Table 1.

Summary of recommendations for the management of people with multiple sclerosis and the desire for parenthood

Preconception counselling  • Wait until the patient has accepted her/his disease • Early consultation in women of child-bearing age is advised • Emphasise that women’s age is the most important factor affecting fertility • Other subfertility factors can be identified at this point • Therefore, both partners should attend the consultation and be examined • Patients should be informed of all available options to conceive • The DMT should be assessed, especially if it requires a washout period • Cervical pathologies should be evaluated • Shared decision-making is fundamental

In vitro fertilisation • Women < 35 years old should try to conceive naturally for 1 year • Women > 35 years old should try to conceive naturally for 6–12 months • Patients should begin the IVF process with the lowest possible number of symptomatic treatments and at the minimum effective dose • DMT should be withdrawn according to prescribing information, as for natural pregnancies • Single embryo transfer in IVF-ICSI is advised in people with MS to avoid multiple pregnancy risks • Hormones used for ovarian stimulation should be individualised • Ovarian stimulation treatments should be adjusted to avoid the risk of ovarian hyperstimulation syndrome • The maximum number of stimulations recommended is three • The concept of cumulative live birth rates should be clearly explained to patients • For men with MS, only if DMT is proven to affect sperm quality, a DMT switch could be justified to obtain a sperm sample • In cases of sexual dysfunction, electroejaculation or testicular biopsy can be used

Oocyte cryopreservation • Take into account that early pregnancy is always more cost-effective than OC • Oocytes or embryos can be cryopreserved • First, the age at which OC is undertaken is the most critical factor • Second, good to moderate ovarian reserve is required for OC • The maximum number of stimulations recommended is three • Women with MS can benefit from OC if they need to delay motherhood for one or more years and fulfil the abovementioned criteria

Multidisciplinary units • Early family planning is vital for the patient to remain without her DMT for the shortest possible time • Age is also considered a risk factor regarding DMT use  • Multidisciplinary units are recommended to manage cases of people with MS and parenthood desire •  The communication between all specialists forming these units must be excellent •  The ethical implications of pregnancy and child-rearing in people with MS should be discussed within these multidisciplinary care units

DMT Disease-modifying therapy (therapies), ICSI Intracytoplasmic sperm injection, IVF in vitro fertilisation, MS multiple sclerosis, OC oocyte cryopreservation