Edith Graham, MD

Edith Graham, MD, Assistant Professor of Neurology, Feinberg School of Medicine, Northwestern University

In women with multiple sclerosis (MS) and clinically isolated syndrome (CIS), continuing disease modifying therapy (DMT) during assisted reproductive technologies (ART) appears to reduce the risk for relapse during this period of marked hormonal fluctuations and stressors, explained Edith L. Graham, MD, and colleagues who shared their findings at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2022.

Previous studies on this topic show a variable range of relapse risk in patients with MS undergoing ART, Dr. Graham noted.


Largest Cohort of Contemporary Women With MS to Date

“Increased risk for relapses has been reported in patients with MS and CIS after undergoing ART,” she said. “However, increases in the annualized relapse rate reported after IVF have varied widely in case studies ranging from four to 32 subjects, from a seven-fold increase in one, to no change in another. The impact of continuing with DMT, a more recent clinical trend, has not been fully evaluated.”

In the largest cohort of contemporary women with MS to date, Dr. Graham and colleagues assessed the risk for relapse after ART and identified risk factors for increased relapse risk. Women with MS or CIS (aged 18-45) who underwent at least one cycle of ART from January 1, 2010, to September 14, 2021, were identified via retrospective chart review.


Just 13.5% of Patients Experienced MS Relapse After ART Therapy

Most (78%) women in the study (average age, 35; average disease duration, 7.5 years) received ART due to infertility or a need for pre-implantation genetic testing, whereas 22% chose the treatment for fertility preservation, the researchers reported. Of the 19 out of 37 patients taking DMTs prior to ART, 10 continued to take the medication throughout ovarian hyperstimulation.

In those who received DMTs in the 12 months prior to ART, treatment included glatiramer acetate (N= 9), interferons (N=3), and dimethyl fumarate (N=1); three participants received B-cell depleting agents. In addition, three patients received medication in response to a rebound after discontinuation. Of these, two received fingolimod and one, natalizumab.

Of total patients, 13.5% experienced MS relapses in the 12 months following ART therapy; in this group, none had been treated with DMTs during the preceding 12 months, the researchers reported. Three of the relapses occurred within 3 months of ART treatment, one within 6 months, and one within 12 months.

For women undergoing ART, those not receiving DMTs had a notably higher relapse risk compared with those who were treated with the drug therapy, Dr. Graham and colleagues noted. “The likelihood of achieving pregnancy through ART while having MS appeared favorable,” the researchers added.