#ECTRIMS2022 – Fertility Treatment Won’t Raise Relapse Risk for Women

Use of DMTs found to help keep MS relapse rate for women low

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Fertility treatments do not significantly increase the risk of relapse in women with multiple sclerosis (MS), even among those who undergo treatment protocols associated with greater levels of hormone exposure, according to a recent U.S.-based analysis.

Older age, a longer MS duration, and the use of MS disease-modifying treatments (DMTs) were all factors associated with the lowest risk of relapse in the three months after fertility treatment.

“Going forward, to support patients and their active treatment for MS while undergoing fertility treatments, we can use disease-modifying therapies with effects that persist beyond their elimination,” Edith Graham, MD, an assistant professor in the department of neurology at Northwestern University, said in an oral presentation.

The study, “Inflammatory Activity after Diverse Fertility Treatments: A Multicenter Analysis in the Modern MS Treatment Era,” was presented by Graham at the 38th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), being held Oct. 26-28 virtually and in Amsterdam, the Netherlands.

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Because MS is most often diagnosed in women of childbearing age, fertility and pregnancy are common concerns among patients.

A large body of data has shown that women with MS are as fertile as females in the general population. Moreover, they usually have safe pregnancies that don’t alter their MS course. But whether undergoing fertility treatments might affect relapse risk is not well-established.

Investigating the effects of fertility treatment

In the past, five small studies, each involving four to 32 patients, found that in vitro fertilization, known as IVF, raised the risk of relapse anywhere from two to seven times. But a more recent study involving 225 women failed to demonstrate a greater risk.

Moreover, fertility treatment practices have seen a shift in recent years, with the use of safer hormone therapies and an increased use of DMTs during fertility treatments. There also has been an “increased societal use of diverse fertility treatments,” Graham said.

To gain greater insight on the question of risk, Graham and her team evaluated relapse rates among women with MS who underwent at least one fertility treatment cycle from 2010 to 2021. The patients were treated at four large U.S. centers.

A total of 124 fertility treatment cycles, among 65 women, were included in the analysis. Patients had either clinically isolated syndrome or relapsing-remitting MS. They had a mean age of 36.3, and had been living with MS for a mean of 7.7 years. Most women (78%) were white and had low levels of disability.

DMTs were used by 60% of patients in the year prior to fertility treatment, and 43% of women were on a DMT at the time of treatment.

Patients underwent a range of fertility treatment types, including controlled ovarian stimulation (15%), embryo transfer (24%), and IVF (49%), which combines the other two approaches. Another 11% underwent oral ovulation induction.

The researchers compared relapse rates in the three months following a fertility treatment cycle with rates in the year prior to such treatments. Overall, six relapses occurred in five patients within the three months, which amounted to an annualized relapse rate of 0.18. In comparison, that rate was 0.23 before the fertility treatment.

“There was no increased risk of relapses observed in the three months after fertility treatment,” Graham said in the presentation.

Notably, relapse rates also were low in the subgroup of patients who received fertility treatments associated with higher levels of hormone exposure – those involving controlled ovarian stimulation. Among those patients, there were five relapses in four patients, and the relapse rates before and after treatment were 0.26 and 0.25, respectively.

“There was a low risk of relapse during fertility treatment, even with protocols that were historically seen as riskier,” Graham said.

The team also looked at potential predictors of relapse. Results showed that relapse rates were significantly lower in patients 37 or older, with a disease duration of two years or longer, and who used a DMT during the fertility treatments.

Overall, 37% achieved a pregnancy with live birth, which also was associated with a reduced relapse rate.

Graham noted that the low number of relapses “limited our ability to identify some specific factors for relapse.” Nonetheless, the “findings expand our knowledge of fertility treatments by showing diverse fertility treatments and not only IVF,” Graham said.

“In this modern case series … we did not observe an elevated risk of relapses after [fertility treatment],” the researchers concluded.

Note: The Multiple Sclerosis News Today team is providing in-depth coverage of the ECTRIMS Forum 2022 Oct. 26-28. Go here to see the latest stories from the conference.

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