Multiple sclerosis and fertility

Danielle Rice MD (Dr. Rice of Loyola University Medical Center has no relevant financial relationships to disclose.)
Anthony T Reder MD, editor. (Dr. Reder of the University of Chicago served on advisory boards and as a consultant for Bayer, Biogen Idec, Caremark Rx, Genentech, Genzyme, Novartis, Questcor/Malinkrodt, Serono, and Teva-Marion.)
Originally released March 13, 2015; last updated September 14, 2016; expires September 14, 2019

This article includes discussion of multiple sclerosis and fertility, fertility, fecundity, multiple sclerosis, and pregnancy and multiple sclerosis. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Key points

 

• Multiple sclerosis predominantly affects women in their childbearing years and is a frequent concern for these patients.

 

• Fertility issues in multiple sclerosis emphasize some of the possible immunomodulatory effects of sex hormones.

 

• Infertility has not been considered to be more prevalent in multiple sclerosis populations, but fertility can be influenced by immunosuppressants used to treat multiple sclerosis or even sexual dysfunction related to multiple sclerosis.

 

• Artificial reproductive therapy increases the risk of relapse in multiple sclerosis patients and raises levels of pro-inflammatory cytokines.

Historical note and terminology

As multiple sclerosis primarily affects females of childbearing age, fertility issues in multiple sclerosis have attracted an increasing share of new research. Also, the prevalence of multiple sclerosis in women versus men has increased significantly over the last few decades, increasing from a ratio of 2:1 to over 3:1 (Wallin et al 2012). Decades ago, physicians were wary of multiple sclerosis patients becoming pregnant due to lack of effective treatments and concern about eventual disability. Physicians also believed that pregnancy would worsen the natural course of multiple sclerosis as it does some other autoimmune diseases like systemic lupus erythematosus. The 1998 PRIMS study was the first large prospective trial evaluating the natural course of pregnancy and multiple sclerosis disease activity and demonstrated the overall decrease of relapses during pregnancy and increase in relapses in the postpartum period. Pregnancy is now widely considered an immune system “tolerant” period for multiple sclerosis patients, and some data may even suggest a beneficial effect. In the era of disease-modifying drugs, there is great interest in the natural history of multiple sclerosis pregnancies and hormonal influences on disease activity.

It is unknown if infertility is more common in multiple sclerosis patients. Some studies have noted a higher incidence of childlessness amongst multiple sclerosis patients (Koch-Henriksen 1989; Runmarker and Andersen 1995), but it is unknown if this relates to true infertility or elective nulliparity. A small retrospective French study found the time lapse before pregnancy was achieved was no different for multiple sclerosis patients compared to the general population, but only 57% of women reported the time to pregnancy (Roux et al 2015). Many family-planning decisions are heavily weighted toward patient disability concerns and financial burden on families due to multiple sclerosis treatment rather than biological infertility. The secondary and tertiary effects of multiple sclerosis, such as paresthesias of the genitals, weakness, depression, and bowel or bladder dysfunction, can all contribute to sexual dysfunction and to diminished fertility as well. Also, various medications used in the treatment of multiple sclerosis can have an impact on future fertility. Studies have also found an increase in multiple sclerosis relapses in women undergoing infertility treatment, suggesting sex hormones have immunomodulatory effects.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.