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Reproductive Information
Progressive MS (Primary, Secondary & Progressive Relapsing)
People with a progressive course of MS may have greater overall disability that could hinder conception as well as parenting abilities. Nevertheless, these people can become pregnant, and father children and reproductive counselling remains relevant. An assessment into the realistic expectations of both potential parents is recommended.
Preconception topics of discussion should include: current and past symptoms (severity, duration, limitations to activities of daily living), the degree of disability now or in the future, the importance of establishing and maintaining a good support system for both the individual with MS and the partner and for their roles in the parenting process, the importance of establishing financial stability or emergency funding in the event of a function impairing relapse.
- The health care professional who knows the MS patient is in the best position to determine whether issues about mood disorders (depression, bipolar disorder, euphoria, psychosis) should be raised with the couple at this time. (See mood and cognition) The clinician who suspects mood disorders should refer to psychiatry for assessment and treatment. It should be noted that the lifetime prevalence rate for depression in MS has been estimated at 50%. (REF: The Neuropsychiatry of Multiple Sclerosis, Feinstein, A, Can J Psychiatry, Vol 49, No. 3 March 2004)
- Cognitive changes may be present and should be addressed. Concerns about cognitive dysfunction (decreased memory, attention deficit, reasoning, verbal fluency) should be raised with the couple at this time. The clinician who suspects cognitive dysfunction should refer to psychiatry for assessment and treatment. It should be noted that cognitive dysfunction in MS can be subtle and is often not detectable by traditional means such as Mini Mental State Exam testing but may significantly interfere with parenting. (REF: The Neuropsychiatry of Multiple Sclerosis, Feinstein, A, Can J Psychiatry, Vol 49, No. 3 March 2004)
- A discussion of sexual functioning should be initiated by the health care provider.(See Conception and Sexual Dysfunction)
- Assess all prescription and non-prescription medications for potential to cause impaired fertility or harm to a developing fetus.(See medications)
- See section on parenting
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