May 2015

In recent years, there has been growing evidence that infertility treatments can raise relapse rates in women with multiple sclerosis (MS). Infertility treatments can also bring on or worsen MS symptoms.

MS is an incurable disease of the central nervous system that can affect the brain, spinal cord and optic nerves. MS affects about 2.5 million people worldwide and twice as many women as men are diagnosed. Women are often in their childbearing years before they are diagnosed. However, having MS does not seem to affect fertility in any significant way. Most women with MS have a normal fertility rate.

A new study, led by Jorge Correale, from the Raul Carrea Institute for Neurological Research, Buenos Aires, Argentina, showed that women with MS who used assisted reproductive technology (such as IVF) to help them become pregnant found that it made their MS symptoms worse.  The research, (published in the Annals of Neurology) showed that about 75% of the women found that their MS symptoms worsened with the infertility treatments. More than 70% experienced new symptoms, and 27% of women found that their existing symptoms became worse.

Rhonda R. Voskuhl, MD, director of the multiple sclerosis program at the David Geffen School of Medicine at the University of California, Los Angeles, says the key difference between this study and others is that it focused specifically on ART, in which women are given drugs called gonadotropin-releasing hormone (GnRH) agonists to stimulate egg follicle production. Also known as luteinizing hormone, GnRH is responsible for the release of follicle-stimulating hormones (FSH), which regulate the release of eggs. GnRH agonists are used to prevent natural ovulation during IVF.

ART with GnRH is not the only infertility treatment available to women. “There are other options,” says Voskuhl, and “if all your options are otherwise equal, you might want to choose another one.” However, she adds that she wouldn’t automatically rule out ART with a GnRH agonist if it were your only choice. Each woman has to weigh the risk of worsening her MS versus the benefit of becoming pregnant and decide for herself, she says.
It is important for women with MS who are considering ART to be aware of the potential increased risk of relapse, particularly if the treatment does not result in pregnancy.