From the Guidelines
Mildly elevated prolactin levels can indeed cause issues with infertility, and treatment with dopamine agonists such as cabergoline is often effective in normalizing prolactin levels and improving fertility outcomes. Prolactin is a hormone produced by the pituitary gland that affects reproductive function in both men and women. Even mild hyperprolactinemia can disrupt normal reproductive hormone balance, leading to irregular or absent menstrual cycles in women and reduced testosterone production in men. According to a recent consensus guideline published in Nature Reviews Endocrinology 1, dopamine agonists reduce pituitary-origin hyperprolactinaemia of any cause, and cabergoline is the dopamine agonist of choice due to its longer half-life and greater affinity for the dopamine receptor.
Key Points to Consider
- Dopamine agonists, such as cabergoline, can induce normalization of prolactin levels, tumour shrinkage, and resolution of visual field defects, as well as improve fertility outcomes 1.
- Cabergoline has been shown to be superior to bromocriptine in normalizing prolactin levels and achieving pregnancy in adult women with prolactinoma 1.
- The treatment of mildly elevated prolactin levels with dopamine agonists can help improve fertility outcomes, with studies showing that 53% of patients achieve normalization of fertility 1.
- It is essential to identify any underlying causes of elevated prolactin, which could include certain medications, thyroid disorders, stress, or rarely, pituitary tumors, and address these underlying causes as part of the treatment plan.
Treatment Options
- Cabergoline is typically started at a dose of 0.25mg twice weekly, and the dose can be adjusted based on the patient's response to treatment.
- Bromocriptine is another option, but it is often associated with more adverse events than cabergoline 1.
- Lifestyle modifications, such as stress reduction and avoiding excessive breast stimulation, may also be helpful in mild cases of hyperprolactinemia.
From the FDA Drug Label
Bromocriptine mesylate tablets, USP are indicated for the treatment of dysfunctions associated with hyperprolactinemia including amenorrhea with or without galactorrhea, infertility or hypogonadism
- Infertility is listed as a dysfunction associated with hyperprolactinemia, suggesting that mildly elevated prolactin levels can cause issues with infertility.
- The FDA drug label indicates that bromocriptine mesylate is used to treat infertility associated with hyperprolactinemia, implying a link between elevated prolactin levels and infertility 2.
From the Research
Effects of Mildly Elevated Prolactin on Infertility
- Mildly elevated prolactin levels can cause issues with infertility, as it may lead to luteal insufficiency in cycling women and is associated with recurrent miscarriage 3.
- In men, chronic and significant hyperprolactinemia may impair fertility or cause infertility, with or without hypogonadism, although more clinical studies are needed to understand the impact of mildly elevated prolactin on male reproductive function 3.
Treatment of Hyperprolactinemia
- Treatment of hyperprolactinemia with dopamine agonists, such as cabergoline or bromocriptine, can restore fertility in the vast majority of cases 3, 4.
- Cabergoline is often preferred due to its better safety profile and efficacy in normalizing prolactin levels and restoring gonadal function 5, 6.
- Bromocriptine has also been shown to be effective in treating hyperprolactinemia and restoring reproductive function, although it may have more adverse effects than cabergoline 4, 6.
Impact on In Vitro Fertilization (IVF) Outcomes
- The relationship between serum prolactin levels and IVF outcomes is still unclear, with some studies suggesting that higher prolactin levels may be associated with improved IVF outcomes, while others find no significant correlation 7.
- Treatment of hyperprolactinemia with dopamine agonists before IVF treatment does not seem to negatively impact IVF results, and may even be beneficial in terms of fertilization rates and conception rates 7.