Impact of autologous haematopoietic stem cell transplantation on fertility in aggressive multiple sclerosis

Background and aims: Autologous haematopoietic stem cell transplantation (AHSCT) is a treatment option for aggressive multiple sclerosis (aMS) with an acceptable safety profile, but few data are available so far on its impact on fertility. Methods: Data on menses recovery following transplant and endocrine assessment (luteinizing hormone, folliclestimulating hormone, oestradiol, progesterone, prolactin, testosterone, anti-müllerian hormone - AMH) were collected in aMS patients treated with AHSCT who had at least one endocrine assessment after transplant. Results: 23 females and six males were included (table 1). After conditioning, 19/23 (83%) females experienced persistent amenorrhea. Four females showed spontaneous menses recovery within six months after transplant; these cases were younger compared to those who did not: median age at AHSCT 26 (range 24–39) vs 38 years (26–50), p=0.027. AMH was aligned with values expected according to patients’ age in 8/9 evaluable cases (89%) at baseline, while at month six it decreased to levels below normal values in 7/9 cases (78%); a further reduction at month 24 was observed in 6/7 (86%) cases. Post-transplant AMH was normal in 2/14 (14%) females for whom only post-treatment assessment was available. No pregnancies were reported. In males, post-AHSCT testosterone levels were within the normal range in 5/6 cases and were not reduced compared to baseline in 2/3 (67%) evaluable cases. Conclusion: Although exploratory, our data confirm that AHSCT deeply affects gonadal function in females, with the deepest effect in older women; a potential additive effect of prior immunosuppressive treatments cannot be ruled out. Gonadal function in males seems to be only minimally affected.