The role of laparoscopy in the diagnosis of infertility in patients with familial Mediterranean fever
- Authors: Sotskiy P.O.1, Sotskaya O.L.1,2, Safaryan M.D.2, Mkhitaryan A.G.2,3, Hayrapetyan H.S.1,2
-
Affiliations:
- Center for Medical Genetics and Primary Health Care
- Mkhitar Heratsi Yerevan State Medical University
- Armenian-German Scientific and Practical Center of Pathology “Histogen”
- Issue: No 8 (2023)
- Pages: 86-94
- Section: Original Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/587790
- DOI: https://doi.org/10.18565/aig.2023.47
- ID: 587790
Cite item
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.
Full Text
![Restricted Access](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_lock.png)
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, YerevanOlga 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; YerevanMarina 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, YerevanArmen 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; YerevanHasmik 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; YerevanReferences
- Ben-Chetrit E., Levy M. Reproductive system in familial Mediterranean fever: an overview. Ann. Rheum. Dis. 2003; 62(10): 916-9. https://dx.doi.org/10.1136/ard.62.10.916.
- Özen S., Batu E.D., Demir S. Familial Mediterranean fever: recent developments in pathogenesis and new recommendations for management. Front. Immunol. 2017; 8: 253. https://dx.doi.org/10.3389/fimmu.2017.0025.
- Sönmez H.E., Batu E.D., Özen S. Familial Mediterranean fever: current perspectives. J. Inflamm. Res. 2016; 9: 13-20. https://dx.doi.org/10.2147/ JIR.S91352.
- Atas N., Armagan B., Bodakci E., Kasifoglu T., Satis H., Sari A. et al. Familial Mediterranean fever associated infertility and underlying factors with fertility [abstract]. Arthritis Rheumatol. 2018; 70 (Suppl. 10).
- Ben-Chetrit E. Clinical manifestations and diagnosis of familial Mediterranean fever. UpToDate. May 22, 2018. Available at: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-familial-mediterranean-fever/print
- Sarı İ, Birlik M, Kasifoğlu T. Familial Mediterranean fever: an updated review. Eur. J. Rheumatol. 2014; 1(1): 21-33. https://dx.doi.org/10.5152/eurjrheum.2014.006.
- Ehrenfeld E.N., Polishuk W.Z. Gynecological aspects of recurrent polyserositis (familial Mediterrranean fever, periodic disease). Isr. J. Med. Sci. 1970; 6(1):9-13.
- Zayed A., Nabil H., State O., Badawy A. Subfertility in women with familial Mediterranean fever. J. Obstet. Gynaecol. Res. 2012; 38(10): 1240-4. https://dx.doi.org/10.1111/j.1447-0756.2012.01857.x.
- Nabil H., Zayed A., State O., Badawy A. Pregnancy outcome in women with familial Mediterranean fever. J. Obstet. Gynaecol. 2012; 32(8): 756-9. https://dx.doi.org/10.3109/01443615.2012.698667.
- Sohar E., Gafni J., Pras M., Heller H. Familial Mediterranean fever: a survey of 470 cases and review of the literature. Am. J. Med. 1967; 43(2): 227-53. https://dx.doi.org/10.1016/0002-9343(67)90167-2.
- Huzmeli C., Candan F., Bagci G., Alaygut D., Bagci B., Yildiz E. et al. Evaluation of 61 secondary amyloidosis patients: a single-center experience from turkey. J. Clin. Anal. Med. 2016; 7(5): 695-700. https://dx.doi.org/ 10.4328/JCAM.448.
- Sotskiy P.O., Sotskaya O.L., Hayrapetyan H.S., Sarkisyan T.F., Yeghiazaryan A.R., Atoyan S.A., Ben-Chetrit E. Infertility causes and pregnancy outcome in patients with Familial Mediterranean fever and controls. J. Rheumatol. 2021; 48(4): 608-14. https://dx.doi.org/10.3899/jrheum.200574.
- Радзинский В.Е., ред. Бесплодный брак: версии и контраверсии. 2-е изд. М.: ГЭОТАР-Медиа; 2020. 432с. [Radzinsky V.E., ed. Infertile marriage: versions and counter-versions. 2nd ed. Мoscow: GEOTAR-Media; 2020. 432p. (in Russian)].
- Сухих Г.Т., Назаренко Т.А., ред. Бесплодный брак. Современный подход к диагностике и лечению. Руководство. М.: ГЭОТАР-Медиа; 2010. 774с. [Sukhikh G.T., Nazarenko T.A., eds. Infertile marriage. A modern approach to diagnosis and treatment: a guide. Moscow: GEOTAR-Media; 2010. 774p. (in Russian)].
- Савельева Г.М., Радзинский В.Е., Манухин И.Б., ред. Гинекология. Национальное руководство. М.: ГЭОТАР-Медиа; 2017. 1088с. [Savelyeva G.M., Radzinsky V.E., Manukhin I.B., eds. Gynecology. National guide. Moscow: GEOTAR-Media; 2017. 1088с. (in Russian)].
- Краснопольская К.В., Назаренко Т.А. Клинические аспекты лечения бесплодия в браке. Диагностика и терапевтические программы с использованием методов восстановления естественной фертильности и вспомогательных репродуктивных технологий. Руководство. М.: ГЭОТАР-Медиа; 2013. 376с. [Krasnopolskaya K.V., Nazarenko T.A. Clinical aspects of treatment of infertility in marriage. Diagnosis and therapeutic programs using methods of restoration of natural fertility and assisted reproductive technologies: a guide. Moscow: GEOTAR-Media; 2013. 376p. (in Russian)].
- Фальконе Т., Херд В.В. Репродуктивная медицина и хирургия. Пер. с англ., под ред. Г.Т. Сухих. М.: ГЭОТАР-Медиа; 2014. 948с. (in Russian)].
- Livneh A., Langevitz P., Zemer D., Zaks N., Kees S., Lidar T. et al. Criteria for the diagnosis of familial Mediterranean fever. Arthritis Rheum. 1997; 40(10): 1879-85. https://dx.doi.org/10.1002/art.1780401023.
- Серов В.Н., Звенигородский И.Н. Диагностика гинекологических заболеваний с курсом патологической анатомии. М.: БИНОМ; Лаборатория знаний; 2003. [Serov V.N., Zvenigorodsky I.N. Diagnosis of gynecological diseases with a course of pathological anatomy. Moscow: BINOM; Knowledge Laboratory; 2003. (in Russian)].
- Хмельницкий О.К. Патология маточных труб. В кн.: Патоморфологическая диагностика гинекологических заболеваний. СПб.: СОТИС; 1994: 286-333. [Khmel'nitskii O.K. Pathology of the fallopian tubes. In: Pathomorphological diagnosis of gynecological diseases. Saint Petersburg: SOTIS; 1994: 286-333. (in Russian)].
- Бродский Г.В., Адамян Л.В., Сухих Г.Т. Маточные трубы при генитальной патологии и интратубарная терапия женского бесплодия. Акушерство и гинекология. 2018; 9: 74-8. [Brodsky G.V., Adamyan L.V., Sukhikh G.T. The fallopian tubes in genital pathology and intratubal therapy for female infertility. Obstetrics and Gynecology. 2018; (9): 74-8. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.9.74-78.
- Малушко А.В., Кольцова Т.В., Ниаури Д.А. Туберкулез половых органов и спаечная болезнь: факторы риска репродуктивных потерь и женского бесплодия. Проблемы туберкулеза и болезней легких. 2013; 3: 3-9. [Malushko A.V., Kol’tsova T.V., Niauri D.A. Tuberculosis of genital organs and adhesions: risk factors for reproductive losses and female infertility. Problems of Tuberculosis and Lung Diseases. 2013; (3): 3-9. (in Russian)].
- Sharma J.B. Current diagnosis and management of female genital tuberculosis. J. Obstet. Gynaecol. India. 2015; 65(6): 362-71. https://dx.doi.org/10.1007/s13224-015-0780-z.
- Sharma J.B., Sneha J., Singh U.B., Kumar S., Roy K.K., Singh N. et al. Comparative study of laparoscopic abdominopelvic and fallopiantube findings before and after antitubercular therapy in female genital tuberculosis with infertility. J. Minim. Invasive Genicol. 2016; 23(2): 215-22. https://dx.doi.org/10.1016/j.jmig.2015.09.023.
- Grace G.A., Devaleenal D.B., Natrajan M. Genital tuberculosis in females. Indian J. Med. Res. 2017; 145(4): 425-36. https://dx.doi.org/10.4103/ ijmr.IJMR_1550_15.
- Djuwantono T., Permadi W., Septiani L., Faried A., Halim D., Parwati I. Female genital tuberculosis and infertility: serial cases report in Bandung, Indonesia and literature review. BMC Res. Notes. 2017; 10(1): 683. https://dx.doi.org/10.1186/s13104-017-3057-z.
- Dabak R., Uygur-Bayramiçli O., Aydin D.-K., Dolapçioglu C., Gemici C., Erginel T. et al. Encapsulating peritonitis and familial Mediterranean fever. World J. Gastroenterol. 2005; 11(18): 2844-6. https://dx.doi.org/10.3748/ wjg.v11.i18.2844.
Supplementary files
![](/img/style/loading.gif)