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Editorial
Assisted reproduction technology in multiple sclerosis
  1. Ger Mullan1,
  2. Stella Hughes2,
  3. David Rog3,
  4. Peter Brex4,
  5. Ruth Dobson5,6
  1. 1Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
  2. 2Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Belfast, UK
  3. 3Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
  4. 4Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
  5. 5Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
  6. 6Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Ruth Dobson; ruth.dobson{at}qmul.ac.uk

https://doi.org/10.1136/pn-2024-004459

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    Assisted reproduction technology (ART) has substantially advanced over the last half century. There are now several methods available potentially to support those who are attempting to conceive or who wish to consider oocyte cryopreservation procedures to preserve future fertility. These include in vitro fertilisation (IVF), embryo transfer, controlled ovarian stimulation, and intrauterine insemination and are described in detail in the recent publication in Practical Neurology by Moores et al, along with their relevance to epilepsy care.1

    Multiple sclerosis (MS) commonly affects women of childbearing age. Women with MS have lower live birth rates compared with women without MS, and overall they are less likely to access ART.2 While MS does not appear to affect fertility directly, co-existing neurological disability and sexual dysfunction may impact on chances of conception for some; additionally, delays in conception along with a choice for smaller family size have been reported to relate to the diagnosis of an incurable neurological disease.3

    Previous research suggests an increased risk of relapse for women with MS during and after ART, particularly in association with gonadotropin-releasing hormone (GnRH) agonist protocols,4–8 an observation seemingly confirmed in a meta-analysis in 2020.9 However, these studies all had small sample sizes (mean n=16; total n=81 across five studies) and likely selection bias. Strikingly, only five women with MS across all studies remained on disease-modifying therapy (DMT) during ART. The remaining 76 participants had either never received DMT or had stopped/paused for prolonged washout periods, often for at least a year.4–8 A significant proportion of the observed relapse risk in these studies may thus have related to prolonged periods without treatment.

    With growing interest in the management of pregnancy in MS alongside increasing use of DMT in and around pregnancy, data to support decision-making for women with MS …

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    Footnotes

    • Contributors RD: concept of manuscript and guarantor. GM: initial survey data analysis, initial manuscript draft. RD, PB: initial draft of survey with additional intellectual input from DR and SH. All authors: revision of manuscript for intellectual content, final review and approval of manuscript.

    • Funding The UK MS Pregnancy Register is supported by the Horne Family Charitable Trust.

    • Competing interests GM: none. SH has received unrestricted educational grants or speaking honoraria from Biogen, Merck Serono, Novartis, Roche and Sanofi Genzyme. DR has received honoraria for speaking, advisory boards and/or traveling from Biogen, Celgene, Hikma, Janssen, MedDay, Merck, Neuraxpharm, Novartis, Roche, Sanofi Genzyme and Teva. His institution has received research income from Actelion, Biogen, GW Pharmaceuticals, Janssen, Merck Serono, Mitsubishi, Novartis, Sanofi Genzyme, Teva and TG Therapeutics. PB, in the past 5 years, has received sponsorship to attend education meetings or honoraria for attending advisory boards or speaking at meetings from Merck, Roche, Biogen, Janssen and Sanofi-Genzyme. RD has received honoraria for speaking and/or traveling from Biogen, Merck, Teva, Janssen, Esai and Sanofi. She served on advisory board of Roche, Biogen, Janssen, Sandoz and Merck. She has received grant support from Biogen, Merck, Celgene, Barts Charity, the UK MS Society, NMSS, MRC, and the Home Family Charitable Trust and is CI of the UK MS Pregnancy Register.

    • Patient and public involvement statement PPI focus groups on the topic of pregnancy have reported the importance of honest risk-benefit discussions with patients, and the importance of clear guidance around IVF to patients.

    • Provenance and peer review Not commissioned; externally reviewed by Alasdair Coles, Cambridge, UK.