MULTIPLE SCLEROSIS AND
DECIDING TO
START A FAMILY
The questions you have. The answers you need.
The information in this brochure is intended as educational and should not replace the advice of your
physician or other qualified healthcare provider. Talk to your physician if you are planning to start a family.
TABLE OF CONTENTS
THINKING OF BECOMING PREGNANT 2
YOU HAVE DECIDED TO BECOME PREGNANT 4
WHAT TO EXPECT DURING PREGNANCY 6
WHAT TO EXPECT DURING DELIVERY 8
TAKING CARE OF YOURSELF AFTER BIRTH 10
ADDITIONAL RESOURCES 12
THINKING
OF BECOMING
PREGNANT
Does MS affect fertility?
No, there is no evidence to suggest that male or female fertility is adversely affected by MS. In fact,
contraception should be practiced (by either the man or woman) if the couple want to avoid pregnancy.
Why is it important to speak with my physician about my plans to start a family?
Your physician will know if the MS medication you are on is safe for use during pregnancy and if there
is a time period needed between stopping the medication and trying to become pregnant. Some
disease modifying therapies (DMTs) are risky even for men who want to father a child.
How does pregnancy affect MS?
Pregnancy does not appear to speed up the course or worsen the effects of MS. Pregnancy has
actually been shown to have a protective effect on women with MS. Many studies done in hundreds
of women with MS demonstrate that pregnancy reduces the number of MS relapses, especially
in the third trimester.
How does MS affect pregnancy?
Women with MS may experience greater fatigue than usual and like any other pregnant woman,
can have troublesome bowel and bladder problems. Towards the end of the pregnancy, your balance
and gait may be affected, again, just like any other pregnant woman. Of course, having MS means
that you will want to manage these issues with your healthcare professionals.
MS appears to have little or no effect on pregnancy. There is no evidence that MS is linked to any
problems with pregnancy, such as miscarriage, ectopic pregnancy, preterm births, stillbirths,
or congenital abnormalities. Women with MS can expect normal pregnancy outcomes.
2
CONNECT
WITH A SUPPORT
GROUP OR OTHER
MS PARENTS
TALK
TO YOUR
DOCTOR
PLAN
FOR THE
FUTURE
Will MS be passed on to my child?
MS has no apparent effect on the fetus. MS is not hereditary. Children of women with MS have a 3%
to 5% lifetime chance of developing MS. In other words, they have an approximately 96% chance that
they won’t develop MS.
What else is important to know when deciding to start a family?
Women with MS usually need no special gynecologic care during pregnancy. Labour and delivery
are usually the same as in other pregnant women.
However, it is very important to let your physician know that you are thinking about starting a family.
As mentioned earlier, your current MS medication may not be safe for your baby and you will need
to stop taking them before you try to become pregnant. This is just as important for the men who want
to father a child.
3
YOU HAVE
DECIDED TO
BECOME PREGNANT
If my current MS medication is stopped, how will my MS be managed?
There may be a waiting period between stopping medication and trying to conceive. Your physician will
be able to determine how to best manage your MS during this time, and while you are trying to become
pregnant. It is ideal to become pregnant as quickly as possible since you will be off medication. Talk
to your physician about how you can increase your chances of conceiving quickly.
What if it takes a long time to get pregnant?
If your physician suspects a problem with you getting pregnant, there are fertility-increasing options available.
• Ovulation monitoring
• Timing intercourse
• Hormone level testing
Remember, this can be an issue in the general population – it is not strictly related to MS.
According to Statistics Canada, almost one in seven Canadian couples trying to have a child seeks
medical help to conceive, including using assisted reproductive techniques such as in vitro fertilization.
Is in vitro fertilization (IVF) an option with MS?
If you are having trouble conceiving, IVF can be a consideration for women with MS. However, some
studies have shown that certain medications used during the IVF process can increase your risk
of experiencing a relapse during the 3 months following IVF treatment. Talk to your physician to
determine if IVF is an option for you.
If MS doesn’t affect fertility, why should getting pregnant be a problem?
MS can impair sexual feelings or sexual responses.
• Decreased or absent sex drive
• Decreased vaginal lubrication
•S
ensations of numbness, pain, or hypersensitivity
• Difficulty or inability to ejaculate
• Difficulty or inability to get an erection
4
Additionally, people with MS may experience symptoms of fatigue, spasticity, bladder and bowel
disturbances, and lack of orgasm.
All of these factors can have an effect on your intimacy and sexuality. Take steps to manage
these sexual problems.
• Step 1: Get comfortable talking about “it”
- A discussion of personal sexual problems or preferences between you and your partner
can deepen the intimacy and reduce feelings of anxiety
• Step 2: Talk to your healthcare team
- Many sexual problems associated with MS can be medically managed
• Step 3: Identify treatment strategies
- Your physician may consult with or refer you to other specialists, including a psychologist,
urologist, and/or gynecologist to help clarify and discuss intimate issues
Confiding in your partner may help to relieve feelings of stress and anxiety that may be interfering
with your sexual relationship.
If you are reading any of the available pregnancy books that are not specific to MS, be sure to consult
the advice of your healthcare team before following any of the suggested guidelines.
7
WHAT TO
EXPECT DURING
PREGNANCY
Just as your physician managed your MS treatment while you were trying to become pregnant,
your physician will continue to treat and monitor you throughout your pregnancy.
It is advised to schedule more frequent prenatal visits to monitor
your MS and the well-being of your child.
Will the course of my MS be affected by pregnancy?
There are many follow-up studies of women with MS going through pregnancy. We now
know that during pregnancy there is a significant reduction in relapses, particularly in
the third trimester.
During pregnancy there are elevated hormonal levels. One of these hormones, estriol, has
been shown to reduce MRI activity in women with MS. Cell production of interferon-gamma,
an interferon that worsens MS, is reduced and there appears to be an increase in certain
immune cells that may also suppress MS activity in pregnancy.
In studies with long-term follow up of women with MS who had children, no increased disability
as a result of pregnancy was found.
Will pregnancy affect my MS symptoms?
Unfortunately, there are no well-defined studies of symptoms of MS during pregnancy outside
of relapse rate. However, women with MS often report feeling well during pregnancy, but there
are no good measures of this.
6
It is common among all pregnant women to experience fatigue, bladder, bowel and gait issues.
These issues may become more frequent or worsen in women with MS who experienced these
prior to becoming pregnant.
All pregnant women need help from time to time. If you aren’t feeling well or are having problems,
let your physician know. Don’t be afraid to ask for supportive assistance from your partner, family
and friends. Your healthcare team may also recommend appropriate exercises to promote muscular
strength and endurance.
7
WHAT TO
EXPECT DURING
DELIVERY
Like most first-time expectant moms, you may find it difficult recognizing when you are in labour.
Be sure to speak with your healthcare team earlier in your pregnancy to know what to watch for.
Will labour and delivery be normal?
Yes, MS does not create any real problems for delivery. Although labour is not affected by MS,
the nerves and muscles used for pushing may be affected. This could mean that instrumental
assistance may be required or maybe a Caesarean section. Your physician will discuss with you
what your delivery options are based on your particular MS symptoms.
Can I use spinal anaesthetics during labour?
Yes, it is still possible for you to have local, spinal or general anaesthetics during labour. Epidurals
have not been shown to increase the chances of a relapse or impact your level of ability once your
baby is born. It is an individual choice as to whether or not to have an epidural.
Is a Caesarean section a safe option?
A Caesarean section does not have any impact on the course of MS. There is no evidence that
having a Caesarean section will cause a relapse or affect the progression of MS. Having a Caesarean
section is an individual choice that you and your physician should discuss.
8
9
TAKING CARE
OF YOURSELF
AFTER BIRTH
Will my MS symptoms change after giving birth?
It has been shown that in the first three to six months after delivery, the risk of MS relapse
increases. Be on the lookout and report any possible symptoms to your physician. These
relapses do not raise your risk of long-term problems.
Can I breastfeed my child?
Yes, provided that you are not on an MS therapy. There is no evidence to suggest that
breastfeeding is a problem for women with MS or their children. However, MS treatments
are not recommended for use while breastfeeding. You should speak with your physician
to determine how to manage your MS while you are breastfeeding.
When do I start back on my MS treatment?
There is no specific timeline for returning to your MS treatment. How long you decide to
breastfeed, is an individual choice. Some mothers choose to resume their MS therapy
immediately and feed their baby formula. Only you can decide what the right decision is for you.
How will the postpartum period affect me?
The postpartum period begins after the delivery of the baby and ends when the mother’s body has
nearly returned to its pre-pregnant state. This period usually lasts six to eight weeks. The postpartum
period involves the mother progressing through many changes, both emotionally and physically, while
learning how to deal with all the changes and adjustments required with becoming a new mother.
10
All new mothers need to take good care of themselves to rebuild strength; plenty of rest, good
nutrition, and ask for help.
What else should I know?
Plan to focus on your health and on mothering your new little one. Rest as much as you can and
leave the housework, laundry, etc. to others. It is generally best for the new mother to be relieved
of all responsibilities except the feeding and care of herself and her baby.
11
ADDITIONAL
RESOURCES
MS Society of Canada
http://mssociety.ca
Toll free to reach the nearest regional office: 1-800-268-7582
MS Discussion Forum
http://www.msdiscuss.com
National Multiple Sclerosis Society
http://nationalmssociety.org
MS Connection
https://www.msconnection.org
Mothers Assisting Mothers (US)
http://www.ms-mam.org
The Consortium of Multiple Sclerosis
Centers (US)
http://www.mscare.org
12
References:
BMJ Group. Fertility treatment linked to increased relapse rate among MS
patients. Accessed July 2014 at http://group.bmj.com/group/media/latestnews/fertility-treatment-linked-to-increased-relapse-rate-among-mspatients.
Confavreux C, Hutchinson M, Hours M, et al. Rate of pregnancy-related
relapse in multiple sclerosis. The New England Journal of Medicine.
1998(5):285–291.
Devonshire V, Duquette P, Dwosh E, et al. The immune system and
hormones: review and relevance to pregnancy and contraception in women
with MS. The International MS Journal. 2003(10):44–50.
Dwosh E, Guimond C, Duquette P, et al. The interaction of MS and
pregnancy: a critical review. The International MS Journal. 2003(10):38–42.
Finkelsztejn A, Brooks JBB, Paschoal FM, et al. What can we really tell
women with multiple sclerosis regarding pregnancy? A systematic review
and meta-analysis of the literature. An International Journal of Obstetrics and
Gynaecology. 2011(118):790–797.
Giannini M, Portaccio E, Ghezzi A, et al. Pregnancy and fetal outcomes
after glatiramer acetate exposures in patients with multiple sclerosis: a
prospective observational multicentric study. Neurology. 2012(12):124–130.
Langer-Gould A, Huang S, Gupta R, et al. Exclusive breastfeeding and the
risk of postpartum relapses in women with multiple sclerosis. Archives of
Neurology. 2009(8):958–963.
Michel L, Foucher Y, Vukusic S, et al. Increased risk of multiple sclerosis
relapse after in vitro fertilization. Journal of Neurology, Neurosurgery and
Psychiatry. 2012(83):796–802.
MS Australia. Pregnancy and MS: Your Questions Answered. Accessed
April 2014 at http://www.msaustralia.org.au/sites/default/files/ms_
pregnancy.pdf.
Multiple Sclerosis Association of America. About MS. Frequently Asked
Questions about MS. Accessed March 2014 at http://www.mymsaa.org/
about-ms/faq/.
Multiple Sclerosis Foundation. Coping with Multiple Sclerosis. MS
Medications and Oral Contraceptives: What you need to know. Accessed
March 2014 at: http://www.msfocus.org/article-details.aspx?articleID=22.
National Multiple Sclerosis Society. Pregnancy and Reproductive Issues.
Accessed March 2014 at http://www.nationalmssociety.org/Living-WellWith-MS/Family-and-Relationships/Pregnancy.
John Hopkins Medicine. Health Library. Multiple Sclerosis and Pregnancy.
Accessed March 2014 at http://www.hopkinsmedicine.org/healthlibrary/
conditions/physical_medicine_and_rehabilitation/multiple_sclerosis_
and_pregnancy_85,P01160/.
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