No rise in MS patients’ risk of relapse seen with fertility treatments

Disease relapses are no more likely in women with multiple sclerosis (MS) after fertility treatment than they were before such treatment, a study found.

Researchers also observed that almost half of the women receiving fertility treatment were on disease-modifying MS therapies, which may have helped to keep a relapse risk low.

“Fertility treatments for people with MS are not as risky as we once thought,” Edith L. Graham, MD, the study’s first author and a professor of neurology at Northwestern University in Chicago, said in a press release.

“We did not see many relapses in our [group of patients], probably due to the fact that most of the patients were treated with disease-modifying therapies in the year prior,” Graham added.

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The study, “Inflammatory Activity After Diverse Fertility Treatments: A Multicenter Analysis in the Modern Multiple Sclerosis Treatment Era,” was published in Neurology: Neuroimmunology & Neuroinflammation.

MS affects the brain and spinal cord, and has a wide range of symptoms that vary from person to person. The disease is known to impact mostly women of childbearing age, so concerns about fertility and pregnancy are common.

According to Graham, women with MS “are more likely to be diagnosed with infertility but have been less likely to receive fertility treatment than those who do not have MS.”

Earlier studies produced mixed results on whether a fertility treatment increased the risk of an MS relapse, helping to explain why fewer of these patients use such treatments. However, there has been a shift in recent years to safer hormone therapies and to an increased use of DMTs during fertility treatments.

To address how those chances impact relapse risk, Graham and colleagues examined the number of relapses experienced by women at four MS centers in the U.S. who underwent at least one fertility treatment between 2010 and 2021.

Initial fertility findings were presented by Graham at the Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in 2022.

Of the 65 women in the study, 56 had a relapsing-remitting MS and nine had clinically isolated syndrome, or a first episode of symptoms suggestive of MS. Their mean age at the time of the fertility treatment was 36.3, and they had been living with MS for an average of 7.7 years.

Fifteen women (23%) already had given birth to one or more children when they received the fertility treatment.

Treatments included controlled ovarian stimulation with or without fresh embryo transfer, embryo transfer alone, and oral medicines to stimulate ovulation. The researchers counted a total of 124 cycles of fertility treatment.

They then reviewed electronic medical records to determine how many relapses the women experienced in the year prior to fertility treatment and in the three months and year after each treatment.

Overall, a total of six relapses were reported in the three months after fertility treatment, and a total of 15 relapses over the year that followed treatment.

Because controlled ovarian stimulation is the procedure with the greatest impact on levels of estradiol, a major hormone produced in the ovaries that can affect relapses, researchers focused their analysis specifically on women who underwent this type of treatment.

Across 80 cycles of controlled ovarian stimulation, four women experienced five relapses within three months after treatment. However, average annualized relapse rates, or the number of relapses per year, were no different before or after the fertility treatment (0.25 vs. 0.26 relapses per year). The findings remained similar when only women without other ovarian stimulation cycles in the previous year were included in the analysis.

Disease-modifying therapies ‘associated’ with lower relapse rates

A total of 53 women (43%) were taking disease-modifying therapies at the time of fertility treatment. Notably, none of the women who underwent controlled ovarian stimulation while on disease-modifying therapy experienced a relapse after this treatment.

This suggested that being on a disease-modifying therapy “was associated with a lower relapse rate,” the researchers wrote.

Researchers also examined whether a fertilization treatment’s outcome — whether a women got pregnant or not — affected relapse rates after treatment. Lower relapse rates were found in pregnant patients, consistent with the known reduction in relapse rates during pregnancy.

Among women who failed to become pregnant, relapse rates remained similar to those before fertility treatment, suggesting that failed treatment did not impact relapse rates.

“We hope our findings provide reassurance to those with MS as well as fertility experts that these treatments are not associated with elevated risks of relapses,” Graham said. “It’s important for people to remember that continuing appropriately timed disease-modifying treatments during fertility treatment can reduce the risk of relapse.”

Study findings “highlight the importance of informed up-to-date management of patients with MS who seek fertility support,” the researchers concluded.

“Continuing highly effective appropriately timed [disease-modifying therapies] during [fertility treatment] may reduce the risk of relapse during this period of marked hormonal fluctuations and stressors,” they added.