Women With MS May Have Increased Relapse Risk After IVF

July 11, 2012 — Women with multiple sclerosis (MS) who undergo in vitro fertilization via hormonal injections may have an increased risk for relapse, a new study suggests.

"We have shown an increased rate of relapse after IVF [in vitro fertilization] for the first time, and have shown an increased risk that is correlated with the use of GnRH [gonadotropin-releasing hormone] agonists and IVF failure," lead author David Laplaud, MD, PhD, of the department of neurology at Nantes University Hospital, France, told Medscape Medical News.

"This is the first and largest study to examine this question and to produce such findings," Dr. Laplaud added.

The study was published online June 11 and appears in the August issue of the Journal of Neurology, Neurosurgery and Psychiatry.

Relapse After IVF

In the study of 32 women who underwent IVF during an 11-year period in 13 French hospitals, the risk of relapse in the 3-month period after IVF was significantly increased compared with 1 year before IVF.

The mean annualized relapse rate (ARR) for the 3 months after IVF was 1.60 compared with a mean ARR of 0.80 one year before the women underwent the procedures (P = .001). This difference in relapse rate was particularly striking in those who received GnRH agonists (mean ARR, 1.60 vs 0.62 in the year before IVF).

Risk of relapse was also more elevated when researchers analyzed their findings according to IVF outcome. Of 70 IVF procedures performed in the 32 patients, 49 failed and 21 resulted in pregnancy.

In cases of IVF failure, the mean ARR in the 3 months after the procedure was 1.96 vs a mean ARR of 0.98 for the year before IVF (P = .019).

"Our paper shows an increased rate of relapse after IVF, but it should not discourage patients with MS from having these procedures," Dr. Laplaud said.

"I would advise clinicians to closely follow patients after an IVF procedure and to counsel them on the possible risks and benefits," he added.

Worth a Discussion

"This study raises some concern about the level of disease activity among patients who undergo in vitro fertilization," commented Aaron Miller, MD, chief medical officer of the Multiple Sclerosis Society, and director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mt. Sinai School of Medicine, New York City.

"The data in this study is not conclusive, but it's worth having a discussion with MS patients prior to IVF about how IVF might alter the natural history of their disease," Dr. Miller said.

"Patients need to consider the pros and cons of these procedures, as they do for pregnancy," he said.

Dr. Laplaud and Dr. Miller report no relevant financial relationships.

J Neurol Neurosurg Psychiatry. Published online June 11, 2012. Abstract

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