Oreja-Guevara Celia, Gónzalez-Suárez Inés, Bilbao Mar Mendibe, Gómez-Palomares José Luis, Rodríguez Corazón Hernández, Rabanal Aintzane, Benito Yolanda Aladro
Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM). Madrid, Spain.
Department of Neurology, Hospital Alvaro Cunqueiro, Vigo, Spain.
Mult Scler Relat Disord. 2024 Dec;92:105893. doi: 10.1016/j.msard.2024.105893. Epub 2024 Sep 21.
Pregnancy is not discouraged in multiple sclerosis (MS) patients. However, MS patients tend to delay motherhood since they must wait for a low clinical and radiological activity before considering pregnancy, which impacts their fertility and their need for assisted reproductive technology (ART). This review aimed to cover, from a multidisciplinary perspective, the most critical aspects revolving around pregnancy in MS patients.
A group of seven experts (four neurologists and three gynaecologists) met for three discussion sessions to review current knowledge on ART in patients with MS. PubMed searches for journal articles published in English or Spanish between 2000 and 2024 were undertaken. 354 articles were revised at the title level.
We reviewed current evidence on fertility in women and men with MS, on the effects of pregnancy on MS, the disease's pharmacological treatment during pregnancy, MS during delivery and breastfeeding, ART (intrauterine insemination, in vitro fertilisation, intracytoplasmic sperm injection, and oocyte cryopreservation) in patients with MS.
Early family planning, supported by good coordination between neurology and gynaecology departments, is paramount to managing MS women with motherhood desire. Besides, although a well-planned, early pregnancy is always the most desirable outcome, ART is considered safe and valuable for MS patients. Finally, multidisciplinary units are deemed pivotal to guide MS patients with parenthood desire through pregnancy.
多发性硬化症（MS）患者并不被劝阻怀孕。然而，MS患者往往会推迟生育，因为他们必须等待临床和影像学活动处于低水平后才考虑怀孕，这影响了他们的生育能力以及对辅助生殖技术（ART）的需求。本综述旨在从多学科角度涵盖围绕MS患者怀孕的最关键方面。
一组七名专家（四名神经科医生和三名妇科医生）召开了三次讨论会，以回顾MS患者ART的现有知识。对2000年至2024年期间以英文或西班牙文发表的期刊文章进行了PubMed检索。在标题层面审查了354篇文章。
我们回顾了关于MS女性和男性生育能力、怀孕对MS的影响、怀孕期间疾病的药物治疗、分娩和母乳喂养期间的MS、MS患者的ART（宫内授精、体外受精、卵胞浆内单精子注射和卵母细胞冷冻保存）的现有证据。
在神经科和妇科部门良好协调的支持下，早期计划生育对于管理有生育意愿的MS女性至关重要。此外，尽管精心规划的早期怀孕始终是最理想的结果，但ART对MS患者被认为是安全且有价值的。最后，多学科单位被认为对于指导有生育意愿的MS患者度过孕期至关重要。
