How does multiple sclerosis affect IVF or fertility?

Question

Hello doctor

I am a 33-year-old female who was diagnosed with multiple sclerosis last year. I am currently receiving Ocrelizumab, and my condition is mostly stable. I am planning to freeze my eggs before beginning in vitro fertilization (IVF). How does multiple sclerosis or its treatment affect fertility, ovarian reserve, or pregnancy risks? Would it be better to delay assisted conception until I have been in remission for a longer period? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Thank you for your important question, and it is encouraging to hear that your multiple sclerosis (MS- a chronic, progressive disease that affects the central nervous system (brain and spinal cord)) is currently stable on Ocrelizumab. Many women with MS successfully pursue fertility preservation and pregnancy, but it is important to consider a few key points:

1. Fertility and ovarian reserve: MS does not directly impact fertility or ovarian reserve. Some disease-modifying therapies (DMTs), such as Cyclophosphamide or prolonged Corticosteroids, may have reproductive effects. Ocrelizumab, however, is not known to impair fertility. Freezing your eggs before in vitro fertilization (IVF) is a proactive and appropriate step.

2. Impact of Ocrelizumab: Ocrelizumab is generally not recommended during pregnancy due to potential effects on fetal B-cell (crucial for developing the fetal immune system) development. Most specialists suggest stopping the medication about six months before trying to conceive. This makes fertility preservation an important part of your timeline, especially if you plan to delay conception.

3. Timing IVF: Many neurologists recommend waiting until MS has been stable for at least six to 12 months before starting assisted reproductive treatments. This helps reduce the risk of relapse during the hormone stimulation phase or early pregnancy.

4. Pregnancy and MS: Pregnancy often reduces MS relapse rates, particularly during the second and third trimesters. However, there may be a slight increase in relapse risk during the postpartum period. Ongoing collaboration with your neurologist is key.

MS and Ocrelizumab do not directly prevent fertility or pregnancy. However, coordinated care with your neurologist, reproductive endocrinologist, and possibly a maternal-fetal medicine specialist is essential. Freezing your eggs now offers future flexibility, while delaying IVF until off Ocrelizumab and in stable remission may help minimize risks.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.