Reply to: “Recurrent miscarriage: Are NK cell subsets a good predictor?” : Journal of the Chinese Medical Association

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Letter to the Editor

Reply to

“Recurrent miscarriage

Are NK cell subsets a good predictor?”

Adib Rad, Hajara; Basirat, Zahraa,*; Mostafazadeh, Amrollahb; Faramarzi, Mahbobeha; Bijani, Alic; Nouri, Hamid Rezab; Soleimani Amiri, Shimad

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Journal of the Chinese Medical Association 82(5):p 444, May 2019. | DOI: 10.1097/JCMA.0000000000000098
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Dear Editor,

We appreciate the interest and comments by Yeh CC et al1 on our study.2They proposed some questions in different sections to improve the quality of the study.

In the “Results” section, we must mention that the mean of abortion was 2.75 in the recurrent miscarriage group and the mean of deliveries (parous) was 1.45 in the control group. Of course, we have excluded women with stillbirth and death child in the control group.

In the “Methods” section, it should be expressed that immune processes have a main effect in recurrent miscarriage.3 Recurrent pregnancy loss (RPL) is the most common form of fertility failure that is defined as loss of two or more pregnancy before the 20th week of pregnancy.4 Therefore, the implantation is done at this time. On the contrary, a study has shown that natural killer (NK) cells can also play a role in the continuation of pregnancy by binding to HLA-G and secretion of growth factors for the fetus.5 Therefore, the role of NK cells is essential in the continuation and maintenance of the pregnancy to the term. In this study, we have noticed this aspect of the role of NK cells. Also, our sampling was 8 weeks after the abortion and that there was no implantation at this time.

Finally, NK cells with up-regulated cytotoxic phenotypic are important in RPL. Also, the regulatory role of NK cells is important in maintaining and continuation of the pregnancy.6 In our study, the phenotypes mentioned may be important in this role (regulatory).


This study was supported by a research grant (9434919) from Babol University of Medical Sciences.


1. Yeh CC, Horng HC, Wang PH. Recurrent miscarriage: are NK cell subsets a good predictor.J Chin Med Assoc201982443
2. Adib Rad H, Basirat Z, Mostafazadeh A, Faramarzi M, Bijani A, Nouri HR, et al. Evaluation of peripheral blood NK cell subsets and cytokines in unexplained recurrent miscarriage.J Chin Med Assoc2018811065–70
3. Sacks G, Yang Y, Gowen E, Smith S, Fay L, Chapman M. Detailed analysis of peripheral blood natural killer cells in women with repeated IVF failure.Am J Reprod Immunol201267434–42
4. Medicine PCotASfRDefinitions of infertility and recurrent pregnancy loss: a committee opinion.Fertil Steril20139963
5. Fu B, Zhou Y, Ni X, Tong X, Xu X, Dong Z, et al. Natural killer cells promote fetal development through the secretion of growth-promoting factors.Immunity2017471100–13.e6
6. Zhao X, Jiang Y, Wang L, Li Z, Li Q, Feng X. Advances in understanding the immune imbalance between T-lymphocyte subsets and NK cells in recurrent spontaneous abortion.Geburtshilfe Frauenheilkd201878677–83
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