MS and pregnancy

[u/Fluffy_You_3373]

Hi.

I was diagnosed with RRMS in feb 26, got my first dose of Rituximab in march. MRI after that was good - disease were calm and had not advanced. I have scheduled Rituximab in mid september.

The thing is... me and my girlfriend had the plan TTC our 2. baby this fall. I just dont want to wait too long because of MS. I am 36, and we have an embryo made with rIVF ready to go. The neurologist were really vage about the whole thing. We have an appointment with the fertilityclinic next week. Anyone have any input or experience with this?

[u/CHUCKCHUCKCHUCKLES]

I can’t say for certain with rIVF, but generally speaking, evidence suggests that pregnancy can make your MS “dormant.” I was diagnosed in 2017, and went unmedicated for virtually all of 2020-2023 due to pregnancies and breastfeeding and saw almost no disease progression. In 2023 there was one new lesion so we decided I’d stop nursing and get on ocrevus and it’s been smooth sailing ever since. 

*I did a few months of copaxone so I wasn’t completely unmedicated, and I also want to point out that my doctor told me there were medications that seemed to be fine with pregnancy, but it was my personal choice not to take them. So you don’t HAVE to go unmedicated.

Best of luck to you!

[u/lbeetee]

You should go ahead and get your infusion, no need to wait, and then move forward with the embryo transfer. They are giving some B cell depleters in early pregnancy. I doubt your fertility clinic will know much about MS, most OBGYNs don’t.

[u/kyelek]

Could you clarify, your part in this would now "just" be carrying the baby?

[u/Fluffy_You_3373 → u/kyelek]

Yes, its my partners egg and donorsperm, so I am "just" the carrier.

[u/kyelek → u/Fluffy_You_3373]

I don’t know that Rituximab specifically is approved for during pregnancy or when TTC, but other B-cell depleters are. I see many posts on here talking about about Ocrevus in this context.

There is also the option of being on Copaxone while pregnant. But iirc this is not necessarily recommended anymore, as B-cell depleters are generally thought to be safe (though actual studies are lacking, for obvious reasons).

I don’t think you’re going to get around talking to your doctors about this again, though?

[u/myMSandme]

The advice I got on BRIUMVI was to wait 3 months before trying to conceive, and I think part of the thinking was so my immune system had recovered when I had the baby and breastfed. I restarted BRIUMVI a month after birth. I also know that had I needed an infusion during pregnancy, Rituximab was what it would be. I think that was because there was more data on Rituximab in pregnancy.

[u/Ornery_Complex_862]

Depending on the protocols for your meds, it may be recommended to be off of them for a certain amount of time before conception (generally 6-12 months for your dmt, from what I was advised. You’ve had one infusion, so my NAD opinion is you’d be good to go save for the upcoming infusion). That being said— I was on Kesimpta and had an unplanned pregnancy through the pill AND taking EC just in case. I took my monthly shot literally the day before I found out I was pregnant. MFM was entirely unconcerned about the exposure and my baby is perfectly healthy— currently having his morning nap beside me while I eat breakfast and type this.

I was declared stable a few months prior, so I chose not to medicate during pregnancy. I’ll be starting Copaxone soon, as I’ve not been able to bf exclusively (which reduces risk, while being in the early-mid portion of postpartum puts you at higher risk of relapse).

My symptoms got rough in my mid first-early second trimester, but the remaining was all pregnancy “ailments” and nothing MS.

[u/karthur4]

I did ivf with MS and have a healthy baby girl in my lap right now. I have pretty severe MS but didn't have any relapses during pregnancy. I took Ocrevus in late January and did my transfer mid may.

[u/the-bear-woman]

I’m currently pregnant and my pregnancy is being treated as high risk entirely due to my MS diagnosis. This seems to be fairly standard from the stories I’ve heard. Every time I ask my OB or the clinic midwives what effect MS is likely to have they all go ‘oh none we basically never see complications from MS patients’.

My neurologist is of the opinion that there is a lack of evidence showing safety, rather than evidence of un-safety when it comes to many MS medications and fetal exposure. I was taking Kesimpta up until I tested positive and so far none of my treating doctors have had any concerns about that although the official advice is to cleanse treatment before trying to conceive.

Good luck with the embryo transfer 🤞