Elevated prolactin levels, or hyperprolactinemia, is among common causes of infertility affecting men, but more often women. The prolactin is a hormone produced by the pituitary gland. When this hormone is in excess, the chances of conceiving are lower than usual.
The Prolactin Hormone and Fertility
The prolactin hormone is secreted by the pituitary gland and is essential in breastfeeding and the production of milk. However, abnormally high levels of prolactin may cause irregularities in the menstruation period and may be associated with infertility. In men, high levels of prolactin may cause erectile dysfunction.
Causes of Hyperprolactinemia
Hyperprolactinemia may be caused by several known factors such as:
- Hypothalamus diseases
- Pituitary gland dysfunctions or tumors
- Certain drugs (i.e. most tranquilizers that block the effects of dopamine, Cisapride, vasodilators such as Minoxidil or Rogaine)
- Liver disease
- Thyroid problems (hypothyroidism)
- Pregnancy
- Elevated levels of stress
- Cushing’s disease
- Renal failure
- Sarcoidosis
- Polycystic ovary syndrome
- Frequent seizures
Hyperprolactinemia may also be idiopathic.
Hyperprolactinemia Symptoms
The elevated levels of prolactin in the system will cause low levels of estrogen and may also lead to anovulation. The menstrual cycle will be disrupted and this will affect fertility. Menstruation may occur less often, while some women may have no menstruation at all (amenorrhea).
In pregnant women, the hyperprolactinemia will cause production of breast milk. Other symptoms may include:
- Vaginal dryness, causing painful intercourse
- Decreased libido
- Migraines
- Milk secretion, even if not pregnant
- Vision problems caused by the swollen pituitary glands that may push against the optic nerves
- Osteoporosis if the prolactin levels are elevated for a long period of time, due to lack of sufficient estrogen
Detection of Hyperprolactinemia
Hyperprolactinemia can be detected through a blood test. Levels over 580 mIU/l are considered abnormal. The doctor may also test the function of the thyroid glands and the pituitary glands. X-rays and ultrasounds may be needed to detect possible tumors that may affect the pituitary gland or thyroid glands. MRI or CT scans may also be performed. If tumors are present, a tissue biopsy will be performed.
Hyperprolactinemia Treatment
The treatment of hyperprolactinemia will depend on the cause of the condition. If there are tumors present interfering with the functions of the pituitary gland or thyroid glands, surgery may be recommended. The doctor will assess the situation and recommend treatment for each cause of high levels of prolactin. If the causes of prolactin hormones in excess are unknown, the doctor may recommend a few drugs that decrease the prolactin levels. Bromocriptine, Norprolac, quinagolide or dopamine agonists cabergoline may often be prescribed.
The patient should be monitored and periodical tests will be required. The fertility should increase once the prolactin levels are regularized. However, the doctor may recommend a 3 month waiting period before trying to conceive to ensure the egg involved is healthy.
