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Fertility Treatment Does Not Increase MS Relapse Risk, Study Finds
Women with multiple sclerosis (MS) who underwent fertility treatment did not exhibit an elevated risk of MS relapse following their treatment, according to results from a multicenter cohort analysis published in Neurology: Neuroimmunology & Neuroinflammation.
Past studies with small historical cohorts have reported variable relapse risk following in vitro fertilization (IVF), while more recent studies have suggested no change in annualized relapse rate (ARR) following fertility treatment. Thus, the study authors aimed to evaluate ARR 12 months pre-fertility treatment and 3 months post-fertility treatment as well as identify factors that may have contributed to an increased risk of relapse.
“This modern multicenter cohort identified no increase in relapse rate after [fertility treatment (FT)] in a group of women with recent or ongoing (43%) [disease-modifying therapy (DMT)] use, regardless of FT type or hormonal protocol used,” wrote Edith Graham, MD, Northwestern University Feinberg School of Medicine, Chicago, and co-authors in the study discussion. “Over the past decade, there has been a trend for more active treatment for patients with MS of childbearing potential, rendering more important the question of active DMT use during [controlled ovarian stimulation] and oocyte harvesting procedures.”
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The authors retrospectively identified 65 patients between the ages 18-45 with at least 1 fertility treatment under the period of study from 4 large academic MS centers, 56 of whom had MS and 9 of whom had clinically isolated syndrome (CIS). Fertility treatments included controlled ovarian stimulation followed by fresh embryo transfer (COS-ET), COS alone, embryo transfer (ET) alone, and oral ovulation induction (OI). The researchers used the Wilcoxon signed rank test and mixed Poisson regression models with random effects to compare ARR pre- and post-fertility treatment.
One hundred twenty-four fertility treatment cycles among the patients were included for analysis: 61 COS-ET, 19 COS alone, 30 ET alone, and 14 OI. Across 80 cycles with COS, there were 5 relapse instances among 4 unique patients within 3 months of treatment. The mean ARR after COS and before was not different (0.26 vs 0.25, P=0.37), and the incidence rate ratio (IRR) was 0.95 (95% CI: 0.52–1.76, P=0.88). No cycles with therapeutic disease-modifying therapies (DMTs) during COS had 3 months relapse (ARR 0 post-COS vs 0.18 pre-COS, P=0.02, n=34). Relapse rates did not vary by COS protocol. Among COS-ET cycles that achieved pregnancy (n=43), ARR decreased from 0.26 to 0.09 (P=0.04) within the first trimester of pregnancy. There were no relapses 3 months after ET alone and 1 relapse after OI.
"Fertility treatments for people with MS are not as risky as we once thought," Graham said in a statement. "We did not see many relapses in our cohort, probably due to the fact that most of the patients were treated with disease-modifying therapies in the year prior."
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