Fertility
does not seem to be impaired to a larger extent in women with MS.
However, infertility and MS might just come coincidentally together and,
therefore, MS patients might undergo assisted reproductive treatment
(ART). Thus, during the last years different studies evaluating the
effects of ART on MS relapses have been published. All of them reported
an increase in annualized relapse rate after ART. Furthermore, in a
recent study clinical worsening was associated with an increase in MRI
activity. Putative mechanisms involved in MS worsening after ART
include: temporary interruption of disease modifying therapies, stressful
events associated with infertility, and immunological changes induced
by hormones such as increase in pro-inflammatory cytokines and anti-MOG
antibodies, as well as an increase in immune cell migration across the
blood-brain-barrier. Overall, neurologists should be aware of this risk
and discuss the pros and cons of the procedures with MS patients.
Have you discussed issues of having ART with your neurologist, if you are thinking of using them you should?