WebMD Medical News
Louise Chang, MD
Oct. 3, 2012 -- There is growing evidence that infertility treatments raise relapse rates in women with multiple sclerosis.
In a new study, 3 out of 4 women with MS had increased disease activity following assisted reproductive technology (ART) infertility treatments.
The study was small, with just 16 infertile MS patients getting the treatments.
But a second study with twice as many patients, published just a few months ago, also suggested that infertility treatments can bring on or worsen MS symptoms.
Timothy Coetzee, PhD, who is chief research officer for the National MS Society, says it is increasingly clear that hormones -- particularly sex hormones -- play an important role in MS.
“This research highlights an issue that needs further study,” he says. “When we manipulate hormones to achieve a pregnancy, there may be a significant impact on MS symptoms.”
Multiple sclerosis is an autoimmune disease that affects about 400,000 people in the U.S. and 2.5 million people worldwide.
Twice as many women as men are diagnosed. Women are often diagnosed in their childbearing years.
Most women with MS are no more likely to suffer from infertility as other women. But fertility can be affected in women treated with certain MS drugs.
“When MS and infertility coincide, patients seek assisted reproduction technology to achieve pregnancy,” says Jorge Correale, MD, of Argentina’s Raul Carrea Institute for Neurological Research.
In the new study, Correale and colleagues followed patients with relapsing-remitting MS who had a total of 26 cycles of infertility treatments.
The treatment included drugs that affect the release of hormones that prepare the body for a pregnancy.
Compared to MS patients in remission who did not have the infertility treatments, the women who did had a sevenfold increase in symptom flares and a ninefold increase in enhanced disease activity; this was seen on MRI scans over nine months of follow-up after the last cycle of infertility treatment.
Nearly 3 out of 4 flares (73%) involved new symptoms, and just over 1 in 4 (27%) were considered a worsening of existing symptoms.
The research appears in the latest issue of the journal Annals of Neurology.
In a separate study published in mid-June, researchers in France followed 32 women with MS.
In the three months following their infertility procedures, there was a higher rate of MS relapses compared to before the treatments. Women who failed to become pregnant were more likely to relapse than women who became pregnant.
Coetzee says women with MS who are considering assisted reproduction need to know that the treatment may worsen their symptoms.
It is not clear if treatment for infertility affects overall disease progression.
Pregnancy is known to bring on a remission of MS symptoms in many women. Symptoms often worsen after delivery, but giving birth is not believed to affect the long-term progression of the disease.
“The message is not that women with MS should not undergo these treatments,” Coetzee says. “Studies like this are important to help them make informed choices. As MS becomes more and more of a manageable disease, quality-of-life issues like this one are likely to become more of an issue.”
SOURCES:Correale, J. Annals of Neurology, Oct. 2, 2012.Timothy Coetzee, PhD, chief research officer, National MS Society.News release, American Neurological Association.Michel, L. Journal of Neurology, Neurosurgery and Psychiatry, June 2012.
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