Findings published in Annals of Neurology suggest that assisted reproduction technology (ART) treatment increases multiple sclerosis (MS) disease activity.
Sex hormones and gonadotropin-releasing hormone (GnRH) have both been found to play a role in autoimmune disorder pathogenesis. Small studies have shown that ART treatments for infertility, which involve hormone manipulation, increase the risk for exacerbation of MS and other autoimmune conditions. However, there has been little information to date on immunologic responses in patients with MS after ART.
Jorge Correale (Raul Carrea Institute for Neurological Research, Foundation Against Neurological Disease in Childhood, Buenos Aires, Argentina) and colleagues conducted a 5-year prospective study of 16 patients with MS who had been given 26 cycles of ART.
Seventy-five percent of patients had exacerbations of their MS after ART treatment, and during the 3-month period following ART, clinical relapses were noted in 58% of the ART cycles. The average numbers of relapses was 0.42 in a 3-month period before ART versus 3.28 in the 3 months after, representing a sevenfold increase.
Likewise, ART treatment was associated with a ninefold increase in radiologic activity, with patients having an average of 0.36 new or enlarging T2 lesions before treatment versus 1.99 after it, and 0.23 versus 1.27 gadolinium-enhancing lesions.
In the 3 months after treatment, immunologic parameters were significantly increased during cycles with relapses. There was a three- to eightfold increase in estrogen and progesterone levels, as well as elevated levels of T cells, cytokines, and antibodies against myelin-oligodendrocyte glycoprotein.
The complex and dynamic interactions between hormonal and immune factors that occur during ART treatment may affect the course of autoimmune diseases, which could explain the increased MS activity seen in this study, note Correale et al.
Given these data, when deciding which infertility treatment to administer to a patient with MS, "different hormonal approaches can be used, the choice of which depends on ART specialist recommendations," they say.
"However, neurologists should be aware of this risk, and discuss pros and cons of the procedure with MS patients."
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