AAN 2024: Fertility treatment in MS doesn’t increase relapse risk

Undergoing fertility treatment with assistive reproductive technologies does not increase the likelihood of having a relapse for women with multiple sclerosis (MS) who are taking a disease-modifying therapy (DMT), according to a new analysis.

“The results are reassurance for women with MS who plan to undergo assistive reproductive technologies,” Nele Range, a medical student at Ruhr University, in Germany, who presented the analysis’ findings at the American Academy of Neurology (AAN) 2024 Annual Meeting, being held April 13-18, in Colorado, and online. Her talk was titled “The Impact of Disease-modifying Therapy on Relapse Risk in Women with Multiple Sclerosis Undergoing Assisted Reproductive Technologies (ART).”

Range noted, however, that the findings emphasize “the need for close disease management and counseling with pregnancy-safe DMTs throughout the reproductive journey.”

The study was conducted “to assess [the] benefits of maintaining disease-modifying therapy (DMT) during [such fertility treatment],” its abstract states.

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MS most commonly affects women, and the disease usually manifests in early adulthood, during most patients’ childbearing years. While MS itself doesn’t affect fertility, problems conceiving are very common among many individuals of childbearing age, and people with MS are no exception.

Yet, whether assistive reproductive technologies can be safely used by women with MS needs further investigation, the researchers noted.

“In Western countries, 10% to 20% of all couples suffer from infertility, so when MS disease and problems to conceive come together, MS patients might be concerned about a negative impact on the disease course when opting for assistive reproductive technologies,” Range said.

Assistive reproductive technologies, abbreviated ARTs, are medical procedures used to help people with fertility issues to conceive. These often include hormone treatments that promote the growth of eggs in the ovaries.

While a few small studies had suggested that undergoing ART could increase the risk of relapses in women with MS, more recent larger studies have found no increase in relapse risk following such fertility treatment.

To gain greater clarity, Range and colleagues analyzed outcomes from a group of 126 women who underwent ART to help them conceive. Most of the women had MS; there also were a handful with clinically isolated syndrome or radiologically isolated syndrome, which are early stages of MS-like disease.

Collectively, the women underwent 344 rounds of fertility treatment, and 67% of those treatments were done while patients were receiving a DMT.

In all, 20 of those rounds of fertility treatment (5.81%) were followed by a relapse within three months of ART.

Using statistical tests, the researchers evaluated whether MS relapses were more common in the three months following each round of treatment, which would suggest that ART increases relapse risk.

The results instead indicated that the risk of relapse was no greater following ART than at any other point in time. Further analyses looking at different types of ARTs likewise showed no increased risk, and there was no difference in relapse rates based on whether or not the fertility treatment actually resulted in a pregnancy.

Maintaining DMT … during [treatment with assistive reproductive technologies] was the only modifiable factor associated with a reduction in relapse risk. … Hence, pregnancy-compatible DMTs should be continued during [such fertility treatment].

However, statistical models showed that the rate of relapses after ART was significantly higher — by 83% — in patients who weren’t on treatment with a DMT versus those who were.

“Maintaining DMT … during ART was the only modifiable factor associated with a reduction in relapse risk,” Range concluded. “Hence, pregnancy-compatible DMTs should be continued during ART.”

Note: The Multiple Sclerosis News Today team is providing coverage of the American Academy of Neurology (AAN) 2024 Annual Meeting April 13-18. Go here to see the latest stories from the conference.