How FMF Reached Reproduction

The Story

Two forces, acting together, explain Stina’s reproductive history — and neither is bad luck. The first is mechanical and anatomical: every episode of FMF peritonitis inflamed the pelvic peritoneumThe membrane lining the abdominal cavity and organs., and inflamed serosal surfaces heal by sticking together. Over years, recurrent serositis (the same serositis that struck her gut in M16) laid down pelvic adhesions — fibrous bands that can tether, kink, and distort the fallopian tubes from the outside, obstructing the very canal where egg and sperm must meet. The second force is hormonal and systemic: chronic inflammation, driven by the IL-1 and IL-6 signaling at the heart of FMF, disrupts the hypothalamic-pituitary-gonadal axisSecond cervical vertebra; has the odontoid process (dens) for pivoting head (“no” motion).. Inflammatory cytokines blunt and desynchronize GnRH/LH/FSH pulsing, so the clean rhythm the cycle depends on becomes noisy — producing irregular, heavy, abnormal uterine bleeding and impaired ovulationThe release of a mature oocyte from the ovary. that owe nothing to a local uterine lesion.

This reframes everything. Stina’s bleeding was systemic inflammation written on the endometriumThe inner lining of the uterus that thickens during the menstrual cycle to support a potential pregn; her infertility was adhesive tubal distortion plus a disrupted cycle, not an unsolvable mystery. And it changes the plan. With FMF finally controlled on colchicine, the inflammatory driver of both problems is quieted, the cycle can steady, and her care team can address fertility from the right diagnosis — managing adhesions, supporting ovulation, and timing conception. Colchicine itself is a central part of that conversation: it is generally continued through conception and pregnancy in FMF because controlling inflammation protects both the pregnancy and the long-term amyloid risk, a planning question that flows straight into the capstone (M21). And while organ-deposited AA amyloid is felt mainly in gut and kidney, the same chronic SAA elevation can, rarely, touch reproductive organs too — one more reason that controlling the inflammation, not just treating the pelvis, is the real fix.

From Stina’s chart: Stina’s later pelvic imaging showed adhesions tethering the adnexa, her cycles were irregular as well as heavy, and the question of colchicine in a planned pregnancy was now squarely on the table.