Service de Neurologie, Centre Hospitalier Universitaire de Nantes, Hôpital Laennec, Nantes Cedex, France.
J Neurol Neurosurg Psychiatry. 2012 Aug;83(8):796-802. doi: 10.1136/jnnp-2012-302235. Epub 2012 Jun 11.
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).
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.
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).
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.
已证实外源性性激素与妊娠均会影响多发性硬化症（MS）的复发风险。辅助生殖技术（ART）中使用的治疗方法可能会通过改变患者的激素状态，从而影响 MS 的短期进展。本研究的目的是确定体外受精（IVF）后 MS 女性发生恶化的风险是否增加。
MS 和 IVF 数据要么从 13 家法国大学医院的数据库中自动提取，要么从转诊神经科医生处获得。在匹配数据库后，系统地查阅患者的临床档案，以收集有关 MS 和 IVF 治疗的信息。使用单变量和多变量统计检验详细分析 IVF 与 MS 复发发生之间的关联。
在 11 年的研究期间，32 名 MS 女性接受了 70 次 IVF 治疗，其中 48 次使用促性腺激素释放激素（GnRH）激动剂，19 次使用 GnRH 拮抗剂。与 IVF 前的同期（ARR 均值 0.80，中位数 ARR 0）相比，IVF 后 3 个月内的年复发率（ARR）显著增加（ARR 均值 1.60，中位数 ARR 0），与 IVF 前 1 年的同期相比（ARR 均值 0.68，中位数 ARR 0）也显著增加。复发的显著增加与 GnRH 激动剂的使用（Wilcoxon 配对检验，p=0.025）以及 IVF 失败（Wilcoxon 配对检验，p=0.019）相关。
本研究中观察到 MS 患者在接受 IVF 后复发率增加，这可能部分与 IVF 失败和 GnRH 激动剂的使用有关。
