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Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis
Multiple sclerosis (MS) predominantly affects women of fertile age. Various aspects of MS could impact on fertility, such as sexual dysfunction, endocrine alterations, autoimmune imbalances, and disease-modifying therapies (DMTs). The proportion of women with MS (wMS) requesting infertility manageme...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10570169/ https://www.ncbi.nlm.nih.gov/pubmed/37679579 http://dx.doi.org/10.1007/s40263-023-01036-1 |
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author | Sparaco, Maddalena Carbone, Luigi Landi, Doriana Ingrasciotta, Ylenia Di Girolamo, Raffaella Vitturi, Giacomo Marfia, Girolama Alessandra Alviggi, Carlo Bonavita, Simona |
author_facet | Sparaco, Maddalena Carbone, Luigi Landi, Doriana Ingrasciotta, Ylenia Di Girolamo, Raffaella Vitturi, Giacomo Marfia, Girolama Alessandra Alviggi, Carlo Bonavita, Simona |
author_sort | Sparaco, Maddalena |
collection | PubMed |
description | Multiple sclerosis (MS) predominantly affects women of fertile age. Various aspects of MS could impact on fertility, such as sexual dysfunction, endocrine alterations, autoimmune imbalances, and disease-modifying therapies (DMTs). The proportion of women with MS (wMS) requesting infertility management and assisted reproductive technology (ART) is increasing over time. In this review, we report on data regarding ART in wMS and address safety issues. We also discuss the clinical aspects to consider when planning a course of treatment for infertility, and provide updated recommendations to guide neurologists in the management of wMS undergoing ART, with the goal of reducing the risk of disease activation after this procedure. According to most studies, there is an increase in relapse rate and magnetic resonance imaging activity after ART. Therefore, to reduce the risk of relapse, ART should be considered in wMS with stable disease. In wMS, especially those with high disease activity, fertility issues should be discussed early as the choice of DMT, and fertility preservation strategies might be proposed in selected cases to ensure both disease control and a safe pregnancy. For patients with stable disease taking DMTs compatible with pregnancy, treatment should not be interrupted before ART. If the ongoing therapy is contraindicated in pregnancy, then it should be switched to a compatible therapy. Prior to beginning fertility treatments in wMS, it would be reasonable to assess vitamin D serum levels, thyroid function and its antibody serum levels; start folic acid supplementation; and ensure smoking and alcohol cessation, adequate sleep, and food hygiene. Cervico-vaginal swabs for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis, as well as serology for viral hepatitis, HIV, syphilis, and cytomegalovirus, should be performed. Steroids could be administered under specific indications. Although the available data do not clearly show a definite raised relapse risk associated with a specific ART protocol, it seems reasonably safe to prefer the use of gonadotropin-releasing hormone (GnRH) antagonists for ovarian stimulation. Close clinical and radiological monitoring is reasonably recommended, particularly after hormonal stimulation and in case of pregnancy failure. |
format | Online Article Text |
id | pubmed-10570169 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-105701692023-10-14 Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis Sparaco, Maddalena Carbone, Luigi Landi, Doriana Ingrasciotta, Ylenia Di Girolamo, Raffaella Vitturi, Giacomo Marfia, Girolama Alessandra Alviggi, Carlo Bonavita, Simona CNS Drugs Review Article Multiple sclerosis (MS) predominantly affects women of fertile age. Various aspects of MS could impact on fertility, such as sexual dysfunction, endocrine alterations, autoimmune imbalances, and disease-modifying therapies (DMTs). The proportion of women with MS (wMS) requesting infertility management and assisted reproductive technology (ART) is increasing over time. In this review, we report on data regarding ART in wMS and address safety issues. We also discuss the clinical aspects to consider when planning a course of treatment for infertility, and provide updated recommendations to guide neurologists in the management of wMS undergoing ART, with the goal of reducing the risk of disease activation after this procedure. According to most studies, there is an increase in relapse rate and magnetic resonance imaging activity after ART. Therefore, to reduce the risk of relapse, ART should be considered in wMS with stable disease. In wMS, especially those with high disease activity, fertility issues should be discussed early as the choice of DMT, and fertility preservation strategies might be proposed in selected cases to ensure both disease control and a safe pregnancy. For patients with stable disease taking DMTs compatible with pregnancy, treatment should not be interrupted before ART. If the ongoing therapy is contraindicated in pregnancy, then it should be switched to a compatible therapy. Prior to beginning fertility treatments in wMS, it would be reasonable to assess vitamin D serum levels, thyroid function and its antibody serum levels; start folic acid supplementation; and ensure smoking and alcohol cessation, adequate sleep, and food hygiene. Cervico-vaginal swabs for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis, as well as serology for viral hepatitis, HIV, syphilis, and cytomegalovirus, should be performed. Steroids could be administered under specific indications. Although the available data do not clearly show a definite raised relapse risk associated with a specific ART protocol, it seems reasonably safe to prefer the use of gonadotropin-releasing hormone (GnRH) antagonists for ovarian stimulation. Close clinical and radiological monitoring is reasonably recommended, particularly after hormonal stimulation and in case of pregnancy failure. Springer International Publishing 2023-09-07 2023 /pmc/articles/PMC10570169/ /pubmed/37679579 http://dx.doi.org/10.1007/s40263-023-01036-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Review Article Sparaco, Maddalena Carbone, Luigi Landi, Doriana Ingrasciotta, Ylenia Di Girolamo, Raffaella Vitturi, Giacomo Marfia, Girolama Alessandra Alviggi, Carlo Bonavita, Simona Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis |
title | Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis |
title_full | Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis |
title_fullStr | Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis |
title_full_unstemmed | Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis |
title_short | Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis |
title_sort | assisted reproductive technology and disease management in infertile women with multiple sclerosis |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10570169/ https://www.ncbi.nlm.nih.gov/pubmed/37679579 http://dx.doi.org/10.1007/s40263-023-01036-1 |
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