Table 1.

Elements to be considered in counseling the patient/family at different stages of the reproductive “cycle” in MS.

There is a need for counseling provided in easily understood language supported by data (where possible) that are tailored to the individual patient and family clinical, psychological and socioeconomic status; different issues may emerge at different stages in the family planning and reproductive cycle of an MS patient:

Prior to conception: Issues of sexual function (male and female), MS impact on fertility and the risk of assistive reproductive techniques; use/impact of contraceptives; potential risks to offspring for developing MS; potential impact of MS treatments on fetal health; prior use of disease-modifying therapies and impact on pregnancy and fetal outcomes; influence of month of birth on development of MS in offspring; short-term and long-term impacts of pregnancy on MS status

During pregnancy: Management of MS during pregnancy (use and impact of disease-modifying and symptomatic therapies and treatment of relapses); use of MRI to assess MS disease status during pregnancy; short-term and long-term impacts of pregnancy on MS status

Postpartum: Expectations for postpartum MS relapse and management; restarting MS disease-modifying/symptomatic therapies that have been stopped during pregnancy; breastfeeding; parenting with a disability; long-term planning

MS: multiple sclerosis; MRI: magnetic resonance imaging.