What is Hyperprolactinemia, and Can It Affect Your Fertility?

Prolactin is a hormone involved in breast development and milk production. When prolactin levels are abnormally high, it’s termed hyperprolactinemia. While not widely discussed, this condition can negatively impact ovulation and fertility. Here’s what to know about hyperprolactinemia.

Prolactin and Ovulation

During a normal menstrual cycle, prolactin levels remain relatively low to allow proper ovulation. Right before ovulation occurs, estrogen peaks triggering a surge of luteinizing hormone (LH) from the pituitary. This LH surge signals the ovarian follicle to release the mature egg for fertilization.

When prolactin is elevated, it suppresses these LH and FSH surges that control ovulation. Excess prolactin inhibits follicle development and maturation, preventing eggs from being released. This results in infrequent, irregular, or absent ovulation.

What Causes Hyperprolactinemia?

Hyperprolactinemia is often traced back to one of three origins:

• Prolactinoma – Benign pituitary tumor that overproduces prolactin. Most common cause.
• Pituitary / Hypothalamic Dysfunction – Injury, tumors or other damage to pituitary / hypothalamus disrupts regulation of prolactin release.
• Medications – Certain prescription drugs elevate prolactin as a side effect.

Less common causes include primary ovarian insufficiency, thyroid problems, and conditions like seizures, chronic liver/kidney disease or rheumatoid arthritis. Talk to your doctor to pinpoint the cause.

Signs and Symptoms

In women not on birth control, the most common symptoms of hyperprolactinemia include:

• Irregular periods or amenorrhea (absent periods)
• Infertility and difficulty conceiving
• Reduced vaginal lubrication
• Breast discharge / galactorrhea (milky nipple discharge)
• Loss of libido
• Headaches and vision changes if due to large pituitary tumor

Diagnosing Hyperprolactinemia

Hyperprolactinemia is diagnosed through blood tests. A prolactin level over 20 ng/ml typically confirms the diagnosis when correlated with symptoms. Levels over 200 ng/ml warrant an MRI to check for pituitary tumors.

Testing may also reveal low estrogen and LH levels. Your doctor will investigate for any underlying causes. Fertility testing like ultrasounds evaluates ovarian function.

Can It Be Treated?

The good news is hyperprolactinemia can often be effectively treated:

• Medications like bromocriptine and carbergoline reduce prolactin production and regulate ovulation.
• Treating underlying thyroid disorders can lower prolactin levels back to normal.
• Pituitary tumors may be treated with medication or surgery to remove the adenoma.
• Eliminating prolactin-elevating medications allows normal prolactin function to resume.

With treatment, ovulation and regular cycles usually resume within a few months, restoring normal fertility. Closely monitor prolactin levels.

Getting Pregnant with Hyperprolactinemia

Successful pregnancy is extremely difficult with unmanaged hyperprolactinemia due to lack of ovulation. But fertility treatments can assist:

• Ovulation-inducing medications like clomid often successfully trigger ovulation after prolactin is lowered.
• IVF with egg retrieval allows fertilization to occur outside the abnormal hormonal environment.
• Egg or embryo freezing preserves fertility before surgery or treatment for pituitary tumors.
• Adjunct treatments like acupuncture may help regulate prolactin and reproductive hormones.

For many, addressing elevated prolactin levels restores normal ovulation and chances of conception either naturally or via fertility treatments. Patience and persistence is key.

Hyperprolactinemia is one potential cause of unexplained infertility to consider. Because it affects ovulation rather than egg or sperm quality, regulating prolactin levels allows conception with assistance. Don’t hesitate to get prolactin testing done along with other fertility bloodwork. Restoring balance to this hormone can be life-changing.