The role of laparoscopy in the diagnosis of infertility in patients with familial Mediterranean fever

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Abstract

Objective: To investigate the prevalence of infertility-related laparoscopic findings among patients with familial Mediterranean fever (FMF), female genital tuberculosis (FGTB), and those without FMF or FGTB.

Materials and methods: This cross-sectional study included 204 patients with infertility. The patients were divided into a group of 50 women with FMF, median age 29 (26; 31.8) years, a comparison group of 44 women with FGTB, median age 29 (25; 33) years, and a control group of 110 patients without FMF or FGTB, median age 32 (28; 36) years.

Results: Compared with control subjects, patients with FMF and FGTB had higher incidence of pelvic adhesions (RR=2.83 [95% CI: 1.97; 4.07]; p<0.001 and 3.3 [95% CI: 2.34; 4.66]; p<0.001, respectively), free fluid (RR=3.3 [95% CI: 1.93; 5.65]; p<0.001 and 3.12 [95% CI: 1.79; 5.45]; p<0.001, respectively), and peritoneal lesions (p<0.001). Conversely, they were less likely to have genital endometriosis (RR=0.46 [95% CI: 0.27; 0.78]), p=0.002 and 0.22 [95% CI: 0.09, 0.51]; p<0.001, respectively). Tubal occlusion was more common in patients with FGTB than in controls and patients with FMF (RR=5.63 [95% CI: 3.5; 9.04]; p<0.001 and 2.41 [95% CI: 1.6; 3.63]; p<0.001, respectively). In the FMF group tubal occlusion was more common than in the control group (RR=2.34 [95% CI: 1.29; 4.24], p=0.009). Tubal peritoneal infertility was predominantly diagnosed in patients with FMF (RR=2.59 [95% CI: 1.99; 3.38]; p<0.001 and FGTB (RR=2.76 [95% CI: 2.13; 3.56]; p<0.001). Repeated pelvic surgery was more common in FMF patients than in patients with FGTB (p<0.001) and in controls (p<0.001); in the FGTB group it was observed more often than among controls (p=0.006) Patients with FMF and FGTB were more likely to undergo coagulation/cauterization of polycystic ovaries (p=0.009 and <0.001, respectively) and ovarian resection (p<0.001).

Conclusion: FMF and FGTB are associated with an increased risk of pelvic adhesion, tubal occlusion, free fluid, peritoneal lesions, and tubal peritoneal infertility. Both conditions often require repeated pelvic surgery such as coagulation/cauterization of polycystic ovaries and ovarian resection.

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About the authors

Pavel O. Sotskiy

Center for Medical Genetics and Primary Health Care

Author for correspondence.
Email: pavel.sotskiy@gmail.com

PhD, obstetrician-gynecologist

Armenia, Yerevan

Olga L. Sotskaya

Center for Medical Genetics and Primary Health Care; Mkhitar Heratsi Yerevan State Medical University

Email: olga.sotskaya@gmail.com

PhD, Associate Professor at the Department of Phthisiology, obstetrician-gynecologist, phthisiogynecologist

Armenia, Yerevan; Yerevan

Marina D. Safaryan

Mkhitar Heratsi Yerevan State Medical University

Email: marina.safaryan@gmail.com

Honored Doctor of Armenia, Dr. Med. Sci., Professor, Head of the Department of Phthisiology

Armenia, Yerevan

Armen G. Mkhitaryan

Mkhitar Heratsi Yerevan State Medical University; Armenian-German Scientific and Practical Center of Pathology “Histogen”

Email: armpath@gmail.com

PhD, Associate Professor, Pathologist; Head of the Laboratory, Armenian-American Health Center Foundation, Chief Pathologist of Yerevan; Senior Lecturer, Department of Pathology

Armenia, Yerevan; Yerevan

Hasmik S. Hayrapetyan

Center for Medical Genetics and Primary Health Care; Mkhitar Heratsi Yerevan State Medical University

Email: hasmik.hayrapetyan@cmg.am

Head of the Laboratory of Genetics of Autoinflammatory Diseases; Dr. Bio. Sci., Professor at the Department of Medical Genetics

Armenia, Yerevan; Yerevan

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