Assisted reproductive technologies in multiple sclerosis

Abstract

Objective of the review: to study the topic of fertility, pregnancy and assisted reproductive technologies (ART) in patients with multiple sclerosis (MS). The analysis of scientific literature in international medical databases was performed.Analysis of literary data. MS is a chronic inflammatory demyelinating disease of the central nervous system that most often affects young people of reproductive age. Research in this area is important given that the average age of MS diagnosis in Ukraine is approximately 31–34 years. As a result, patients are in the process of making important decisions about their future lifestyle and family planning.According to the data of modern research, MS does not affect the course of pregnancy and is not associated with obstetric pathologies. However, patients are often forced to postpone their desire to become pregnant due to the risks of taking drugs for disease-modifying therapy (DMT), the need to stabilize the disease along with reducing its radiological activity. It is also important to consider the presence of sexual dysfunction in patients with MS, particularly in men, which often negatively affects male fertility and requires timely diagnosis and treatment. For example, in case of ejaculation disorders, a testicular biopsy or electroejaculation can be used to collect seminal fluid.The algorithm of proper counseling before conception for both partners was analyzed. It is important to use a multidisciplinary approach for joint decision-making of the patient with both a neurologist and a gynecologist, which allows for the formation of the most reasonable conclusions regarding pregnancy planning. In particular, the elimination periods of the main DMT drugs are discussed and drugs that can be used during pregnancy are specified.Conclusions. Women with MS are more likely to need AR than the general population. This is associated with a later age of pregnancy planning and infertility. In this regard, the method of in vitro fertilization and cryopreservation of oocytes as the most effective types of ART for patients with MS was considered in detail.