International Journal of
Reproductive Biomedicine
Wed, Oct 8, 2025
[Archive]
Volume 23, Issue 7 (July 2025)
IJRM 2025, 23(7): 587-589 |
Back to browse issues page
Ethics code: IR.ARUMS.REC.1399.604
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Salehzadeh F, Mohammadi Kebar Y, Nezhadseifi E. Familial Mediterranean fever and reproductive systems, our experience in two decades: A letter to editor. IJRM 2025; 23 (7) :587-589
URL: http://ijrm.ir/article-1-3483-en.html
URL: http://ijrm.ir/article-1-3483-en.html
1- Pediatric Department, Bouali Children's Hospital, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran.
2- Emam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran. ,yousefmk506@yahoo.com
3- Emam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran.
2- Emam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran. ,
3- Emam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran.
Full-Text [PDF 360 kb]
(220 Downloads)
| Abstract (HTML) (173 Views)
Ethical Considerations
The Ethical Committee of Ardabil University of Medical Sciences, Ardabil, Iran has approved the study (Code: IR.ARUMS.REC.1399.604). Written informed consent was obtained from all the participants.
Acknowledgments
We express our gratitude to all patients who participate in this study. No artificial intelligence was used.
Conflict of Interest
The authors declare that there is no conflict of interest.
Full-Text: (32 Views)
Dear Editor,
Due to the chronic nature of familial Mediterranean fever (FMF), there have always been conflicting reports regarding the effect of disease complications such as amyloidosis and its treatment by colchicine on the reproductive system, fertility, and pregnancy (1). The presence of recurring peritonitis and its possibility of intestinal obstruction has led to a secondary effect on the reproductive system and increased risk of infertility and miscarriage.
Continuation of colchicine with its potential teratogenic and birth defects, and even premature delivery with the possibility of early miscarriage in case of attacks, are the main challenges in females with FMF. The presumptive side effects of treatment, such as oligospermia and azoospermia, have been a dilemma for males with FMF.
Finally, following pregnancy, breastfeeding by the infant, in case of colchicine consumption by the mother, is another issue that needs to be discussed more (1).
Here we discuss FMF and its effect on reproductive systems of women, and we share our 2 decades of experience considering this complicated issue.
This study included all women with FMF at Bouali Children’s hospital, Ardabil and the FMF Registration Center in Iran (http://WWW.FMFIRAN.IR). Nearly 600 patients were enrolled in this study; all patients had FMF according to Tel-Hashomer clinical criteria and/or based on MEFV gene mutation analysis.
In 2 decades, 11 female patients with FMF, phenotypically and or genetically confirmed, without renal or amyloidosis-related complications of FMF, decided to become pregnant. All of them were advised to continue colchicine (1-2 mg daily) through their pregnancy and lactation periods, any sort of dose reduction of colchicine was not suggested. All were in their active reproductive age of life, and most of them were primipara. 3 women showed M694V mutations as homozygotes, one woman had M680I homozygotes, and 5 women had compound heterozygotes, and the rest were heterozygote mutations.
All these women had a healthy pregnancy and childbirth without any adverse effects. They did not suffer from amyloidosis as a main complication of FMF and a history of infertility.
According to the results of our study, all participants had a healthy pregnancy and childbirth with a lack of any unusual complications and a successful lactation period of at least 6 months. After the introduction of colchicine as a known treatment for FMF in the 1970s, some researchers, based on initial reports, suggested discontinuation of the drug 3 months before conception due to its potential risk of chromosomal abnormalities, such as trisomy 21 (1).
In contrast, the increased risk of miscarriage in these women raised the issue of therapeutic intervention. Studies have shown that before the 1970s, the risk of early termination of pregnancy in FMF patients was higher than normal population, probably due to the higher levels of inflammatory markers in these patients and amniotic fluid (2). Therefore, the rate of cesarean sections in these women has also been traditionally higher than the general population (3). Since the course of the disease is highly variable in pregnant FMF women, some may face no symptoms and encounter decreased attacks, while others may experience severe attacks during pregnancy. Therefore, therapeutic intervention in this period seems to be reasonable (2).
It has been thoroughly demonstrated that having renal damage, such as amyloidosis, is associated with increased pregnancy complications, such as miscarriage and stillbirth (4, 5). Regarding the adverse effects of colchicine, previous reports suggested an increase in chromosomal disorders such as trisomy 21 with colchicine usage in pregnancy (3, 6). To date, in several subsequent studies, this association has not been reported, and the initial result has been abandoned (5, 7). Recent studies have also shown the lack of increased miscarriage by colchicine usage during pregnancy; therefore, colchicine is recommended during pregnancy (7).
In this study, all these pregnant women who took colchicine during their pregnancy had a healthy course and childbirth without any adverse effects or attacks, which confirms recent studies on the safety of colchicine and the possibility of a low-risk pregnancy (2). It was also requested that all mothers continue their colchicine consumption without interruption during postpartum and lactation time. Regarding breastfeeding, no complications were reported in infants such as delayed development or neurological abnormalities and growth failure, at least during 6 months of follow up.
Conversely, in male infertility and azoospermia, oligospermia, and motility disorders have been reported with colchicine consumption in males. Recent studies have shown that at therapeutic dosage, colchicine had no effect on sperm motility; however, disease-related factors such as Behçet's disease or FMF complications such as amyloidosis seem to be the most common causes of oligo- and or azoospermia rather than colchicine usage (8).
Regarding the colchicine effect on male infertility, our FMF clinic and registration system included 600 patients, of which half were male and two-thirds were of reproductive age. However, no reports of infertility were found among our patients who had been under treatment with colchicine so far. As a result, the therapeutic doses of colchicine have no adverse effect on the male reproductive system. However, this finding needs to be re-evaluated by further research.
Retrospective review was the main limitation of this study. Although we did not include males in this research, we shared our additional findings about male and their reproductive system.
In conclusion, because of early miscarriage of inflammatory attacks during pregnancy, colchicine is recommended throughout conception and pregnancy.
Key points
Due to the chronic nature of familial Mediterranean fever (FMF), there have always been conflicting reports regarding the effect of disease complications such as amyloidosis and its treatment by colchicine on the reproductive system, fertility, and pregnancy (1). The presence of recurring peritonitis and its possibility of intestinal obstruction has led to a secondary effect on the reproductive system and increased risk of infertility and miscarriage.
Continuation of colchicine with its potential teratogenic and birth defects, and even premature delivery with the possibility of early miscarriage in case of attacks, are the main challenges in females with FMF. The presumptive side effects of treatment, such as oligospermia and azoospermia, have been a dilemma for males with FMF.
Finally, following pregnancy, breastfeeding by the infant, in case of colchicine consumption by the mother, is another issue that needs to be discussed more (1).
Here we discuss FMF and its effect on reproductive systems of women, and we share our 2 decades of experience considering this complicated issue.
This study included all women with FMF at Bouali Children’s hospital, Ardabil and the FMF Registration Center in Iran (http://WWW.FMFIRAN.IR). Nearly 600 patients were enrolled in this study; all patients had FMF according to Tel-Hashomer clinical criteria and/or based on MEFV gene mutation analysis.
In 2 decades, 11 female patients with FMF, phenotypically and or genetically confirmed, without renal or amyloidosis-related complications of FMF, decided to become pregnant. All of them were advised to continue colchicine (1-2 mg daily) through their pregnancy and lactation periods, any sort of dose reduction of colchicine was not suggested. All were in their active reproductive age of life, and most of them were primipara. 3 women showed M694V mutations as homozygotes, one woman had M680I homozygotes, and 5 women had compound heterozygotes, and the rest were heterozygote mutations.
All these women had a healthy pregnancy and childbirth without any adverse effects. They did not suffer from amyloidosis as a main complication of FMF and a history of infertility.
According to the results of our study, all participants had a healthy pregnancy and childbirth with a lack of any unusual complications and a successful lactation period of at least 6 months. After the introduction of colchicine as a known treatment for FMF in the 1970s, some researchers, based on initial reports, suggested discontinuation of the drug 3 months before conception due to its potential risk of chromosomal abnormalities, such as trisomy 21 (1).
In contrast, the increased risk of miscarriage in these women raised the issue of therapeutic intervention. Studies have shown that before the 1970s, the risk of early termination of pregnancy in FMF patients was higher than normal population, probably due to the higher levels of inflammatory markers in these patients and amniotic fluid (2). Therefore, the rate of cesarean sections in these women has also been traditionally higher than the general population (3). Since the course of the disease is highly variable in pregnant FMF women, some may face no symptoms and encounter decreased attacks, while others may experience severe attacks during pregnancy. Therefore, therapeutic intervention in this period seems to be reasonable (2).
It has been thoroughly demonstrated that having renal damage, such as amyloidosis, is associated with increased pregnancy complications, such as miscarriage and stillbirth (4, 5). Regarding the adverse effects of colchicine, previous reports suggested an increase in chromosomal disorders such as trisomy 21 with colchicine usage in pregnancy (3, 6). To date, in several subsequent studies, this association has not been reported, and the initial result has been abandoned (5, 7). Recent studies have also shown the lack of increased miscarriage by colchicine usage during pregnancy; therefore, colchicine is recommended during pregnancy (7).
In this study, all these pregnant women who took colchicine during their pregnancy had a healthy course and childbirth without any adverse effects or attacks, which confirms recent studies on the safety of colchicine and the possibility of a low-risk pregnancy (2). It was also requested that all mothers continue their colchicine consumption without interruption during postpartum and lactation time. Regarding breastfeeding, no complications were reported in infants such as delayed development or neurological abnormalities and growth failure, at least during 6 months of follow up.
Conversely, in male infertility and azoospermia, oligospermia, and motility disorders have been reported with colchicine consumption in males. Recent studies have shown that at therapeutic dosage, colchicine had no effect on sperm motility; however, disease-related factors such as Behçet's disease or FMF complications such as amyloidosis seem to be the most common causes of oligo- and or azoospermia rather than colchicine usage (8).
Regarding the colchicine effect on male infertility, our FMF clinic and registration system included 600 patients, of which half were male and two-thirds were of reproductive age. However, no reports of infertility were found among our patients who had been under treatment with colchicine so far. As a result, the therapeutic doses of colchicine have no adverse effect on the male reproductive system. However, this finding needs to be re-evaluated by further research.
Retrospective review was the main limitation of this study. Although we did not include males in this research, we shared our additional findings about male and their reproductive system.
In conclusion, because of early miscarriage of inflammatory attacks during pregnancy, colchicine is recommended throughout conception and pregnancy.
Key points
- "Inflammatory attacks during pregnancy may increase the risk of early miscarriage".
- "Colchicine treatment is safe and recommended during conception and pregnancy".
- "Breastfeeding while taking colchicine poses no known risks to infants".
- "FMF patients receiving treatment have normal fertility".
- "Therapeutic doses of colchicine do not negatively impact male fertility".
Ethical Considerations
The Ethical Committee of Ardabil University of Medical Sciences, Ardabil, Iran has approved the study (Code: IR.ARUMS.REC.1399.604). Written informed consent was obtained from all the participants.
Acknowledgments
We express our gratitude to all patients who participate in this study. No artificial intelligence was used.
Conflict of Interest
The authors declare that there is no conflict of interest.
Type of Study: Letter to Editor |
Subject:
Reproductive Epidemiology
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
