Fertility Treatment Does Not Raise MS Relapse Risk, Study Finds

Patients with multiple sclerosis (MS) undergoing fertility treatments (FT), including disease-modifying therapies (DMT), were not found to be at an elevated relapse risk following treatment, according to an observational retrospective study published in Neurology Neuroimmunology & Neuroinflammation.

“Our findings provide reassurance to patients and fertility experts that the use of [embryo transfer (ET)] only and [oral ovulation induction (OI)] are not associated with elevated risk of relapses,” researchers wrote. “Our findings highlight the importance of informed up-to-date management of patients with MS who seek fertility support. Of importance, continuing highly effective appropriately timed DMT during FTs may reduce the risk of relapse during this period of marked hormonal fluctuations and stressors.”

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Participants included patients aged 18 to 45 years—the mean age at the time of treatment was 36.5 ± 3.8 years—with clinically isolated syndrome (CIS) or MS who underwent at least 1 fertility treatment from January 1, 2010, to October 14, 2021. FTs included controlled ovarian stimulation followed by fresh embryo transfer (COS-ET), COS alone, ET alone, and OI. Researchers compared the annualized relapse rate (ARR) between the 3 month-period after FT and the 12-month period before FT using mixed Poisson regression.

In total, 124 FT cycles in 65 patients with MS (n = 56) or CIS (n = 9) were included and the relapse rate within 3 months of treatment was found to be low, with only 5 relapses occurring in 4 patients in 80 cycles of COS. No relapses occurred in COS cycles with disease-modifying therapies (DMTs), and no relapses were observed after ET alone. There was 1 relapse recorded after OI. Among COS-ET cycles that achieved pregnancy, the ARR decreased significantly (p=0.04) within the first trimester. Mean ARR did not change before versus after COS (p=0.37). 

“Patients with CIS/MS, along with the general population, may use FT to optimize conception in several clinical and social scenarios, including fertility preservation, older age, single parenting, male factor infertility, and same-sex relationships,” researchers concluded. “As the use of FTs has evolved, so have questions about the optimal management of MS during these periods. The low risk of relapses in this contemporary treated cohort, confirms more recent reports.”

Reference
Graham EL, Bakkensen JB, Anderson A, et al. Inflammatory activity after diverse fertility treatments. Neurol Neuroimmunol Neuroinflamm. 2023;10(3). doi.org/10.1212/NXI.0000000000200106