Pregnancy, Infertility and Hormones: MS and Motherhood
Multiple sclerosis is most commonly diagnosed in women who are of child-bearing age. As such, patients diagnosed with MS are frequently interested in the topics of fertility, pregnancy, motherhood, and disease. Since the incidence of MS can be affected by hormones, it is understandable that women with MS may have concerns.
What is the effect of MS on fertility?
According to the National MS Society, no evidence suggests that MS impairs fertility or leads to a higher number of spontaneous abortions, stillbirths or birth defects.
Results from various studies have shown that women who have MS do not experience any more complications related to pregnancy, labor or delivery than women without the disease. However, one study did suggest that MS-related fatigue, weakness of abdominal muscles, or the inability to feel contractions may make a women more likely to require a Caesarean delivery or the use of forceps during delivery.
Does pregnancy have an effect on MS?
Half a century ago, it was believed that pregnancy might make MS worse. That has turned out to not be the case. In fact, many women experience a decrease in MS symptoms and relapse rate during the second and third trimesters of pregnancy.
What about after childbirth?
Exacerbation rates to tend to rise in the first three to six months after childbirth with the risk of relapse estimated to be 20 to 40 percent, according to the National MS Society.
Some neurologists may recommend a course of Solumedrol to preemptively stave off postpartum exacerbations. Fortunately, pregnancy or postpartum relapses have little effect on long-term disability in women with MS.
Do infertility treatments have an effect on MS?
A study published online in the Journal of Neurology, Neurosurgery, and Psychiatry confirms the results of prior studies suggesting that infertility treatments have an impact on MS relapse rate. Hellwig K, et al (2009) found a statistically significant increase in relapse rate in 23 MS patients who underwent hormonal stimulation associated with assisted reproductive technology (ART), which includes in vitro fertilization (IVF).
In another study, researchers obtained data related to MS patients and IVF procedures from 13 French university hospital databases or referring neurologists. From 1998 to 2008, 32 women with MS underwent a total of 70 IVF treatments. In 48 cases gonadotrophin releasing hormone (GnRH) agonists were used, GnRH antagonists used in 19 cases, and information is unknown for three treatment cycles.
Annualized relapse rate (ARR) was calculated for different times periods before and after IVF treatment. As shared by MedPageToday, 19 women in the study had a total of 26 relapses during the three months after the IVF treatment.
Data analysis revealed that the ARR was significantly higher during the three-month period following IVF treatment (mean ARR 1.60) compared with the three months prior to IVF (mean ARR 0.80) and a three-month period one year before the procedure (mean ARR 0.68).
This represents double the risk of relapse in the three months post-IVF as compared to the three months before IVF.
Supplementary data reveals that a significant increase in relapses was associated with the use of GnRH agonists but not with GnRH antagonists. The ARR for the GnRH agonist cohort was significantly higher during the two-month period following IVF treatment (mean ARR 2.12) compared with the two months prior to IVF (mean ARR 0.75). This represents almost triple the risk of relapse in the two months post-IVF when GnRH agonists are used.
Of the 70 IVF procedures, 21 resulted in successful pregnancy and 49 failed. A significant increase in relapses was also associated with IVF failure (mean ARR 2.08) compared to successful pregnancies (mean ARR 0.86) in the 2-month period following IVF. When examining the six months after a failed procedure, the increase in relapses was no longer statistically significant.
It is important that neurologists and gynecologists be aware that the risk of relapse in MS patients is increased if the IVF procedure fails and/or GnRH agonists are used.
Cavalla P, et al. "Fertility in patients with multiple sclerosis: current knowledge and future perspectives." Neurol Sci 2006;27:231-230. doi:10.1007/s10072-006-0676-x
Hellwig K, et al. "Increase in relapse rate during assisted reproduction technique in patients with multiple sclerosis." Eur Neurol 2009;61:65-68. doi:10.1159/000177937
Michel L, et al. "Increased risk of multiple sclerosis relapse after in vitro fertilization." J Neurol Neurosurg Psychiatry 2012; doi:10.1136/jnnp-2012-302235. (Supplementary data](http://jnnp.bmj.com/content/early/2012/05/25/jnnp-2012-302235/suppl/DC1)
"Pregnancy and Reproductive Issues," National Multiple Sclerosis Society, accessed June 13, 2012.
Voskuhl RR, Gold SM. "Sex-related factors in multiple sclerosis susceptibility and progression." Nat Rev Neurol 2012 Mar 27;8(5):255-63. doi: 10.1038/nrneurol.2012.43
Todd Neale. "MS Relapse More Common After In Vitro Procedure." MedPageToday, published June 11, 2012.
Grace Rattue. "Multiple Sclerosis Patients Who Receive Fertility Treatment Have Higher Relapse Rates." Medical News Today, published June 12, 2012.