Diagnosis of Infertility and Infertility Treatment in Women with and without Multiple Sclerosis

Background: There is a scarcity of data regarding infertility diagnosis and treatment in women with multiple sclerosis (MS) compared with women without MS.

Objectives: To use US retrospective commercial claims data to compare the prevalence of infertility and the extent of use of infertility treatments in women with and without MS.

Methods: A cohort of US women with MS (ICD-9-CM code: 340.xx), aged 18–55, with a minimum of 1 year of continuous insurance eligibility from 1/1/2006 to 12/31/2015 were identified from the IMS Health Real World Data Adjudicated Claims – US database. The number of women with MS meeting the eligibility criteria was 117,041. A comparator group of women without MS was also selected (n=1,422,836). Exact matching controlled for baseline age, geographic region, and index-year quarter. Rates of infertility diagnosis, infertility treatments, and live births were compared between the matched samples (n=96,937 in each group). Infertility treatments evaluated included oral infertility medications (clomiphene and/or letrozole); injectable medications for controlled ovarian stimulation (COS), defined as ≥1 gonadotropin (Gn) and an ovulation trigger, either human chorionic Gn or Gn-releasing hormone (GnRH) agonist; and other infertility treatments (Gn without trigger or GnRH antagonists).

Results: The mean (standard deviation) duration of follow-up was 3.77 (2.36) years for women with MS and 3.82 (2.43) years for women without MS. A statistically significantly greater proportion of women with MS had a diagnosis of infertility compared with women without MS (8.52% vs 8.08%; p=0.0006). A significantly lower proportion of women with MS used any infertility treatment compared with women without MS (1.01% vs 1.19%; p=0.0002). Of patients receiving infertility treatments, over half received oral infertility medications without Gn (MS 54.9% vs non-MS 54.8%); the remainder received injectable COS medications (MS 22.9% vs non-MS 25.0%) or other treatments (MS 22.3% vs non-MS 20.2%). The proportion of women using each of the individual infertility treatments was significantly lower in women with MS compared with women without MS (p<0.05), except for GnRH antagonists. The rate of live births was lower in women with MS than in women without MS (5.00% vs 6.98%; p<0.0001).

Conclusions: Compared with women without MS, women with MS were more likely to have a diagnosis of infertility, less likely to use infertility treatments, and less likely to have a live birth.