Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory disorder of the central nervous system. It is common in the reproductive period and can lead to infertility and significant disability. The treatment on multiple sclerosis is recently more successful and enables better quality of life, therefore rising hope and desire for the future parents, also in terms of successful infertility treatments. In this context the couples should be managed concerning the detrimental effect of the disease itself on fertility, detrimental effect of the drugs used for treatment on gonads and in terms of the implementation of drugs used for ovarian stimulation and their impact on the basic disease (MS). Article finds solutions on the legal outcomes in situations where infertility treatments may negatively impact the progress of MS, as well as the solutions on how to (successfully) provide infertility treatments to the patients with MS. It proposes interdisciplinary approach between gynecologists and neurologists to perform required weighting of benefits and risks (burdens), deriving from specific action or treatment, whereas for the patients who shall not undergo infertility treatments due to their medical status, related to MS, it proposes storage of gametes under conditions, set by the law.
Highlights
Chronic neurological diseases often occur during the reproductive period
We need to know whether the disease itself affects the diminished ovarian reserve (DOR is a condition in which the ovary loses normal reproductive potential, compromising fertility; the condition may result from disease, injury and the normal aging process) and whether the medication we use to treat the underlying disease is gonadotoxic
This study showed that long-term treatment with immunomodulators did not have a negative effect on the ovarian reserve (Cil et al, 2010: S98)
Summary
Chronic neurological diseases (including multiple sclerosis – MS) often occur during the reproductive period. Treatment options for infertile couples with chronic neurological diseases depend upon answers to several possibilities. Any treatment of infertile couples with chronic diseases must be interdisciplinary and individual, as the small number of such patients provides little solid data in the literature on which we can rely exclusively. The purpose of this article is to evaluate both the legal and ethical outcomes of the situation when there is the possibility of risk of MS relapses in the course or as a result of infertility treatments. We offer grounds for this evaluation by exploring the medical background of both conditions (MS, infertility), and by providing the legal framework for specific situations, from which we can derive significant legal (and ethical) burdens. Much progress has been made in the past two decades in treating MS with the advent of effective immunomodulatory therapies which can potentially slow down the progression and alter the disease course
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