week 23 - no news is good news #pregnancyDiary

My job has been quite stressful lately. Some people left and now there is a lot more work for the rest of us until they find and hire replacements which will probably take months. I've had to do a fair bit of overtime recently too. At least, this was a short week at work which was nice. Baden wurttemberg had two public holidays in a row this year, October 31st and Nov 1st. Hubby and I had a lot of relaxation time. Not much else to report lately. We binge watched the new season of Stranger Things which was really good. I've been catching up on my reading.

The most annoying pregnancy symptom at the moment is probably the heartburn. I tend to get it really bad most evenings. It feel like my throat is on fire! I've been managing quite well with antiacid tablets though. As I mentioned before we already have gotten quite a lot for the baby. Mostly things were given to us by friends who don't need them anymore and we also picked up some stuff second hand. We plan to buy a chest of drawers to put all the clothes and blankets in. We also have to get the cot still. I love the idea of the ones which attach next to the parents' bed to make feeding easier and so the baby is close to you but also in their own space to avoid the danger of SIDS. I've been picking up lots of tips from talking to friends so I think I'm starting to get a pretty good idea of what life could be like with a newborn.

I did feel a little uncomfortable at first with us getting so much baby stuff already as if it were up to me I would have waited longer to start preparing. In Ireland traditionally people are very suspicious about buying things for a child before he or she is born! My parents' generation were like that and some people still are. Things have change massively in recent years though. On a facebook group I'm in for Irish women due the same month as me I noticed that most of the woman had already gotten loads of stuff by this stage. I decided that I don't want to wait until the baby is here to start getting everything- that would be totally stressful! I'd rather be prepared. Also I think at this stage in the pregnancy it is ok to feel relatively secure that everything will be fine. So we are going to continue to prepare and aim to have most things ready by January.

Since the 20 week scan I've also started feeling a lot more relaxed about the pregnancy in general. I'm not as anxious anymore. I've been letting myself believe that we will have a baby and just feeling happy and excited! I've also started to feel more relaxed about things in general, not being as anxious that any little thing I do could negatively affect the baby. I've even introduced some gluten into my diet again. I had quit it as I'd read undiagnosed gluten intolerance was frequent among women with unexplained infertility and it had also been giving me some digestive issues. I find now though that eating it occasionally seems to be ok. I've also been eating dairy which I'd cut out during the past IVF cycle. I was craving it a lot (particularly cheese!) and thought I should have some in case my body is missing the calcium or protein. I try to go for the low lactose options of course though as I still have a lactose intolerance. At first I wondered if I was becoming too relaxed- basically worrying about whether I'm not worrying enough! However I realised how silly that sounded and also decided that me feeling less stressed and more happy has to be a good thing for the baby.

Life can be hard, there's no doubt about that. There are plenty of times when things are awful and there probably will be in the future unfortunately, so when things ARE going well why not let yourself be happy? I'm not going to worry about "jinxing" it but will allow myself enjoy this special time. So that's been my attitude lately! I've been spending some quality moments with hubby, catching up with friends, and having daydreams about the future when we will be a family of three.

What I've been eating lately

Yes, I'm one of those annoying people who takes photos of their food in restaurants before eating! Anyway I thought I'd share pictures of some of the meals I've enjoyed lately while eating out or at home.

Firstly, pumpkin risotto. Yum. I'm a big fan of risotto. Love it with mushrooms or pumpkin in particular. This one was covered in lots of parmesan cheese too. (Meaning I had to take several lactase tablets but so worth it!) This was eaten an international restaurant chain with Italian cuisine, Vapiano.

Another time I had a burgerless burger with avocado sauce and salad. I generally love all things avocado. This was at another restaurant chain, though it's only in Germany as far as I know, called Hans im Glück (happy Hans!). I got the burger bunless as I wanted to avoid any gluten. I also didn't get any cheese as I was trying to be dairy free that day. It came with a vegan sauce.

At home I cooked a yummy vegan meal recently; butternut squash, lentil and spinach curry. I was loosely following this recipe and it turned out really well. Hubby said it was "delicious". The following day I used the leftover squash to make a carrot and butternut squash soup by basically throwing it into a pot along with ginger, onion, garlic, vegetable stock, italian herbs, turmeric and black pepper then using my smoothie maker to blend it once it was soft. I also added coconut milk so it would be creamy. That's a good cream alternative when you are dairy free.

I made myself a healthy salad one evening with rocket leaves, cocktail tomatoes, cucumber, walnuts, avocado and cheese. For the dressing I used olive oil, a little lemon juice and basil and oregano with black pepper.

My husband and I eat a lot of vegan meals as we try not to eat a large amounts of animal products. When we do eat meat, then ideally it's organic and not processed. This was gnocchi with mediterranean veg and rocket leaves at the vegan place in town.

I've got quite a sweet tooth. Dessert used to be my favourite course when I was younger! This is a gluten free carrot cake I enjoyed recently with a caffeine free cappuccino and soya milk.

Natural killer cells - friend or foe?

The first time I heard the term "natural killer cells" in relation to miscarriages and failed IVF cycles, I thought it sounded awful. As if certain women have these toxic cells in their bodies destroying any potential babies! However, I have since learned that everyone has natural killer cells and they are generally a good thing. They help your body fight off infections and diseases (including cancer) and indicate a strong immune system. The theory, which is quite new in the infertility industry, is that some women (I read somewhere it's around 10-15%) have elevated levels which could then interfere with pregnancies. Initially when an embryo arrives into the womb, it will appear as a something foreign since it will have different DNA, and her body will need to decide that this is something good and should be protected and not fought off. It is a complex process so I guess it's easy to imagine that something might go wrong along the way.

While researching NK cells (which has left me more confused than ever to be honest!) I came across a blog saying that if you have elevated levels then you should figure out why, and not just take medicine to reduce them. That makes sense but I don't think it's so easy. I went to a gastrologist recently to discuss some occasionaly digestive issues I've been having and am now getting tested for celiac, just to rule out any other food intolerances. I hope I don't have any more as living with lactose intolerance is already difficult enough! I'm not sure what else I could be tested for. The gastrologist I went to was actually really uncaring and abrupt. He agreed to do some testing but when I tried to show him the blood tests results, he basically just told me to discuss them with my gyno. I had mentioned my miscarriage following IVF to him to explain why we had done the further blood testing and he looked like he couldn't care less. He certainly didn't show any sympathy. Clearly he doesn't believe that stomach issues may have any connection with infertility. I felt quite upset actually after the encounter. On my way home I was sad thinking about those three IVF potential babies that were transferred into me during the first and second round and what could have been...

These days a lot of people have food allergies and intolerances. It's probably due to the western diet, too many processed foods, plus we eat too much dairy in general. A cow's milk is designed for calves not humans. I still eat dairy with lactase enzyme tablets. Completely cutting it out is just too difficult since I love yoghurts and cheese but I have been trying to reduce the amount. I tried osteopathy two years ago when I was attempting natural fertility options (such as acupuncture) and the lady told me that she has had several women who couldn't get pregnant who she advised to quit dairy for three months and they then fell pregnant shortly after! She had the theory that a lot of people probably have undiagnosed food intolerances that they don't know about but could be causing stomach inflammation. It could be the case that your body then says, oh something is wrong, and the natural killer cells get elevated. One of the women on an IVF forum I frequent was able to substantially reduce her elevated NK cells naturally when she followed the so-called AIP diet (Autoimmune Protocol) which is an even stricter version of the paleo diet. It is great to hear there may be some other ways to treat the NK cells, and I also read something about omega3 helping (I'm taking supplements now), but I don't think I would be able to follow such a restrictive diet for that long!

During my research I came across a website saying how great natural killer cells are, that they fight off cancer and some tips on how to elevate them which seemed ironic since I am trying to do the opposite! In general I rarely get the flu and don't come down with many colds so maybe I do have a strong immune system. The treatment for elevated NK cells can leave you more prone to infections so it's important to be aware of that. I came across IVIG & Intralipid Therapy in IVF: Interpreting Natural Killer Cell Activity for Diagnosis and Treatment which mentions the importance of testing for NK cells in relation to fertility and wishes more reproductive doctors would take it seriously.

However then I also found Fertility Fraud: Natural Killer (NK) Cell Testing which says there are too many false positives and no need for the unnecessary treatments. Another negative article: Natural killer (NK) cells – fertility fraud? which suggests the idea of the human uterus attacking an embroyo it is designed to nurture is "preposterous". And from another post on the same site:
Anxious IVF patients are soft targets for hard marketers. In consulting rooms and online, they’re told their bodies may be sabotaging their pregnancies because their embryos are perceived as infections. This ‘NK’ scare may be completely unfounded. Natural killer cells: you have to hand it to the person who coined that phrase. It’s a mortifying description for vulnerable IVF patients willing to try anything to improve their chances. The truth is, intralipids might help. Might. Not will

The next article I read, Reproductive Immunology – What is the truth about Natural Killer cells? sums it up such;
Studies looking into these cells have produced conflicting results, but the majority of leading scientists in this area dispute that Natural Killer cells are a problem in fertility treatment and pregnancy. Given the potential side effects accompanying Natural Killer cell treatments, there does not seem to be enough justification for undergoing this testing and treatment.

Reading all those of course makes me wonder if the tests and treatments could just be a complete waste of money, unjustified and potentially put my health or that of my future unborn baby at risk. Going through IVF, I am already prepared to take certain risks with my own health but I definitely would not want to negatively affect any children! Then again I also read lots of sites which were on the other side of the controversy, for instance: Miscarriages can be Prevented, and this study which concludes:
The results of present study demonstrated that the level of NK cells as a risk factor is associated with pregnancy loss in women with IVF failure.

There was also this interesting article: Natural Killer Cells & Fertility:Cutting Through the Controversy which summarizes;
Studies are beginning to surface that demonstrate IntraLipid therapy does in fact improve the odds of pregnancy for those with recurrent implantation failure. In fact, well-reputed journals (Human Reproduction (2016) 31 (1): 217–218; “The absence of evidence is not the evidence of absence” and (2015) 30 (7): 1526-1531 “Enough! Stop the arguments and get on with the science of natural killer cell testing”) are publishing articles outlining both the pro’s and con’s of testing natural killer cells. Unfortunately, many people opposed to the testing only cite the publication that argues against it. That being said, not everyone requires testing for natural killer cell activation – it should be reserved for certain patients that have already demonstrated an implantation issue. And treatment of these individuals, should their test be positive, has been successful in thousands of anecdotal cases.

I asked around a bit. Two doctor friends think that having high natural killer cells does not cause fertility issues and the numbers can just be raised due to other factors such as stress and to be wary of any "treatment". I heard from someone else who has a doctor friend in Hannover that specializes in fertility that she has had eight patients helped by the NK treatment, even a few of them who got pregnant naturally after failed IVF! I've also read loads of stories on forums from women who had several miscarriages and then got the treatment which worked for them. It doesn't work for everyone though, I know that. Hearing the positive stories makes me hopeful and I think it could be worth trying in our case. That said, I do feel somewhat uncomfortable about it and will definitely be asking my doctor a lot about the risks and side effects.

Would you pursue the natural killer cell treatment if you were me?