Ask the Advocate: MS and Fertility

Multiple sclerosis (MS) advocate and mother of three, Stephanie Lynch explains how the condition can affect your decision to start a family and the ensuing pregnancy.

She also shares the measures she took to stay well and keep symptoms under control during her three pregnancies.

This interview has been edited for brevity, length, and clarity.

When my husband and I were ready to start a family, we knew my MS would be a significant factor in our family planning. At the time, I was on a daily medication that is not safe to take while pregnant.

To manage my symptoms and minimize disease progression while trying to conceive, I had to work with my doctor to time stopping my DMT [disease-modifying therapy] medication.

For me, this meant making sure my symptoms were managed before stopping my medication, considering the time of year I would be stopping and having a plan in place to “bridge the gap” while I was not taking medication until I became pregnant.

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We decided to stop my medication in the late fall so that the heat wouldn’t be an issue or risk factor for me, and I did one day of steroid infusions each month to keep my symptoms managed until I became pregnant.

Fortunately, my MS did not have a direct effect on my fertility. We did ultimately wind up growing our family through fertility treatments due to another condition, and my MS symptoms also needed to be managed closely through the IVF [in vitro fertilization] process.

Due to the very precisely timed nature of fertility and IVF, this actually provided an opportunity to also time additional steroid infusions to keep my MS symptoms at bay.

Because of my MS diagnosis and immunocompromised state, I was followed by a high-risk maternal-fetal medicine obstetrician for my pregnancies. I also checked in regularly with my neurologist and, starting with my third pregnancy, an infectious disease specialist.

I found that my MS symptoms were quite stable throughout my pregnancies for the most part, with the exception of my neurogenic bladder. My bladder symptoms presented a risk for UTIs [urinary tract infections], so my healthcare team had a plan in place for any infections that could have occurred.

I also worked on my balance and strength with a physical therapist during my first two pregnancies and postpartum.

One of the most significant times my healthcare team planned for was around delivery due to the postpartum risk of relapse . I checked in with my neurologist after each of my deliveries and plan MRI imaging within 3 months to assess any active lesions or disease progression.

To manage my symptoms throughout pregnancy and postpartum, there were a number of things I could do myself as well including gentle yoga, resting as much as I could, and avoiding heat and humidity as much as possible.

Starting a family can be overwhelming for anyone, and adding a chronic illness to the equation can certainly intensify that. While pregnancy with MS can be physically challenging and emotionally complex, it’s also quite empowering.

Throughout the entire journey, an open line of communication with healthcare professionals, partners, family, and friends is paramount. The extra considerations that a person with MS faces during pregnancy aren’t always obvious or intuitive, so it’s crucial to be able to advocate for ourselves and ask questions when something feels new, different, or “just off.”

Motherhood is beautiful, and in the context of chronic illness, it provides an immense opportunity to foster compassion, empathy, and model self-advocacy and supportive partnership.

Stephanie Lynch

Stephanie Lynch was diagnosed with multiple sclerosis 13 years ago at age 19. The New Jersey native, who now lives in Boston’s suburbs, worked with her doctors and other healthcare professionals to find treatments that managed her symptoms and prevented relapses. Then, she and her husband decided to start a family. Through three pregnancies, Stephanie had to stop taking certain medicines and time others to keep herself and her developing children safe and healthy. Now the mother of three boys under the age of 5, she shares her journey with kids, health, and wellness at @linenandlittles on Instagram.

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• Lynch S. (2023). Personal interview.
• Varytė G, et al. (2020). Pregnancy and multiple sclerosis: An update on the disease modifying treatment strategy and a review of pregnancy’s impact on disease activity.
  ncbi.nlm.nih.gov/pmc/articles/PMC7074401/

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