Effects of autologous hematopoietic stem cell transplantation on female fertility in multiple sclerosis: A systemic review and meta-analysis.

This research was conducted to determine the effect of autologous hematopoietic stem cell transplantation (AHSCT) on female fertility in multiple sclerosis (MS). PubMed, Scopus, Google Scholar, and the Cochrane Library were searched using the search string: (multiple sclerosis OR MS) AND (AHSCT OR Autologous hematopoietic stem cell transplantation) AND (pregnancy OR pregnant OR conception OR conceive OR gestation∗). Only those studies that involved AHSCT in MS female patients were included in the study. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. The random-effects model was used to calculate the Inverse Variance (IV) and its corresponding 95 % confidence interval (CI). Moreover, qualitative analysis was conducted to analyze anti-Mullerian hormone level (AMH), amenorrheic status, restoration of menstruation, pregnancy outcome, and mode of delivery post-AHSCT. Four cohorts were used in the study. The prevalence of pregnancy was reported as 10 % (95 % CI = 4-17 %, I2 = 20 %). Qualitative analysis reports a positive correlation between the restoration of normal menses, live birth, and normal vaginal delivery with AHSCT, while a negative correlation is reported between AMH, amenorrhea, abortion, and cesarean section with AHSCT. Our systematic review and meta-analysis are the first to demonstrate an effect of AHSCT on female fertility in MS patients; however, small sample size and limited number of studies are the main limiting factors. Further studies are needed to strengthen the findings of our study.