| Abstract [eng] |
Recurrent miscarriages are an increasingly significant fertility issue, affecting a growing number of couples of reproductive age. In recent years, scientists have focused more attention on the role of endometrial natural killer cells during pregnancy, particularly in cases of unexplained infertility. Natural killer cells in the uterus assist in trophoblast invasion, vascular remodeling, and immune response regulation. These processes must function precisely to ensure successful embryo implantation and proper placental development. Studies show that an imbalance of endometrial natural killer cells may be associated with recurrent miscarriages. An excessive concentration or heightened cytotoxic activity of these cells in the endometrium can lead to inflammatory processes, while an insufficient number of natural killer cells can cause circulatory disorders. Both factors can disrupt pregnancy progression. Aim: To evaluate the relationship between endometrial natural killer cell concentration and recurrent miscarriage, and to present a clinical case. Objectives: To assess the association between endometrial natural killer cell concentration and recurrent miscarriage; to evaluate the clinical relevance of natural killer cell concentration changes based on a literature review and clinical case; and to discuss potential diagnostic and treatment approaches. The reviewed scientific literature includes case-control studies, and a clinical case is presented in which endometrial natural killer cell concentration was evaluated and treatment applied to a woman who experienced recurrent miscarriages. The explored treatment strategies include the use of glucocorticosteroids, intravenous lipid infusions, injectable human immunoglobulin, and granulocyte colony-stimulating factor. Conclusion: As shown by the literature review, although both excessive and insufficient endometrial natural killer cell concentrations are often linked to unsuccessful pregnancy outcomes, their role is complex and depends not only on their number but also on their cytotoxic and receptor activity. To address this fertility issue more effectively, future research should go beyond counting the number of natural killer cells in the endometrium and analyze their cytotoxic activity. This approach would allow for more accurate identification of women who may benefit from immunomodulatory treatment. |
