Assisted reproduction does not increase multiple sclerosis risk

Women who underwent assisted reproduction had a similar risk for developing multiple sclerosis as women who conceived without being exposed to assisted reproductive technology, according to a Danish register-based cohort study.

Multiple sclerosis is largely influenced by the presence and levels of sex hormones, according to study background. Assisted reproductive technology (ART) treatments, such as IVF and intracytoplasmic sperm injection (ICSI), involve lengthy exposure to hormones.

“Indeed, several case series have shown that women with multiple sclerosis experience increased disease activity after ART treatment (ie, IVF or ICSI),” Tine Iskov Kopp, MSc, PhD, a senior researcher at the Danish Multiple Sclerosis Registry at Copenhagen University Hospital, Denmark, and colleagues wrote in Fertility and Sterility. “However ART treatment has also been suspected to trigger multiple sclerosis.”

Kopp and colleagues created a cohort of women who gave birth to their first child with a conception date between 1996 and 2018. All women were listed in the Danish Medical Birth Register, which records all live births in Denmark. Women who had undergone a first ovarian stimulation cycle before ART treatment were recorded in the Danish IVF Register and were also included in the study.

The researchers evaluated risk for multiple sclerosis in the cohort using data from the Danish Multiple Sclerosis Registry.

In total, 585,716 women were included in the cohort, 63,791 (11%) of whom had begun an ART cycle between 1996 and 2018. Women who underwent ART treatment were more likely to be older (31.8 vs. 27.5 years), to have a university degree (45% vs. 36%) and to have undergone intrauterine insemination prior to entering the cohort (26% vs. 3%) compared with women who were not exposed to ART.

There was no association between multiple sclerosis risk and exposure to ART. The finding remained the same in sensitivity analyses.

Kopp and colleagues cautioned that the study was limited by observational design and lack of ethnicity data for the cohort. However, they noted that the population of Denmark is largely homogenous, so the findings may still be limited to white Europeans.

“In conclusion, results from this large, nationwide cohort study showed that ART treatment does not seem to pose any major risk factor for developing multiple sclerosis compared with the exposure to a pregnancy without previous ART treatment,” the researchers wrote. “This is reassuring for women and couples considering ART.”