In patients with relapsing-remitting multiple sclerosis (MS), assisted reproduction treatment (ART) was associated with a sevenfold increase in risk of new exacerbations and a ninefold increase in risk of MRI activity, according to research published online in the October 3 Annals of Neurology. In all, 73% of exacerbations were new, and 27% corresponded with worsening of pre-existing symptoms.
Jorge Correale, MD, Head of Neuroimmunology and Demyelinating Diseases at the Dr. Raúl Carrea Institute for Neurological Research in Buenos Aires, and colleagues recruited 16 patients with relapsing-remitting MS for a prospective study of the effect of ART on disease activity. Eligible patients had tried to become pregnant naturally for 12 months without success. The researchers recruited 15 healthy volunteers and 15 patients with relapsing-remitting MS in remission as age- and gender-matched controls.
The 16 active patients received 26 cycles of hormonal treatment (ie, 100 to 450 IU/day of gonadotropin-releasing hormone and 150 to 225 IU/day of recombinant follicle-stimulating hormone for seven to 10 days). The researchers conducted neurologic exams, brain MRI, and immunology testing every three months for one year. The risk period was defined as three months following an ART cycle.
Twelve of the 16 active patients had exacerbations after receiving ART. The researchers observed relapses in 15 of the 26 cycles in the three-month period following ART. Annual exacerbation rate was 3.28 during the risk period, compared with 0.42 during the nonrisk period.
Imaging data were available for 94% of the active patients. On average, the 16 patients had 1.99 ± 0.3 new or enlarging T2 lesions and 1.27 ± 0.2 gadolinium-enhancing lesions during the risk period, compared with 0.36 ± 0.2 T2 lesions and 0.23 ± 0.1 gadolinium-enhancing lesions during the remaining observation period.
“ART involves complex and dynamic interactions between hormonal and immune factors, which could affect the course of an autoimmune disease, explaining increased disease activity,” said Dr. Correale. “Overall, these data demonstrate a significant increase of disease activity in MS patients after ART.… Neurologists should be aware of this risk and discuss pros and cons of the procedure with MS patients.”