This report is part of a 12-month Clinical Context series.By Todd Neale, Senior Staff Writer, MedPage Today
Published: June 11, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
Women with multiple sclerosis may have an increased risk of relapse in the months following in vitro fertilization (IVF), a French study showed.
The annualized relapse rate (ARR), or the number of relapses divided by the person-years at risk, was significantly higher during the 3-month period following IVF (mean ARR 1.60) compared with the 3 months just prior to the procedure (mean ARR 0.80) and a 3-month control period a year before the procedure (mean ARR 0.68), according to David-Axel Laplaud, MD, PhD, of the University of Nantes in France, and colleagues.
The greater risk was possibly associated with a failure of the procedure to result in pregnancy and the use of gonadotropin-releasing hormone agonists to desensitize the ovaries, the researchers reported online in the Journal of Neurology, Neurosurgery Psychiatry.
“Multiple sclerosis patients should be aware of a possible increased risk of … relapse after IVF, particularly if the procedure does not result in a pregnancy,” the authors wrote. “Furthermore, because there is a reasonable doubt that gonadotropin-releasing hormone agonists may make patients more prone to such an increase in relapse rate, gonadotropin-releasing hormone antagonists might be preferred for IVF protocols.”
Sex hormones have been shown to be associated with disease activity in multiple sclerosis, and so it is possible that the hormonal treatments used during assisted reproductive techniques may influence short-term disease processes, according to the researchers.
To explore the issue, they examined data on 32 women with multiple sclerosis who underwent 70 IVF treatments from 1998 through 2008. The women were identified either through French university hospital databases or by direct referral from neurologists.
Each IVF treatment included the initial step of ovarian desensitization with either gonadotropin-releasing hormone agonists (in 48 cases) or antagonists (in 19 cases), followed by ovarian stimulation with follicle-stimulating hormone. Data on the drugs used for ovarian desensitization were missing for three treatments.
Of the 70 IVF treatments, 49 failed and 21 resulted in a pregnancy.
During the 3 months after the procedures, 19 women had a total of 26 relapses, with a significant increase in the relapse rate compared with periods immediately prior to and 1 year before the treatment.
The researchers noted, however, that when the period of interest was extended from 3 to 6 months after the treatments, the increase in relapses was not statistically significant.
“Thus, it is difficult to conclude whether IVF may provoke additional relapse or only shorten the delay between IVF and the following relapse,” they wrote.
The significant increases in relapses were related both to IVF failure (P=0.019) and the use of gonadotropin-releasing hormone agonists (P=0.025), although the latter interaction did not reach significance for all statistical tests.
IVF performed with gonadotropin-releasing hormone antagonists did not lead to a significant difference in ARR, regardless of study period length.
“Failure of IVF led to a decrease in sex hormones that might be similar to that observed in the postpartum period where an increased relapse rate has been demonstrated, thus providing a plausible explanation for the results observed in our multivariate analysis,” the authors wrote.
They added that the stress of an in vitro fertilization treatment may also trigger relapses.
The study was limited, they wrote, by the small cohort, possible bias introduced by pooling patients recruited through different means, and the lack of a control group.
The study was supported by a grant from the PHRC Inter-régional 2005 (French Ministry of Health).
The authors reported that they had no conflicts of interest.
Primary source: Journal of Neurology, Neurosurgery Psychiatry
Michel L, et al “Increased risk of multiple sclerosis relapse after in vitro fertilization” J Neurol Neurosurg Psychiatry 2012; DOI:10.1136/jnnp-2012-302235.
Senior Staff Writer
Todd Neale, MedPage Today Staff Writer, got his start in journalism at Audubon Magazine and made a stop in directory publishing before landing at MedPage Today. He received a B.S. in biology from the University of Massachusetts Amherst and an M.A. in journalism from the Science, Health, and Environmental Reporting program at New York University. He is based at MedPage Today headquarters in Little Falls, N.J.
Article source: http://www.medpagetoday.com/Neurology/MultipleSclerosis/33212