Impact of Assisted Reproductive Technologies (ART) on Relapse Risk in Women with Multiple Sclerosis
Nele Range1, Sandra Thiel1, Kerstin Hellwig1, Ralf Gold1
1Department of Neurology, St. Josef Hospital, Ruhr University, Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany
Objective:
To determine the impact of ART on the relapse risk in a cohort of 91 women with relapsing remitting MS, clinically isolated syndrome or radiologic isolated syndrome mainly treated with disease modifying treatment immunomodulatory treatment (DMT) during ART.
Background:
Several studies have shown an increased relapse risk after ART in MS patients, newer studies lead to different conclusions.
Design/Methods:
Women were prospectively recruited in an ART and MS sub-registry of the German Multiple Sclerosis and Pregnancy Registry (DMSKW). Stimulations were followed prospectively but these women- who had not contacted us before- were also asked for stimulations prior to the current stimulation and included into analysis. Information on stimulation protocols, pregnancy, disease course was collected with a standardized questionnaire in telephone interviews during stimulation and following months.
Results:
We analyzed data on 270 stimulations in 91 women, of which 49/270 (18,15%) were followed prospectively and 221/270 (81,85%) retrospectively. Most women with a mean age of 34,15 [±3.75] years and a median disease duration of 4,3 [0,15–18,64] years had relapsing remitting MS. 83/91 (93,41%), 6/91 (4,4%) clinically isolated syndrome and 2/91 (2,2%) RIS. 186/270 (68,90%) women continued their DMTs during ART, 84/270 (31,11%) stimulations were without DMTs. 92/270 (34,07%) stimulations resulted in pregnancy. Relapses occurred in 25/270 (9,26%) stimulations after three months, interestingly only with small differences between those who got pregnant (7/92 (7,61%)) and those who did not (18/178 (10,11%)) (p = 0.6519). Women who continued DMT during ART had fewer relapses per stimulation (11/186 (5,91%)) compared to women without DMT during ART (14/84 (16,67%)) (p = .009). Updated information including adjusted regression models will be presented at the time of the meeting.
Conclusions:
The maintenance of DMT during ART can be a determining factor in reducing the relapse risk. MS disease activity should be controlled and pregnancy compatible DMT treatment during ART continued.