Fertility in patients with multiple sclerosis: current knowledge and future perspectives

Abstract

The issue of fertility in patients with multiple sclerosis (MS) has not been exhaustively studied. Epidemiological data have suggested that spontaneous fecundity might be reduced; several endocrine and sexual disturbances potentially interfering with reproduction have been evidenced in MS patients of both sexes. Moreover, some medical treatments used in MS (e. g., mitoxantrone, cyclophosphamide) may exert detrimental effects on spermatozoa as well as on oocytes, leading to early impairment of fertility. This review illustrates the factors potentially interfering with fertility in MS and discusses the therapeutic tools that may be used to promote fertility in these patients. The safety of hormonal therapies in MS is also examined. The current applications of assisted reproductive technology (ART) are discussed, including in vitro fertilisation (IVF) techniques. Currently available methods to preserve fertility in patients that undergo cytotoxic treatments by means of sperm/oocyte cryostorage or by ovarian fragment cryopreservation and autografting are considered.

Pregnancy in Multiple Sclerosis

“…However, women with MS tend to have fewer children, even before diagnosis, and undergo ART more frequently, possibly due to a higher incidence of hormonal disorders such as hyperprolactinemia, decreased estrogen levels, thyroid disorders and endometriosis [2]. With regard to DMT, short-term methylprednisolone pulse therapy does not appear to have an adverse effect on fertility, whereas menstrual disturbances have been reported with interferon-beta (IFN-β) and permanent amenorrhea with mitoxantrone, especially in women older than 35 years [2]. …”

Therapy of female sexual dysfunction in multiple sclerosis

“…Może to wynikać z obniżonej płodności spowodowanej zaburzeniami osi podwzgórze-przysadka-gonady (zwiększone stężenia FSH, LH i zmniejszone stężenie estrogenów na początku fazy folikularnej, częstsze hiperprolaktynemia i hiperandrogenizm) i zmniejszenia rezerwy jajnikowej, zaburzeń cyklu wywoływanych stosowanymi w rzutach SM wysokimi dawkami metyloprednizolonu. Drugą grupę czynników stanowią dysfunkcje seksualne utrudniające współżycie, unikanie ciąży z obawy przed jej przebiegiem, wpływem na chorobę i nieradzeniem sobie z opieką nad dzieckiem [23][24][25][26]. Badanie PRIMS (Pregnancy-Related Relapse in Multiple Sclerosis) wykazało, że SM nie ma bezpośredniego wpływu na częstość poronień, ciąż pozamacicznych czy na występowanie wad wrodzonych u płodu [27,28].…”

Serum Anti-Müllerian Hormone Levels in Multiple Sclerosis: A Case Control Study

“…The first manifestations commonly appear within the second and third decades of life. There is a 3-fold level of risk in females [1][2][3], which leads to several challenging concerns about the fertility and pregnancy of MS patients.…”

“…Auto-immunity, sexual disturbances, and a neurological dysfunction of the ovaries are recognized as some suspicious etiologies [3][4][5]. Moreover, studies evaluated MS patientstreated with immunosuppressive or immunomodulating agents like mitoxantrone and interferon β, respectively -have uncovered diminished follicular reserves and fertility in the treatment groups compared to the age-matched healthy controls [6,7].…”