The multifactorial nature of reproductive decision-making among women with multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is a chronic neurological disease that frequently affects women during their reproductive years and may influence fertility intentions and family planning decisions. This study aimed to identify factors associated with reproductive choices among women with MS and to examine the role of psychological, social, and disease-related variables in fertility decision-making. METHODS: A cross-sectional study was conducted in Greece between August 2023 and December 2024, involving 103 women aged 18-50 years with neurologist-confirmed MS (mean age: 38.05 ± 7.01 years). Participants were recruited from the Naval Hospital of Athens and the Greek Multiple Sclerosis Society. Structured questionnaires assessed social support, psychological wellbeing, relationship dynamics, repro-ductive motivation, and quality of life. Associations between clinical, psychosocial, and demographic var-iables and childbearing were examined using univariate analyses and binary logistic regression. RESULTS: In univariate analyses, childbearing was associated with relapsing-remitting MS compared with progressive disease forms (73.9% vs 0%, p=0.001), marital status (all unmarried women were childless, p=0.001), fingolimod exposure (all users were childless, p=0.008), higher mental health scores (p=0.035), greater health-related distress (p=0.006), and stronger fatalistic motivation for parenthood (p=0.005). However, in multivariable logistic regression, none of these variables independently predicted childbearing status (all p>0.05). CONCLUSIONS: These findings suggest that reproductive decision-making among women with MS may involve multiple disease-related, psychological, and relationship-related considerations. Further studies with larger sample sizes are needed to confirm these associations.