Hormonal imbalance is one of the most common infertility culprits. Speaking of hormones, it is generally progesterone and estrogen which are held responsible for female infertility. Prolactin is the hormone less heard of but its imbalance can hamper fertility to a considerable extent. Therefore, it is important to be aware of the condition so that the problem can be nipped in the bud.
Hyperprolactinemia is a condition when prolactin is synthesized in excessive amounts. Prolactin is the hormone which stimulates the growth of breast tissue in women. It is this hormone which promotes breast milk production in women after they give birth. The level of this hormone is very small in women but it goes up during pregnancy and after delivery. Imbalance in prolactin levels can interfere with the reproductive capacity of women, and even men.
Before delving deeper into the condition, it is important to understand the significance of prolactin first. The hormone is produced in pituitary gland, which lies at the base of the brain. It is synthesized in both men and women, though its imbalance is more likely to cause female infertility. Prolactin imbalance is a hidden enemy that attacks from behind. Excessive production of prolactin in a woman (who is not pregnant) causes drop in estrogen levels. The estrogen imbalance, in turn, results in ovulation dysfunction and consequent female infertility issues.
Hyperprolactinemia is characterized by irregularity of menstrual cycle due to irregular ovulation. The woman may even have no periods. Some women produce breast milk even if they are not pregnant. Low bone density, hot flashes, poor sex drive, and vaginal dryness are some other symptoms of hyperprolactinemia. The condition may be asymptomatic in some woman, but the doctor investigating female infertility must carry out tests to rule out this condition.
Causes of Hyperprolactinemia
Primarily, a benign tumor on the pituitary gland causes hyperprolactinemia. Known as prolactinoma, this tumor may grow in men and women. It can be treated with medicines most of the time but in very rare cases, it can be cancerous. The presence of this tumor can cause vision- related problems and headaches. There are several other reasons for hyperprolactinemia too:
- Overactive pituitary function
- Hypothyroidism or underactive thyroid
- Medications for high blood pressure or depression
Besides these causes, the reason of prolactin imbalance may be unknown in some cases. The general awareness related to this hormone is comparatively low. This is the reason why the condition is likely to be skipped during infertility evaluation. An expert infertility specialist would, however, keep the hyperprolactinemia analysis on her checklist to ensure timely and effective treatment.
Diagnosis and Treatment of Hyperprolactinemia
Hyperprolactinemia is diagnosed using a simple blood test that measures the levels of prolactin. For non-pregnant women, a level below 25 micrograms per liter is regarded as optimal and anything above that indicates hyperprolactinemia. An excessive prolactin level (above 250 micrograms per liter) is an indication of prolactinoma. The doctor will recommend an MRI scan to check out the existence of tumor and its size. A positive hyperprolactinemia test is followed up by a diagnostic test for hypothyroidism. This test is done to verify if underactive thyroid is the reason behind hyperprolactinemia.
A woman with mild or no symptoms of the condition does not need treatment. However, those encountering female infertility issues require help at the earliest. Medication is the first line of treatment used to shrink the tumor and restore ovarian function. A low dose therapy is recommended to begin with and the specialist might increase the dosage if necessary. Prolactin level starts coming down within 2-3 weeks for most women. The therapy may have to be taken for years if needed but the tumor might still come back when stopped. The specialist might stop the medication once a woman conceives.
Treatment options may vary if hyperprolactinemia is induced by thyroid imbalance or some medications. For such cases, the underlying condition has to be handled to treat prolactin imbalance. On the other hand, surgery is recommended for larger tumors. This is usually done when medication fails to shrink the tumor or the woman suffers from acute vision problems. Women should opt for the surgical procedure before they plan pregnancy. Once treated with medication or surgery, they can try to conceive naturally. The chances of conception are good, provided that there is no other fertility related complications. Further investigation and treatment may be required if the ovulation cycle fails to come back to normal.
Hyperprolactinemia in Men
Hyperprolactinemia is not as common in men as it is in women. However, men suffering from abnormal prolactin levels may encounter male factor infertility. The issues they may face include poor sperm count, erectile dysfunction, and poor libido. Prolactin in small quantities supports the production of testosterone, the male hormone. But too much of it can actually hamper testosterone production, which directly influences male fertility. Therefore, diagnostic tests for hyperprolactinemia are to be included in the checklist for male infertility treatment too.
Hyperprolactinemia is an absolutely treatable condition and getting pregnant is possible if treated in time. It is best to approach an expert infertility specialist for restoring the hormone levels to normal so that conception becomes possible.
Gaudium IVF is a leading IVF centre in Delhi where patients are offered high quality infertility treatment along with comprehensive gynecological care. Contact award-winning IVF doctor in Delhi Dr. Manika Khanna for a free second opinion regarding your fertility treatment options.