Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis.

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY
CNS drugs Pub Date : 2023-10-01 Epub Date: 2023-09-07 DOI:10.1007/s40263-023-01036-1
Maddalena Sparaco, Luigi Carbone, Doriana Landi, Ylenia Ingrasciotta, Raffaella Di Girolamo, Giacomo Vitturi, Girolama Alessandra Marfia, Carlo Alviggi, Simona Bonavita
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引用次数: 0

Abstract

Multiple sclerosis (MS) predominantly affects women of fertile age. Various aspects of MS could impact on fertility, such as sexual dysfunction, endocrine alterations, autoimmune imbalances, and disease-modifying therapies (DMTs). The proportion of women with MS (wMS) requesting infertility management and assisted reproductive technology (ART) is increasing over time. In this review, we report on data regarding ART in wMS and address safety issues. We also discuss the clinical aspects to consider when planning a course of treatment for infertility, and provide updated recommendations to guide neurologists in the management of wMS undergoing ART, with the goal of reducing the risk of disease activation after this procedure. According to most studies, there is an increase in relapse rate and magnetic resonance imaging activity after ART. Therefore, to reduce the risk of relapse, ART should be considered in wMS with stable disease. In wMS, especially those with high disease activity, fertility issues should be discussed early as the choice of DMT, and fertility preservation strategies might be proposed in selected cases to ensure both disease control and a safe pregnancy. For patients with stable disease taking DMTs compatible with pregnancy, treatment should not be interrupted before ART. If the ongoing therapy is contraindicated in pregnancy, then it should be switched to a compatible therapy. Prior to beginning fertility treatments in wMS, it would be reasonable to assess vitamin D serum levels, thyroid function and its antibody serum levels; start folic acid supplementation; and ensure smoking and alcohol cessation, adequate sleep, and food hygiene. Cervico-vaginal swabs for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis, as well as serology for viral hepatitis, HIV, syphilis, and cytomegalovirus, should be performed. Steroids could be administered under specific indications. Although the available data do not clearly show a definite raised relapse risk associated with a specific ART protocol, it seems reasonably safe to prefer the use of gonadotropin-releasing hormone (GnRH) antagonists for ovarian stimulation. Close clinical and radiological monitoring is reasonably recommended, particularly after hormonal stimulation and in case of pregnancy failure.

多发性硬化不孕妇女的辅助生殖技术与疾病管理。
多发性硬化症主要影响育龄妇女。多发性硬化症的各个方面可能影响生育能力,如性功能障碍、内分泌改变、自身免疫失衡和疾病改良疗法(DMTs)。随着时间的推移,患有多发性硬化症(wMS)的女性要求不孕管理和辅助生殖技术(ART)的比例正在增加。在这篇综述中,我们报告了关于wMS中ART的数据,并解决了安全问题。我们还讨论了在计划不孕治疗方案时需要考虑的临床方面,并提供了最新建议,以指导神经学家对接受ART的wMS进行管理,目的是降低该手术后疾病激活的风险。根据大多数研究,ART后复发率和磁共振成像活性增加。因此,为了降低复发风险,在病情稳定的wMS中应考虑ART。在wMS中,尤其是那些疾病活动性高的患者,在选择DMT时应尽早讨论生育问题,并在选定的病例中提出生育保存策略,以确保疾病控制和安全怀孕。对于病情稳定、服用与妊娠期相容的DMT的患者,在ART之前不应中断治疗。如果正在进行的治疗在妊娠期是禁忌的,则应改用相容的治疗。在开始对wMS进行生育治疗之前,评估维生素D血清水平、甲状腺功能及其抗体血清水平是合理的;开始补充叶酸;确保戒烟戒酒、充足睡眠和食品卫生。应进行解脲支原体、人型支原体和沙眼衣原体的宫颈阴道拭子检查,以及病毒性肝炎、HIV、梅毒和巨细胞病毒的血清学检查。类固醇可以在特定的适应症下使用。尽管现有数据没有明确显示与特定ART方案相关的复发风险增加,但似乎更喜欢使用促性腺激素释放激素(GnRH)拮抗剂进行卵巢刺激是合理安全的。合理地建议进行密切的临床和放射学监测,特别是在激素刺激后和妊娠失败的情况下。
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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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