Reproductive Information
Medications
Management of the course of MS and its symptoms frequently involves the use of a variety of medications. The consideration of how to discontinue medication, implications for the return of symptoms, drug washout periods, and alternative management strategies warrant discussion with the treating neurologist as soon as pregnancy is being considered, or ASAP in the case of an unplanned pregnancy.
DISEASE MODIFYING DRUGS (DMT)
For Women
The first group of medications (disease modifying therapies) are drugs that impact the underlying disease. These drugs are also called immunmodulatory therapies and generally work by targeting some aspect of the inflammatory process of MS, with an aim of preventing inflammation which causes relapses.
None of the currently approved disease modifying therapies have been approved for use during pregnancy and breastfeeding.
The health care provider should enquire about methods of birth control to prevent unplanned pregnancy while taking DMT.
Women who are planning a pregnancy should discontinue DMT three (3) months prior to attempting conception to prevent the medications from having any adverse effects on the developing fetus. This is a good time to begin taking a prenatal multivitamin which includes folic acid.
To reduce the amount of time without medication, some health care providers recommend the use of ovulation prediction kits to increase the likelihood of more quickly achieving a pregnancy.
If an unplanned pregnancy does occur and is exposed to DMT, comprehensive counselling should be provided by a physician, genetic counsellor or pharmacist familiar with drug interactions during pregnancy. Interruption of the pregnancy is not necessarily warranted. Discussion with the physician about potential teratogenic properties of medications is suggested.
DMT use should not be resumed until breastfeeding is complete
For Men
Men should discontinue disease-modifying treatments 2-3 months (the amount of time required to complete one cycle of spermatogenesis is 64 days) prior to attempting to father a pregnancy to prevent the medications from having any adverse effects on the sperm or being transmitted along with the seminal fluid. This is a cautious approach based on limited evidence that medications taken by men in the peri-conception period can cause developmental defects or spontaneous abortion. MS disease modifying therapies have not specifically been studied for this effect.
Once a pregnancy is achieved, disease-modifying therapy can be resumed by the male patient.
An alternative would be sperm banking prior to beginning DMT therapy. This would allow continuation of DMT therapy while trying to conceive.
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SYMPTOM MANAGEMENT MEDICATIONS
There is a wide variety of medications used to manage the many symptoms of MS. Each carries its own profile with respect to reproductive issues. Discussion with the neurologist prior to stopping any of these medications is recommended.
CHEMOTHERAPY
Chemotherapy treatments for MS tend to be used to arrest aggressive forms of the disease. Patients who are treated with chemotherapy must be using a reliable form of birth control.
For Women
Chemotherapy use during pregnancy is contra-indicated due to teratogenic effects of the drugs. Chemotherapeutic agents have been associated with transient or permanent ovarian failure in some women and may therefore cause decreased fertility or sterility. The risk for permanent amenorrhea increases with maternal age at the time of treatment.
Women should be counselled that future fertility may be impaired by use of chemotherapy. Egg retrieval and storage prior to chemotherapy treatment may be an option but traditional methods used to preserve unfertilized ova may yield a lower rate of pregnancy. Newer methods (vitrification) are improving pregnancy rates.
Women who are in a committed relationship may choose to undergo egg retrieval and fertilization so that embryos may be stored. This method has a greater success rate for achieving pregnancy.
For Men
There should be at least a 3 month period of time free of chemotherapy before conception is attempted.
Chemotherapy use has been shown to cause decreased sperm production that may be permanent. Men should be counselled that future fertility may be impaired by use of chemotherapy.
Men who are considering chemotherapy for MS and have not started or completed their families should be advised to bank a sperm sample prior to commencing of treatment.
Men who do not wish to bank sperm should discontinue chemotherapy treatments 3 months (the amount of time required to complete one cycle of spermatogenesis is 2-3 months) prior to attempting to father a pregnancy in order to prevent the medications from having any adverse effects on the sperm or being transmitted along with the seminal fluid surrounding a conceptus. This is a cautious approach based on limited evidence that chemotherapy taken by men in the peri-conception period can cause developmental defects or spontaneous abortion.
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