Multiple sclerosis (MS) is a chronic neurological illness affecting adults at the time when they are most likely to consider starting a family. It is known that the risk of MS relapse declines during pregnancy but increases in the first 3 to 6 months postpartum. It is also known that this risk is not affected by delivery method, anesthesia type, or parity. Unanswered questions remain, including long-term pregnancy effects on MS outcomes, effects of lactation on postpartum relapses, or the best management strategies of MS patients through reproductive cycle. This review provides information and guidelines for counseling patients with MS desiring motherhood.