Marja-Liisa Sumelahti, Tampere University, Finland, discusses the often neglected topic of considerations for family patients with MS who are planning to start a family.
When male patients with MS come to talk about starting a family the biggest concern they usually bring up is the question about heritability of MS and we have an easy answer for that because MS in big picture is not a heritable disease and it is a rare disease in population because the risk in general population is 1 per 330 and if you have a first degree relative with MS the risk increases and it’s 1 to 48 and if there is a second degree relative it’s a 1 to 110. So there is a certain risk but we don’t talk about a heritable disease. So, there is an easy answer to my patient.
Of course, men are, as women are, concerned about their ability to bring up the children. If disease progresses, or if severe relapses occur, they are, of course, problems related to active MS and, in case of highly active MS, the problem we have to face concerns certain medications because some highly active drugs are not good in a situation where a female is pregnant and even if a male partner uses these drugs he has to withdraw from these drugs. So, this is an important question to consider, of course. But, considering all the drugs we have in MS today this problem concerns only a few drugs. So, it’s not a huge problem. If a male MS patient is using the new highly active, or some of the new highly active drugs, he has to withdraw but usually it’s not a problem because the treatment episode is very short. And, it’s only a year and then they have to wait for 6 months after that. So it’s not a real withdrawal. It’s just that we have to postpone the family planning to a safer period when using the new drugs.
The main barriers among men with MS when we discuss about starting a family, they bring up mostly problems in sexual dysfunction – that’s the main problem. In some cases I’ve run into question that a young man is wondering if he’s even even, you know, if it’s even possible for him to start a relationship, and start for family planning when he has received MS diagnosis.
The main unanswered questions concerning male fertility in MS are epidemiological. In a way, it would be interesting to know if their family size is equal to men in the same age group, for example. What’s the age distribution, for example, when they start their families. And one important question; is how does disability affect family planning? When general neurologists meet a man with MS who starts to talk about family planning, the most important question is to consider the medication – the situation has to be safe. He has to be withdrawn from the highly active medications that are teratogenic – that’s the most important thing. And, I think that general neurologists should be ready to discuss all the matters that concern family planning in general – all the views: the social view, individual view of the patient, because this is a huge commitment in MS patients’ life. It’s a lifelong commitment. Disease is lifelong. So, this is a very important decision for both patients and for the doctor as well. Usually, what a general neurologist could do, I think, they could reassure the patient that it’s okay for them to start a family.