RT Journal Article
SR Electronic
T1 Increased risk of multiple sclerosis relapse after in vitro fertilisation
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 796
OP 802
DO 10.1136/jnnp-2012-302235
VO 83
IS 8
A1 Michel, Laure
A1 Foucher, Yohann
A1 Vukusic, Sandra
A1 Confavreux, Christian
A1 de Sèze, Jérome
A1 Brassat, David
A1 Clanet, Michel
A1 Clavelou, Pierre
A1 Ouallet, Jean-Christophe
A1 Brochet, Bruno
A1 Pelletier, Jean
A1 Labauge, Pierre
A1 Lebrun, Christine
A1 Lepage, Emmanuelle
A1 Le Frere, Fabienne
A1 Jacq-Foucher, Marylène
A1 Barriere, Paul
A1 Wiertlewski, Sandrine
A1 Laplaud, David-Axel
A1 ,
YR 2012
UL http://jnnp.bmj.com/content/83/8/796.abstract
AB Background Exogenous sexual steroids together with pregnancy have been shown to influence the risk of relapses in multiple sclerosis (MS). Treatments used during assisted reproductive techniques may consequently influence the short term evolution of MS by modifying the hormonal status of the patient. The objective of this study was to determine if there was an increased risk of developing exacerbations in women with MS after in vitro fertilisation (IVF).Methods MS and IVF data were either automatically extracted from 13 French university hospital databases or obtained from referring neurologists. After matching databases, patient clinical files were systematically reviewed to collect information about MS and the treatments used for IVF. The association between IVF and the occurrence of MS relapses was analysed in detail using univariate and multivariate statistical tests.Findings During the 11 year study period, 32 women with MS had undergone 70 IVF treatments, 48 using gonadotrophin releasing hormone (GnRH) agonists and 19 using GnRH antagonists. A significant increase in the annualised relapse rate (ARR) was observed during the 3 month period following IVF (mean ARR 1.60, median ARR 0) compared with the same period just before IVF (mean ARR 0.80, median ARR 0) and to a control period 1 year before IVF (mean ARR 0.68, median ARR 0). The significant increase in relapses was associated with the use of GnRH agonists (Wilcoxon paired test, p=0.025) as well as IVF failure (Wilcoxon paired test, p=0.019).Interpretation An increased relapse rate was observed in this study after IVF in patients with MS and may be partly related both to IVF failure and the use of GnRH agonists.