Multiple Sclerosis is an autoimmune disease increasing in incidence and prevalence. It affects women 3 times more than men and is often diagnosed at childbearing age. While previously neurologists recommended their patients not to fall pregnant there is now mounting evidence that pregnancy has a positive effect on the disease course. The protective effect of pregnancy especially in the third trimester has been described already in the 1990ies. After the introduction of highly efficacious treatments, which are recommended to be stopped prior to pregnancy, this picture has changed, and we see now more relapses in the third trimester. There is still an increased risk of relapse postpartum, but this is diminished if patients were stable on therapy for the two years prior to pregnancy. Especially highly active patients are likely to be treated up to first trimester with potential implication for the baby (anemia and thromobocytopenia for Natalizumab and hypoglobulinemia for Ocrelizumab). There is still a question around impaired fecundity in women with MS with multiple factors potentially effecting the ability to fall pregnant including disease symptoms and treatment or disease specific immune dysregulations. There seems to be an increased use of artificial reproductive technology in women with MS but evidence is scarce. The mode of ART is also still debated with GnRH agonists potentially increasing the risk of relapse. As the stress of failed cycles and the delay in restarting disease modifying therapy are confounding factors, even a recent meta-analysis was too small to answer this question. Therefore, family planning in women with MS is complex and requires the input of neurologist, general practitioner and obstetrician.