# High NK cells then natural bfp - what next?



## Catwoman86 (Aug 24, 2016)

Hi all,

Quick question! I was told a few years ago I had high uterine NK cells, so took prednisolone until 12 weeks during my last IVF cycle which resulted in a healthy baby girl. By some miracle, we've had a natural BFP!!! I rang the clinic who weren't much help. Do I need to push to speak to someone to go back on the prednisone again or is there no point? So confused. Has anyone been in this position before? Thanks....


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## aster10 (Nov 4, 2015)

I haven’t been in this position but I would have an appointment with a private gynaecologist asap and get a prescription. Or maybe even with an immunes specialist. Which country are you in, are you in the UK, are you close to London?


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## Aley (Dec 13, 2016)

I had high uterine nk cells and was put on prednisolone for one of my transfers, I had 4 in total. Difference with me is that I never got pregnant with IVF including the cycle which I had steroids and intralipids. I got pregnant naturally and never in my mind did I think to take anything and here I am 21 weeks pregnant. Tbh, I wouldn’t have taken anything anyway because obviously it didn’t make any difference whatsoever and I felt so sick on steroids. The high nk cell theory is controversial anyway and a lot of doctors don’t believe in them.


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## Londonwriter (Mar 18, 2015)

I think you have to weigh up whether you think you actually have a real immune problem in your uterus, which you think might have affected your chance of conception. And whether the pred was a material factor in your last pregnancy or whether it could have been down to luck alone.

The blood NK tests, for example, are not illustrative of your chance of carrying to term. I have a real immune dysfunction. I have symptoms where their severity (usually) maps to my cytokine level. I conceived naturally when my cytokine levels were low for me, after three years of complete implantation failure. I refused Dexamethasone because it crosses the placenta, but took clexane and did IVIG. My NK and cytokine numbers remained crazy up to 19 weeks, despite the IVIG, but this didn’t affect my son at all.

I’m a classic case of someone for whom reproductive immunology is supposed to apply (immune dysfunction with no diagnosed autoimmune disease)  and it’s obvious it’s not that simple even for me. My immune system never attacked my son. I was already six weeks pregnant when I started on clexane and IVIG. It seems my immune problem needs to be under control for me to conceive, but my immune system attacking an embryo is not the cause of my infertility. 

There are thousands of reasons why implantation failure might happen. If you have no immune symptoms at all and your health was not better on pred, I’d think carefully about whether you want to take it again now you’re pregnant naturally. It’s obvious the evidence simply isn’t there for immune treatment for the vast majority of people.


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## Catwoman86 (Aug 24, 2016)

That's really interesting, thanks. I hadn't really considered any side effects tbh. I know my daughter was born healthy, so I put that down to the steroids at the time but who knows. What are the effects of steroids on the foetus?


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## Londonwriter (Mar 18, 2015)

Catwoman86 said:


> That's really interesting, thanks. I hadn't really considered any side effects tbh. I know my daughter was born healthy, so I put that down to the steroids at the time but who knows. What are the effects of steroids on the foetus?


If you don't need steroids, my clinic information said it can raise the risk of miscarriage (!!)  It can increase the chance of low-birth weight and premature birth, although I don't know how significant that is if you only take it for the first trimester. There's also a low risk of cleft palate.

They give steroids if the clinical benefit outweighs the risk and, obviously, if you're going to lose a baby otherwise, that's worth the risk. Certainly, pred is probably the safest immunosuppressant in pregnancy and is taken by thousands of women with autoimmune disease.

However, I wouldn't want to take it unless you're sure you actually need it to carry to term. Not least because it has various health effects on the mum - it's not something you want to take for more than a couple of weeks if avoidable.

If it's possible you have a hidden egg quality issue that reduces your fertility, for example, you definitely don't want to be taking pred. That's why I asked about immune symptoms. If you have a suite of bad Chicago test results and health problems potentially associated with subclinical autoimmune disease, you might want to take pred as a precaution to keep that under control. If it's just uterine NKs that are wrong, but you have normal (or near normal blood NKs) and you're otherwise healthy, I'd try to carry on as you are.

There's also an emotional component, of course, about whether you'll blame yourself for not taking the pred if something goes wrong, which might tip your decision one way or another...


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