Hyperprolactinemia and Fertility

Ultrasound and blood work for hormone levels are often part of the evaluation for infertility..  In patients with a history of infertility and irregular cycles or pregnancy loss, checking a blood prolactin level is indicated. If this lab is elevated at the initial testing, it is usually repeated prior to initiating any further testing or treatment. A recent meal, sexual intercourse or nipple stimulation can temporarily increase prolactin level; therefore, overnight fasting and abstinence are recommended prior to repeating the test.  


Hyperprolactinemia in women can cause irregular menses, anovulation, or luteal phase defect.1  Some women may also experience nipple discharge. Women with this diagnosis may require a brain MRI.  This imaging is needed to determine if a benign, non-cancerous tumor is growing on the pituitary gland and overproducing prolactin..  These tumors are also called prolactinomas.This is one of the most common causes of hyperprolactinemia in women.   Other causes can be due to hypothyroidism and certain medications. Hyperprolactinemia in men can cause nipple discharge, impotence, and if untreated, sperm count can be decreased. 
In most cases, hyperprolactinemia can be treated withoral medications. Bromocriptine and Cabergoline are used to help decrease prolactin levels. Prolactin levels should normalize and shrinkage of benign prolactinomas may also be seen.  For women, periods should normalize and ovulation may occur more regularly.. Pregnancy rates are also improved with treatment prior to pregnancy. 1 Rarely, large prolactinomas may require surgical management.

For more information regarding evaluation and treatment options that are available, please schedule an appointment with one of our physicians at the Fertility Institute of Hawaii at 808-545-2800 or visit our website at https://www.ivfcenterhawaii.com.

References

  • Sokhadze K, Kvaliashvili S, Kristesashvili J. Reproductive function and pregnancy outcomes in women treated for idiopathic hyperprolactinemia: A non-randomized controlled study. Int J Reprod Biomed. 2020;18(12):1039-1048. Published 2020 Dec 21. doi:10.18502/ijrm.v18i12.8025
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