The fertility question in multiple sclerosis is mostly solved, the ovarian question is not

Reproductive counselling in women with multiple sclerosis has historically been dominated by safety concerns. However, recent therapeutic advances have substantially reduced the need for prolonged treatment interruption and reshaped the clinical management of reproduction in multiple sclerosis. In parallel, concerns regarding the safety of assisted reproductive technology have been mitigated by emerging evidence from contemporary cohorts, reflecting improved disease control during fertility treatment. As a result, reproductive planning is increasingly integrated into early disease management rather than deferred, and fertility itself is less frequently a limiting factor when patients are managed within multidisciplinary care pathways, as we witnessed in our clinical practice. This evolving landscape prompts a shift in perspective. Rather than focusing solely on whether multiple sclerosis or its treatments impair fertility, attention may turn to whether reproductive biology reflects underlying disease mechanisms. Observational data suggest that ovarian reserve markers, particularly anti-Müllerian hormone, may be associated with distinct aspects of multiple sclerosis activity, including inflammatory burden and neurodegeneration. These findings raise the possibility that ovarian biomarkers could provide insights into disease biology, with reproduction in multiple sclerosis no longer only a matter of safeguarding fertility, but an opportunity to better understand the disease itself.