Assisted Reproductive Techniques in Multiple Sclerosis: Recommendations from an Expert Panel

Abstract

Introduction: Multiple sclerosis (MS) is mainly diagnosed in women of reproductive age. However, there is a paucity of guidelines jointly prepared by neurologists and gynaecologists on managing women with MS and the desire for motherhood. Therefore, in this review we propose recommendations for such cases, with an particular focus on those requiring assisted reproductive techniques (ART).Methods: A group of seven MS experts (4 neurologists and 3 gynaecologists) came together for three discussion sessions to achieve consensus. Results:The recommendations reported here focus on the importance of early preconception counselling, the management of disease-modifying therapies before and during ART procedures, important considerations for women with MS regarding ART (intrauterine insemination, in vitro fertilisation and oocyte cryopreservation) and the paramount relevance of multidisciplinary units to manage these patients. Conclusions: Early preconception consultations are essential to individualising pregnancy Celia Oreja-Guevara and Jose ´Luis Go ´mez-Palomares contributed equally to this work.

Family Planning in Fertile-Age Patients With Multiple Sclerosis (MS) (ConPlanEM Study): Delphi Consensus Statements

“…Furthermore, recent studies suggest that in vitro fertilization (IVF) may not be linked with MS relapses, as previously proposed. This improvement in disease control during IVF could be explained, at least in part, by advancements in the treatment landscape for MS and better family planning [ 26 ]. In this vein, recent data has shown that continuing the use of disease-modifying therapy (DMT) until receiving a positive pregnancy test after IVF could help reduce the incidence of relapses [ 27 ].…”

Planificación familiar en hombres y mujeres con esclerosis múltiple. Análisis del Registro Andaluz (2018-2022)

“…Como consecuencia, es frecuente que las pacientes tengan que posponer su deseo gestacional, y es habitual que haya un retraso en la edad a la que consiguen ser madres con respecto a la media en mujeres sanas [ 10 ]. Esto puede dar lugar a un incremento en el número de pacientes que tienen que recurrir a una técnica de reproducción asistida [ 12 ]. Habitualmente, la evolución de la enfermedad, en el caso de mujeres con EM que deciden quedarse embarazadas, es favorable, ya que la tasa anualizada de brotes disminuye significativamente durante este período para incrementarse ligeramente tras el parto y volver a estabilizarse con el tiempo hasta alcanzar niveles previos a la gestación [ 9 , 13 - 15 ].…”