Prolactin and infertility

Prolactin is a hormone produced by the pituitary gland, in smaller quantities by the endometrium, ovaries, and placenta. Its main function is to stimulate lactation, but a high level of prolactin outside of pregnancy and breastfeeding is a pathological condition called hyperprolactinemia. This disorder is most often detected during an examination in women suffering from infertility.

What is hyperprolactinemia?

Hyperprolactinemia is a chronic increase in the level of prolactin in the blood, not related to physiological causes such as pregnancy or breastfeeding. This condition can lead to menstrual cycle disorders, suppression of ovulation, decreased fertility, and alterations in hormonal balance, affecting the overall well-being of the woman.

Causes of increased prolactin

Prolactin production can increase for several reasons: during pregnancy, breastfeeding, at the end of the menstrual cycle, or during puberty. However, in cases of pathological hyperprolactinemia, prolactin inhibits the secretion of luteinizing hormone, disrupting the maturation of eggs and ovulation, making conception impossible.

In addition to reproductive disorders, hyperprolactinemia can be accompanied by high levels of androgens, excessive hair growth, an increase in breast gland volume, and even spontaneous milk secretion. Pituitary dysfunction, hypothyroidism, liver diseases, tumors, surgical interventions on the mammary glands, and the use of certain medications can all contribute to the development of this pathology.

Consequences of hyperprolactinemia

A high level of prolactin inhibits progesterone and estrogens, disrupting the structure of the endometrium, which becomes too thin to allow the implantation of the embryo. Even in the case of pregnancy, the risk of miscarriage remains high. A high level of prolactin can also promote mastopathy, the formation of cysts, acne, weight gain, and other metabolic disorders. Women often complain of headaches, decreased visual acuity, and bone problems due to poor calcium absorption.

Possibility of conception and transition to assisted reproductive technology

Despite its serious consequences, hyperprolactinemia is effectively treatable. With early diagnosis and appropriate treatment, prolactin levels stabilize, ovulation resumes, and the chances of natural conception increase.

However, if pregnancy does not occur within 6 to 12 months following the normalization of the hormonal profile, it is recommended to consult specialists in assisted reproductive techniques. Depending on the clinical situation, ovulation stimulation, intrauterine insemination (IUI), or in vitro fertilization (IVF) may be prescribed. In cases of reduced ovarian reserve in women or severe spermogram disorders in the partner, programs of IVF with donor eggs or sperm may be used. In the most complex cases, when fertility is impaired in both partners, a IVF with double donation is performed. These methods offer a real chance of carrying a pregnancy to term, even in cases of pronounced hormonal imbalance.

How is hyperprolactinemia treated?

Treatment primarily aims to eliminate the cause. In the presence of a pituitary tumor, medication is prescribed to reduce prolactin, and rarely, surgery may be necessary. If a medication-related cause is identified, an alternative to the current medications is sought. The patient is also advised to regulate her sleep, avoid stress, adopt a balanced diet, and exclude foods that stimulate prolactin production.

The help of a reproductive specialist

At the "Natuvitro" clinic, specialized gynecologists conduct a comprehensive diagnosis of the causes of hyperprolactinemia and infertility. An individual approach to each patient allows for the restoration of reproductive function while considering all associated factors and making the best use of modern medicine's capabilities.