Saturday, December 12, 2009

Prolactin Level and Clomid for 30 yr. old TTC'r



Question:



Hi Dr. Ramirez,

I recently had a blood test done and it showed that my prolactin level is 41ug/L (the lab report indicates that normal should be less than 26ug/L) and macroprolactin is 54%. The month that I had this test done was very stressful and my period was about 12 days late. I am usually very regular 30-33 days. I did have a miscarriage in November 2008. My husband and I have been trying to conceive for about 2.5 years.

I just started my first round of Clomid. I am 30 years old. I was wondering if my prolactin level is something to be very concerned about and will it affect my fertility? Will the clomid regulate this? Does my prolactin level indicate hyperprolactinemia?

Thank you for taking the time out to read my question.

Answer:


Hello,


Yes, if in fact your prolactin is elevated, it will affect your fertility. It needs to be brought down to normal first. However, in order to check the Prolactin level, it should be done fasting and preferable in a non-stress situation. So, please have yourself retested, since I see that your level is not too high.

Prolactin is a very volatile hormone. It is affected by sleep, stress, time of day and meals. That is why it should always be rechecked at a fasting level. The normal level should be less than 20. It may be the only thing affecting your fertility. If the prolactin remains elevated, you should see a medical endocrinologist or reproductive endocrinologist for evaluation and treatment. Often this indicates that there is a microscopic tumor in the pituitary. Medication is sufficient to treat this tumor but a larger tumor would need to be surgically removed.

However, if when you are retested and the Prolactin level is normal, the fact that you have not gotten pregnant after two years of trying at your age would be reason for concern. You are still at your peak fertile years and should have gotten pregnant within one year. Before going to treatment such as with Clomid, you should undergo a complete infertility evaluation to find out what the problem is. The treatment is then chosen according to what needs to be treated. For example, if your tubes are blocked, Clomid won't work. If there is a male infertility factor, such as low sperm count, Clomid with intercourse won't work. See my March 2008 blog concerning "Infertility Evaluation ABC's" http://womenshealthandfertility.blogspot.com/2008/03/infertility-evaluation-abcs.html

It seems obvious to me that you are seeing a Family Practice doctor or a general Ob/Gyn. That is the reason you are going straight to Clomid, when in fact since you have regular periods it is a sign that you are ovulating. Clomid will increase the number of eggs that you ovulate, but having eggs available has not been your problem since you have regular cycles. Something else is going on. The problem with non-infertility specialists is that they jump to Clomid as if it were a miracle drug. It is not. It works great for some women who don't ovulate and don't have normal periods, which is certainly not your case.

I would recommend that you seek out a fertility specialist that is going to give you the proper evaluation and care. In answer to your last question, "hyperprolactinemia" means elevated prolactin levels in the blood. If your level is over 20, then you have it. Your single miscarriage in Nov. 2008 is not a major cause for alarm. That being said, get yourself retested and move on from there, keeping in mind what I have advised above.

I hope this helps,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
www.montereybayivf.com

5 comments:

  1. Hi Dr. Ramirez,

    At the age of 18yrs I was diagnose with pituitary adenoma, I was first place on parlodel for a year. But the tumor had increased dispite the medication and my doctor suggest surgery. A year after surgery, the tumor grow back and I was placed on dostinex (cabergoline).

    I am now married and 30 yrs old and I was off the cabergoline for almost 2 yrs due to lost of health insurance coverage, but now I have coverage and being treated.

    At my initial doctors visit 4 mos ago my lab results read that my prolactin level was 112.2 H(ng/mL) and my recent level is 88.2 H (ng/mL). My doctor has increase my dosage from 24mg/wk to 32mg/wk in hopes to reduce it.

    My question is: My husband and I want to start a family but I have not had a menstrual cycling in over 2 yrs, is it possible to have a baby if I take clomid in conjuction with the cabergoline?

    Thank you for reading my question

    ReplyDelete
  2. Hello,

    You will need to get your prolactin level down to normal levels (< 20). Otherwise, it will interfere with ovulation, as it has been doing.

    ReplyDelete
  3. hello dr. Ramirez,

    I had a prolactin test done randomly,which showed a level of 43.However,a repeat test done on the 3rd day of my period on fasting showed a level of 17.I also have a little breast discharge from both nipples off and on,and have been on Dostinex .25mg twice a week for about 3 months now

    I am 29 years old and tryng to conceive.Is it possible to have normal prolactin levels and still have breast discharge?please advice..do i need to get my prolactin levels retested?

    ReplyDelete
  4. Hello,

    A valid prolactin level is always done fasting. Prolactin is a very volatile (meaning it can be affected by many things) hormone and should be done fasting, first thing in the morning and preferably with the least amount of stress. Anything less than 20 is fine. The fact that you have a little discharge could be due to an elevated prolactin, but you can also induce a discharge if you try hard enough i.e. massage the breast and nipples or stimulate the breast and nipples enough. The discharge in this case is not mild, prolactin causes mild production. If your prolactin level is now 17 on your current dose of Dostinex, then it is working just fine. Nothing further needs to be done in that regard.

    The usual starting dose of Dostinex is 0.25 mg twice per week and increased every 4 weeks until the prolactin level is normalized, up to a maximum dosage of 1 mg twice per week.

    I don't think that this is the reason you are not getting pregnant, however. There probably is something else going one that hopefully will be found in a complete infertility evaluation. Only then will you know what the appropriate treatment is.

    Good Luck.

    ReplyDelete
  5. I had my thyroid removed in April. I had my prolactin checked at 11am and hadn't had anything to eat since dinner the night before. My level was 30. I orginially went becase I'm having severe pain in my ovaries (especially during intercourse), nausea, headaches, acne, the hair on my lip and stomach are darker and slight breastmilk. I did just get a positive on an ovulation predictor kit for 2 days. I know prolactin can affect gettin pregnant but wasn't sure which part. Thank you for your time!

    ReplyDelete

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