Keishi pearls are never naturals as they are the bi-product of the culturing process. What happens is a piece of the inserted mantle tissue breaks off and forms another pearl sac. The resulting keishi pearl has a weird shape because it has no real nucleus. So, keishi pearls are a result of human intervention like all cultured pearls.
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About freshwater? Not all, then what about Scotttish and Bavaran river pearls?
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This I am really not sure of. I do not know of any commercial harvesting in those regions in a long, long time...