Q&A 16 - MS-Selfie

I cannot ejaculate; what can I do? AHSCT has failed me; should I start teriflunomide or leflunomide? As a male will teriflunomide cause harm to my partner's unborn child? What else can I do?

Questions

Case 1

Q1: I have had MS for 16 years, and I am now on ocrelizumab. I have erectile dysfunction and take Viagra, which helps with erections, but I can’t ejaculate when I have sex. I have heard about a device that is used in fertility clinics to help with ejaculation. Is it something I can try?

Case 2

Q2a: I was diagnosed in 2010 with RRMS and had AHSCT in 2019, but I have seen a steady decline in function. I now struggle to walk 200m unless it is on a flat surface. Foot drop and balance are my main issues. I have had stable MRIs but have always had a sizeable cervical lesion and some cerebellar lesions that presumably are major contributing factors. Should I try teriflunomide or leflunomide (for funding reasons)? 

Q2b: However, my partner is now 17 weeks pregnant.  If I start teriflunomide or leflunomide, should I be worried about the teratogenic risk to the baby?

Q2c: Other than exercise and fampridine, what recommendations would you have?

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Answers