systemic inflammation. The immune system is also affected by increase in Natural Killer Cells and increased activated T cells, which then lead to reduced implantation and a stressed uterine environment.

The indirect effects of stress are that people will drink more alcohol, smoke, exercise less, sleep less, eat more junk foods and generally have a poor diet and lifestyle, all of which have a direct effect on fertility also.

In summary

In summary, lifestyle interventions and taking care of one’s emotional wellbeing can help reduce stress, anxiety and adrenaline. This should be a priority for all couples trying to conceive, or for those having difficulties conceiving. Body-Mind Medicine and Traditional Chinese Medicine have long understood that stress, diet, lifestyle and emotional factors are a huge cause of infertility. Modern medicine and research is now validating this and advocating for proper preconception care. By addressing the known possible emotional and lifestyle factors that affect fertility by utilising preconception care and a multimodality approach (including counselling and psychology), people can greatly improve their fertility, successful pregnancy outcomes, as well as improve their overall health.

Final Word

If you are having trouble conceiving please call our friendly staff and find out how our fertility program may assist you in having a baby. Our fertility program uses a multimodality, ‘no stone left unturned’ approach which looks at both the male and female aspects of fertility, is used alongside medical interventions, and also gives you access to counsellors and psychologists who have a special interest in fertility.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine

-The International Fertility Experts

-The Experts Program

References

Paulson JF, Bazemore SD. Prenatal and Postpartum Depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010;303(19):1961-1969. doi:10.1001/jama.2010.605
Effects of caffeine, alcohol and smoking on fertility, http://yourfertility.org.au/resource/effects-of-caffeine-alcohol-and-smoking-on-fertility/
Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323(7307):257-60.
Akioyamen LE, Minhas H, Holloway AC, Taylor VH, Akioyamen NO, Sherifali D. Effects of depression pharmacotherapy in fertility treatment on conception, birth, and neonatal health: A systematic review. Journal of Psychosomatic Research. 2016;84:69-80.
Cesta CE, Viktorin A, Olsson H, Johansson V, Sjolander A, Bergh C, et al. Depression, anxiety, and antidepressant treatment in women: association with in vitro fertilization outcome. Fertility and Sterility. 2016;105(6):1594-602 e3.
Sejbaek CS, Hageman I, Pinborg A, Hougaard CO, Schmidt L. Incidence of depression and influence of depression on the number of treatment cycles and births in a national cohort of 42,880 women treated with ART. Human Reproduction. 2013;28(4):1100-9.
Ververs T, Kaasenbrood H, Visser G, Schobben F, de Jong-van den Berg L, Egberts T. Prevalence and patterns of antidepressant drug use during pregnancy. Eurpean Journal of Clinical Pharmacology. 2006;62(10):863-70.
Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis CL, Koren G, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. Journal of Clinical Psychiatry. 2013;74(4):e321-41.
Deave T, Heron J, Evans J, Emond A. The impact of maternal depression in pregnancy on early child development. BJOG. 2008;115(8):1043-51.
Ross LE, Grigoriadis S, Mamisashvili L, VonderPorten EH, Roerecke M, Rehm J, et al. Selected pregnancy and delivery outcomes after exposure to antidepressant medication. A systematic review and meta-analysis. Outcomes after antidepressant use in pregnancy. JAMA Psychiatry. 2013:1-8.
Rich-Edwards JW, Spiegelman D, Garland M, Hertzmark E, Hunter DJ, Colditz GA, Willett WC, Wand H, Manson JE. 2002. “Physical activity, body mass index, and ovulatory disorder infertility.” Epidemiology 13:184-190.
Palomba, S, Falbo A, Valli B, et al. 2014. “Physical activity before IVF and ICSI cycles in infertile obese women: an observational cohort study.” Reproductive Biomedicine Online, 29(1): p. 72-9.
Ferreira RC, Halpern G, Figueira Rde C, Braga DP, et al. 2010. “Physical activity, obesity and eating habits can influence assisted reproduction outcomes.” Womens Health [Lond Engl] 6:517-524.
Kucuk M, Doymaz F, Urman B. 2010. “Effect of energy expenditure and physical activity on the outcomes of assisted reproduction treatment.” Reproductive Biomedicine Online 20:274-279.
Morris SN, Missmer SA, Cramer DW, Powers RD, McShane PM, Hornstein MD. 2006. “Effects of lifetime exercise on the outcome of in vitro fertilization.” Obstetrics and Gynecology 108:938-945.
Green BB, Daling JR, Weiss NS, Liff JM, Koepsell T. 1986. “Exercise as a risk factor for infertility with ovulatory dysfunction.” American Journal of Public Health 76:1432-1436.
Gudmundsdottir SL, Flanders WD, Augestad LB. 2009. “Physical activity and fertility in women: the North-Trondelag Health Study ” Human Reproduction 24:3196-3204

Explaining The Facts of Fertility- “How long is a piece of string?”

Posted on January 15, 2020January 15, 2020 by Andrew Orr

When people ask me about what is the cause of most couples issues trying to conceive, I always say ” How long is a piece of string?”

There can be so many factors involved and there is never just one clear answer. Many times people are focussing completely on the wrong thing too.

In this video blog below, I have an honest discussion about fertility on every level. I discuss diet, lifestyle, preconception care, supplements, natural medicines, western medicines, investigations, genetic issues, stress, IVF procedures, Natural killer cells, unrealistic expectations, self sabotage, weight issues and much much more.

So again, when anyone asks what the cause of fertility issues are, I will always answer “How long is piece of string?”

Because in reality, there are so many factors that couple are unaware of, and need to be aware of too.

Regards

Andrew Orr

-Master of Reproductive Medicine

-No Stone Left Unturned

-The International Fertility Experts

Natural Killer Cells Nourish & Promote the Growth of The Fetus

Posted on December 28, 2017August 31, 2020 by Andrew Orr

A study published in the journal Immunity shows that part of the uterine Natural Killer cell population helps to optimize maternal nourishment of the fetus at early stages of development, not hinder it.

These Natural Killer Cells have actually been shown to secrete growth promoting factors that can also reverse impaired fetal growth and help prevent miscarriage, not cause it.

For many year now I have had people contact me and trying to kill the killer cells, or treat high natural killer cells, or wipe out these cells that they are being told is causing them to miscarry, or not be able to hold an embryo.

For those same amount of years I always said that Natural Killer Cells are meant to be there and the reason they are there is because of inflammation and are doing their job. Now finally, what I have been saying has been proven to be true and now we have an explanation of what these immune cells actually do and the mechanism behind it. They don’t harm the embryo at all. They are there to protect it, nourish it and help it grow.

Natural killer cells are among the most abundant immune cells in the uterus during the first trimester of pregnancy, but their numbers decline substantially after the placenta forms. Up until recently many in the fertility profession have led people to believe that Natural Killer Cells are the cause of all their issues and these new findings may have them eating their words.

Not only have women been offered hormones, steroids and the likes that have never been proven to do they say they do, but they not only have major side effects, but could actually be trying to regulate the very thing that is meant to help a pregnancy.

The results of these new findings not only reveal new properties of natural killer cells during early pregnancy, but also point to approaches for therapeutic administration of natural killer cells in order to reverse restricted nourishment within the uterine environment

Acting as our bodies’ frontline defense system, natural killer cells guard against tumors and launch attacks against infections. This is something that I have been trying to explain for years. If natural killer cells are in high amounts, they are there for a reason and that reason needs to be treated, not the high killer cells.

There has been much research on how Uterine natural killer cells promote immune balance and the growth of blood vessels in the placenta, having a positive impact on birth weight as well as fetal growth. But until now, it was not clear which subset of natural killer cells in the uterus are responsible for promoting fetal growth, or whether these cells help to optimize fetal nourishment at early developmental stages.

In the new study it was discovered that a specific subset of natural killer cells in the human uterine lining secretes growth-promoting factors, which are involved in wide-ranging developmental processes. This subset of cells made up a smaller proportion of natural killer cells in the uterine lining of patients who experienced recurrent spontaneous miscarriage and reduced implantation (42%) compared to healthy females (81%). These findings suggest that insufficient secretion of growth-promoting factors by a specific subset of natural killer cells may be responsible for restricted fetal development in humans.

The studies also showed that a deficiency in this subset of natural killer cells resulted in severe fetal growth restriction and defective development of the fetal skeletal system. The studies also showed that the transfer of uterine natural killer cells reversed fetal growth impairments.

For the purpose of promoting fetal growth in humans, it may be possible to transfer natural killer cells via intravenous infusion or the administration of a vaginal suppository to mothers, avoiding the need for invasive procedures. Moreover, uterus-like natural killer cells are a much safer alternative to many of the methods used in immunotherapy and safer that steroids, or other immunosuppressant’s.

Obviously more study is needed, but these findings are about to turn part of the fertility profession upside down and make it re-evaluate itself.

I’ve always said it isn’t the natural killer cells killing off embryos and always said it was from inflammation and inflammatory gynaecological conditions that weren’t being treated.

We now know that stress uterine cells are also a big part of the issue too. I always say treat the cause to treat the symptoms and now we know that Natural Killer cells aren’t part of the cause, they are actually there to help.

If you are having troubles not conceiving, my fertility program may be able to assist you. If you would like to find out more, please call my friendly staff and they will be able to explain more to you.

Take care

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The International Fertility Experts

Stressed Uterine Cells & Inflammation Cause Miscarriage, Not Natural Killer Cells

Posted on December 28, 2017August 26, 2019 by Andrew Orr

It is stressed uterine cells and inflammation causing miscarriage and causing the embryo not to implant, not Uterine Natural Killer cells.

For the first time the functions of natural killer cells in the womb have been identified by Researchers at the University of Warwick and University Hospitals Coventry

Although it has long been known that the lining of the womb harbours dynamic uterine natural killer cells, no functions have so far been given to these cells outside of pregnancy.

The researchers have discovered that the uterine natural killer cells remodel and refresh the lining of the womb at the time of embryo implantation. This is the first time a role for uterine natural killer cells in the lining of the womb has been identified outside of pregnancy. The research was published on December 14, 2017.

In addition they discovered that this process isn’t always balanced in each cycle. The natural killer cells perform the role of targeting and clearing inflammatory stressed cells, thereby making space for the implanting embryo. However sometimes not enough of these cells are cleared away and sometimes too many are targeted and removed. Excessive inflammation or insufficient clearance by uterine natural killer cells makes miscarriage more likely.

For many years I have been trying to tell people that they need to stop trying to get rid of the natural killer cells, or reduce their numbers. I have long known that natural killer cells are meant to be in the body and their job is to protect us from infections, bacteria, cancers, tumours and inflammation.

If killer cells are in high numbers, it means that there is something wrong and that is what needs to be treated, not the killer cells. But unfortunately, many clinics play on couples emotions and the use of the word “Killer”. So then we get this war on killer cells and people wanting to kill the killer cells because they think it is killing their babies.

No matter how hard I have tried to explain it, people just don’t listen and now it is finally great to have the research to back up what I knew all along, plus additional knowledge of how Killer cells actually help with implantation and reducing miscarriage.

The researchers have explained what happens if the natural killer cells cannot do their job properly, or there is inflammation that they haven’t been able to target. They said that a good analogy is Swiss cheese: without holes, the embryo has nowhere to go which will cause implantation failure; but if the holes are too large, the tissue will physically collapse and lead to miscarriage.

This imbalance, which may be short-lived or last for multiple cycles, explains the high rate of early pregnancy failure. It really can be a numbers game on how long that cycle could last and why it is important to make sure there are enough natural killer cells there to do their job properly. Without the natural killer cells, there is more chance of inflammation and stressed uterine cells being left behind, which will then lead to higher pregnancy loss and reduced implantation.

The researchers conducted an analysis of 2,111 endometrial biopsies, which is more than had ever been conducted previously. The research team examined the acutely stressed cells in the lining of the womb which generate tissue inflammation. They found that the natural killer cells which are in the womb perform the important function of selectively targeting and eliminating acutely stressed cells.

When there are high acutely stressed cells in the lining of the uterus, the lining of the uterus fails to sense the chemical signals from the fertilised egg and it then silences many of the genes involved in allowing the embryo to implant and embed into the uterus.

One of the chemicals needed for this process to take place is Trysin, which is a common enzyme the embryos gives off. If trysin isn’t detected the embryo is not accepted and left to disintegrate and then the cycle is reset once again. The lack of Trysin signal appears to indicate to the endometrium that the quality of the embryo is not very high and initiates a reduction of receptivity to implantation. These findings could help to improve the success rates of IVF, because one of the biggest problems with IVF is getting the embryo to implant

The research team also found that high numbers of Natural Killer cells in the endometrium are not only a sign of high inflammation and acutely stressed uterine cells, but also indicate a insufficient production of steroids, which in turn leads to reduced formation of fats and vitamins that are essential for pregnancy nutrition.

Again, this is exactly what I have been trying to say for years and why when I treat women who are having implantation issues and recurrent miscarriage I look at treating the cause of the issue, rather than masking it.

To treat miscarriage and help with embryo implantation you need to do the following

Reduce inflammation in the uterine environment and pelvic cavity
Make sure the pelvis, tubes and uterus have been surgically evaluated properly prior to conception, or assisted reproduction (IVF, IUI, ICSI etc)
Increase blood flow and nutrients into the uterine lining
Ensure adequate essential fats and nutrients are given prior to conception
Reduce stress levels
Increase protein and reduce inflammatory refined carbohydrates
Make sure the couple in are optimum health (healthy sperm + healthy eggs=health baby)
Make sure the man is being treated at the same time the woman is (up to 85% of miscarriage issues are related to chromosomal and DNA factors related to poor quality sperm, which cannot be measured by a normal semen analysis)

We need to stop blaming high NK cells as being the cause of miscarriage and embryos not implanting. We need to look at the real cause, which is inflammation, stressed uterine cells ( due to stress in the person), lack of nutrients and blood flow in the uterus and lifestyle factors that is also leading to increase miscarriage rates and reduced embryo implantation.

Let’s not forget that faulty sperm and DNA damage and chromosomal issues with sperm are also a big part of miscarriage too. Miscarriage is not just a woman’s issue. To be honest, statistically it is more likely to be on the male side of the equation and often gets overlooked. But that is a whole other post in itself.

Couples who are part of my fertility program are educated on issues such as this and all the things they need to do to assist them in having a child. The program has assisted over 12,500 babies into the world and my motto is “No Stone Left Unturned.”

Hopefully in the future this new information will be used to screen women at risk of reproductive failure and help with new treatment options for women suffering recurrent miscarriages or recurrent IVF failure.

If you are having trouble conceiving my fertility program may be able to assist you in getting the answers that you need. If you would like to find out more about my fertility program, please call my friendly staff to find out more.

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The International Fertility Experts

The Truth About Natural Killer Cells & Miscarriage

Posted on November 8, 2017August 25, 2019 by Andrew Orr

On a daily basis we get people, who are having failed IVF cycles, calling my clinic looking for some miracle pill, to supposedly eradicate the body of natural killers cell and wipe them off the face of the planet in some war like rage, all because they have been told this will bring an end to their fertility woes.

I wish it was that easy and when my staff go on to explain that treating natural killers cells (uterine killer cells), and especially looking at the cause of natural killer cells (uterine killer cells), is complex, there is no one miracle cure, nor some magic pill, people get annoyed and hang up the phone in a huff ,without listening to the reasons why.

One of the things I always say, when people ask me about regulating natural killer cells for fertility purposes, is “How long is a piece of string?”

This is because this subject is very complex and there are many reasons why natural killer cells may be impacting implantation. So, hence the response is always going to be “How long is a piece of string?”

While Natural killer (NK) cells have an important role in the early responses to viral infections, they have also been linked with failure of pregnancy.

Increasingly, clinics are offering blood tests, at an increased cost to the patient, to measure the number and activity of circulating NK cells. As a result of these investigations, many women are offered treatments such as steroids, intravenous immunoglobulins, and tumour necrosis factor blocking agents. The scientific rationale for these tests and treatments, however, is not always supported by our current knowledge of the function of uterine NK cells.

So, I thought it was about time I set the records straight on the BS information, that seems to being handed around as gospel, by money hungry fertility clinics run by big health conglomerates, and by the rotten Dr Google, about natural killer cells (uterine killer cells) and these supposed miracle pills, that will miraculously fix someone’s fertility issues.

Let’s Look at the Facts about Natural Killer Cells Relating to Miscarriage

There is no miracle pill, or one supposed miracle treatment, or a one pill solution to treat, or get rid of natural killer cells. You do not want to get rid of NK Cells.
Natural Killer Cells are a natural part of the immune system designed to target inflammation, kill of cancer cells, kill off bacteria and protect the body from harmful invasion of foreign organism
There is huge difference between natural killer cells that are circulating in the blood stream, compared to uterine killer cells
Uterine Killer Cells are in large numbers during a pregnancy to protect the embryo
Natural Killer Cells are only in large number and are only being sent out by the immune system because there is some inflammatory process going on in the pelvis, or the rest of the body
You cannot regulate Natural Killer Cells numbers unless you first address the inflammatory process that is causing them to be in high numbers in the first place (Eg- Inflammatory gynaecological conditions such as PID, Endometriosis, PCOS, Adenomyosis, Adhesions, STI’s, CIN, HPV, Herpes etc)
Many people have not had the proper initial fertility investigations and testing needed to actually fall pregnant in the first place and looking at Natural Killer Cells, before all that proper testing etc is done, is actually not assessing the patient properly.
If you do not treat the cause of the Natural Killer Cells being in high numbers, you will not be able to reduce the numbers of Natural Killer Cells that are actually doing the job they are meant to do, which is …. Protect the Body.
Many of the so called treatments for Natural Killer Cells, regarding fertility, have never been approved for such treatment and research on it is still inconclusive.
Some of the treatments being proclaimed as miracle cures (Intralipids etc) are purely money making exercises that are preying on the vulnerability of people who have been told wrong information and have this perception of some killer being inside their body attacking their embryos.
Intralipids have never been proven to treat Natural Killer Cells and are derived from highly inflammatory soy based compounds, which then in turn can cause more inflammation.
The drugs used in the treatment of Natural Killer Cells are steroidal based and carry many side effects and are for more harmful to the body that any natural killer cell will ever be. The steroids are also a category C drug that has been shown to have an effect on the neonate
Steroids, such as Prednisone, do work on regulating NK cells, but they do so by suppressing the immune system, thus compromising a person’s immunity. There are also risk to peoples minerals by using these long term and there are also other side effects to the body.
Natural Killer Cells are there to protect the body, not hurt it.
Natural Killer Cells may only be attacking embryos because they are seen as foreign body as well and when they are there trying to kill of the diseases and issues causing inflammation in the body, they just happen to kill of any other foreign organism and inflammatory processes at the same time
Again, to address natural Killer Cells, you need to address the inflammatory process as to why they are in high numbers in the first place
The perception around Natural Killer Cells being this “thing” killing off embryos in the body is misguided and is actually not a true representation of what Natural Killer Cells actually do. It is purely often used to tug on the heartstrings of unsuspecting patients, who are highly emotive and clinics use these emotions to get them to pay for treatments that have never been fully proven to work.
The name “Killer Cell” is too often exploited in the wrong context by many in the fertility world
Blood tests cannot measure the number of Natural Killer Cells in the Uterus, Only a biopsy can do this.
A Natural Killer Cell (uterine killer cells) Biopsy has to be done between the 24^th and 28^th day of your menstrual cycle to give the best results.
Blood tests can only measure the circulating NK cells in the body and not the uterine killer cell activity, which can be the cause of recurrent miscarriage. So, if you have had a blood test, it is not measuring what is needed. Everyone will have circulating NK cells in their blood stream.
The percentage of CD56+ NK cells in peripheral blood in normal healthy individuals varies from 5% to 29% (2)Despite this, more than 12% NK cells in women with infertility or miscarriage has been arbitrarily defined as abnormally raised and used as an indication for treatment (4)
The percentage of NK cells in blood can be affected by many factors including sex, ethnicity, stress, and age too.
There is now new evidence that shows that natural killer cells help with implantation and a healthy uterine environment, which now supersedes old outdated research.

Natural Killer cells (Uterine killer cells and other NK cells) are the main immune cell-type found in the uterus. Their numbers increase through the menstrual cycle to peak at the time of implantation. If an embryo does implant, NK cell numbers increase further to 70% of all cells.

Uterine NK numbers start to decrease at around the 20 week mark of pregnancy and are all but absent at the end of pregnancy.

Natural killer cells acquired their name as a result of the initial test used to identify them in vitro. Unlike T lymphocytes, NK cells are able to spontaneously kill cells in a non-MHC restricted manner.

Regrettably, this is a misleading name in reproduction, and the powerful image of maternal cells attacking the fetus is emotive and easily exploited. None the less, these NK cells can kill off the embryo at early stages of pregnancy, but there is nearly always a reason why. That reason is inflammation in the pelvic cavity and uterus. This needs to be addressed to regulate the number of NK cells, not some notion of killing off the “Killer Cells”.

Types of Inflammation causing high Natural Killer Cells (Uterine Killer Cells)

Endometriosis & Adenomyosis
PCOS/PCO
Fibroids, Myomas
Vaginal Infections & Bacteria
STI’s
Cancer, Trauma, Localised Lesions & Others
Stress

Yes, stress can lead to a compromised immune system, which then leads to high TNF (Tumor Necrosing Factor) and increase Natural Killer Cells, which then leads to prolonged increase activated T Cells, and this then causes reduced implantation of embryos.

This is also a reason why any inflammation in the uterus or pelvic cavity needs to be addressed to help fix this issue and one of the reasons why any woman having fertility issues needs to be investigated and treated properly.

This needs to involve proper differential diagnosis, proper pathology testing, genetic testing and surgical investigations such as laparoscopy prior to any further fertility treatment. A laparoscopy is the gold standard for addressing and treatment of issues in the uterine and pelvic cavity.

Natural Killer Cells (Uterine Killer Cells) may be a part of recurrent miscarriage, but we need to stop the misinformation and perception of them being some killer organism that isn’t meant to be in the body. They are meant to be in the body and the name is all too often exploited by many to offer unproven treatments and medications by clinics trying to increase profits.

If you want to regulate and treat natural killer cells (relating to recurrent miscarriage) properly, you need to find out what is causing them to be there in the first place. There is no magic pill to get rid of Natural Killer Cells.

You cannot rid the body of Natural Killer Cells anyway. They are meant to be there. You can only regulate the amount of killer cells doing their job and you need to find out why they are in higher numbers in the first place. This is usually because there is some sort of inflammation, infection, bacteria, or malignancy going on in the body that has not been investigated properly in the first place. Let’s not forget that stress, yes stress, increases the amount of Natural Killer Cells in the body too.

As part of my fertility program, I talk to couples about the facts about Natural Killer cells, and makes sure that proper investigations, testing and treatments are administered and managed properly. This can also be done alongside current medical protocols such as the Bondi protocol, or California protocol.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The International Fertility Experts

References

Moffett-King A. Natural killer cells and pregnancy. Nat Rev Immuol 2002;2: 656-63.[CrossRef][Web of Science][Medline]
Pijnenborg R, Vercruysse L, Hanssens M, Van Assche A. Incomplete trophoblast invasion: the evidence. In: Critchley H, MacLean A, Poston L, Walker J, eds. Pre-eclampsia. London: RCOG Press, 2003: 15-2615. Parham P. NK cells and trophoblasts: partners in pregnancy. J Exp Med 2004;200: 951-5.[Abstract/Free Full Text]
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