Monday, September 20, 2010

High Prolactin Levels Can Interfere With A Successful IVF Cycle


Question:

Hiya,

I'm 28 years old and had the first cycle of ICSI done a month ago. The reason for ICSI was that my husband has a very low sperm count and motility. My test date was 26th August and I started bleeding on the 24th of Aug. I went for a beta hcg which was 4.73.

I had a high prolactin level (35) for which I was given Dopergin (Bromocriptine) until Embryo transfer which was on the 12th of Aug. I was not told to continue it and I was stupid enough not to ask about it. I had 3 Grade A embroys transferred but there was no implantation. I had my prolactin test done on the 25th of Aug and it was 48.

My question is, could the high prolactin have been a reason for implantation failure? I'm not trying to play a blaming game but I need to know if this could've been avoided particulary as have nine day 2 frozen embryos and I plan on going for FET after my next cycle in September.

Thank you. A. from Spain

Answer:

Hello A. from Spain,

It is our protocol in the U.S. to check all the hormones prior to starting any infertility treatment cycle. This is so that we can eliminate anything that might interfere with the success of the IVF cycle. Of course, we check other things as well, and thus, have the highest pregnancy rates in the world. Traditionally, prolactin levels were measured in ng/ml, and normal prolactin levels in women are less than 20 ng/ml. (The new units now are pmol/l and to convert you need to multiply by 44. This means a normal level is less than 700 pmol/l.)

Since your prolactin was found to be elevated prior to the IVF cycle, and 35 is not very elevated, you were been placed on the Bromocriptine ahead of time in order to get the level back to normal prior to starting the cycle. There is no question that an elevated prolactin level can interfere with fertility.

My recommendation would be to get your level back to normal prior to your FET cycle!

Sincerely,

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

21 comments:

  1. my age is 21 years n 9mnths my prolectin level is 25 n im not getting pregnant im worried about that what can i do my periods date is always 4 days up to last date

    ReplyDelete
    Replies
    1. Hello,

      First, the prolactin level is slightly elevated but this may not be abnormal. The prolactin level needs to be repeated as a fasting prolactin done first thing in the morning. Many things can cause a prolactin to elevate such as time of day, stress, eating, etc. That is why it should be repeated to confirm.

      If it continues to be over 20, then treatment can be given by medication but such a low level would not be a cause for infertility.

      In terms of getting pregnant, there are 10 steps your body goes through to get pregant. Each of those steps need to be checked and that requires an infertility evaluation. So the best thing you can do, if it has been at least one year of trying for pregnancy, is to undergo an infertility evaluation. If it has not been 12 months of trying, then I would counsel you not to worry so much about it and keep trying. Most women under 30 years of age take 8-12 months to get pregnant.

      Good Luck

      Delete
  2. hello Dr.Edward ramirez,
    my age is 24 and I had my blood test done
    prolactin 23.1 ng/ml
    FSH 3.89 mlU/ml
    TSH 1.87 ulU/ml
    LH 5.50 mlU/ml
    insulin 9.70 uU/ml
    i m trying to conceive for more than 1.6 years.
    i have done 3 round of clomiphene citrate 100mg along with metformin 1000mg.
    i am taking metformin since 6 months,also i have a problem of vaginal dryness.
    mu periods are pretty regular and
    i am really worried :(
    Thanking You

    ReplyDelete
    Replies
    1. Hi you don't have a question here but let me offer these comments. Based on the elevated LH/FSH ratio, you probably have PCOD and that is why your doctor is using Clomid and Metformin. However, you do not have insulin resistance so the Metformin is probably not necessary (besides the usual treatment dose is 1500 mg per day).

      Clomid can be used up to 250 mg for five days. But, your doctor needs to use ultrasound surveillance to determine if you are responding to any dosage given. If he/she is not, then you are wasting cycles.

      Your prolactin is slightly elevated and I would recommend a fasting prolactin to double check it.

      I presume that your blood tests were done on either cycle day #2 or 3 of the cycle. If not, then they were not done at the correct time and should be repeated.

      Finally, if it has been 1.6 years without pregnancy, you shold see an infertility specialist. You can find one by asking a simple question: "do you do IVF." If they say "no", then he/she is not an infertility specialist.

      Delete
  3. Hi,
    I have one fallopian tube closed (the left ), can I do IUI and what is the success rate?
    If my prolactin hormone is high can I do IUI or IVF or it interferes with them ?
    Tank you.

    ReplyDelete
    Replies
    1. Hello, You certainly can try IUI but the chances of pregnancy would be decreased because of the possibility that even though the right tube is open, it may be damaged. Often, the event that causes a tube to become blocked affects both sides but just did not damage the tube enough to block it. If the internal structure of the tube (cilia) are damaged, even if the tube is open, it will not work or your chances of a tubal pregnancy would be greatly increased.

      As mentioned in this blog subject, an elevated prolactin can prevent pregnancy so it needs to be treated regardless of doing IUI or IVF.

      Delete
  4. Hi

    I'm 30 yrs of age and have been trying to conceive for 3 yrs. We are having our first cycle of icsi next month, (male factor). I have high prolactin levels (834 mU/L). I get some breast milk discharge when I squeeze my nipple. My fertility clinic don't seem to think it's a problem, but I'm really concerned it will affect our cycle. Can you pls advise what I should do, will our success rate be affected? Many thanks.

    ReplyDelete
    Replies
    1. This is a very high prolactin level and could indicate a pituitary tumor. I would postpone your fertility treatment for now. That needs to be addressed first. In some cases, surgery might be required. Pituitary tumors are right behind the bridge of the nose and can lead to headaches and vision changes. Please see a Medical Endocrinlogist ASAP! From a fertility point of view, the elevated prolactin will absolutely affect your chances of pregnancy in a negative way. Based on what you've told me, I would also advise that you seek out some competent doctors to care for you because your doctors are NOT doing a good job.

      Delete
  5. Hello Dr. Ramirez.

    I have failed few rounds of IVF transfers. I recently did the prolactin test and it was at 30 ng/ml.
    Could this be the reason of the failure of IVF in my case.
    I also have hashimotos and i am taking 125 mcg of thyroxine.
    I have failed total 4 transfers and we can't understand why are the cycles failing.

    ReplyDelete
    Replies
    1. Yes. Both an elevated prolactin and thyroid problems can cause pregnancy failure or miscarriages. A prolactin level of 30 should be rechecked as a fasting prolactin level to verify that it is elevated. If it is still above 20, then it should be treated with bromocriptine (Parlodel).

      Delete
  6. Thank You Sir.

    I have recently started the meds to lower the prolactin .
    Also, would like to ask you whether elevated prolactin also causes the endometrial lining to not grow sufficiently?
    In my IVF cycles, the thickness never got higher than 7 mm and I have never taken meds for high prolactin during the cycles.

    ReplyDelete
    Replies
    1. No an elevated prolactin would not interfere with endometrial lining development, but can interfere with ovarian stimulation and implantation.

      Delete
  7. Dr. Ramirez,

    First I wish to thank you so much on behalf of myself and all the women out here that appreciate so much the clinical/medical information that you provide. As you know healthcare is a complicated world and when it comes to specialty care like IVF it gets even more tangled. Not all physicians are good communicators or take the time to figure out how to explain the information in a manner that is clear to patients and sometimes patients are afraid to ask questions. So, I thank you.

    My question for you is as follows:

    Since I'm doing a Donor IVF treatment cycle, so far I have been suppressed on Day 1 of my period on July 2nd and then started Estradiol tabs for uterine lining on July 4th. It is now July 14th and I checked my levels of Estradiol and it is currently 266 as of tomorrow so that part is okay but could be better.

    Now my concern is that I checked my Prolactin level also with my recent hormone checks and it is elevated at 31.

    I am scheduled to travel to Europe to do the treatment:
    Plan to do uterine lining scan on July 21.
    Start Progesterone shots on July 21st.
    Do embryo transfer on July 27th.

    My doctor is recommending starting me on Bromocriptine and still move forward with the treatment plan as directed and remain on Prolactin for some time.

    Will starting Prolactin now cause me to start my period or interfere with the suppression drug I already took? Please advise.
    Thank you so much.

    ReplyDelete
    Replies
    1. Hello,

      Your prolactin is elevated and needs to be suppressed. So, your doctor is correct about starting on Bromocriptine. It will not cause you to have a period or interfere with the medications you are on.

      I am a little confused about your treatment plan, however. If you go to Europe on 7/21 and start progesterone on that day (which is the medication that sets the transfer date), what happens if your lining is not adequate when you get there? Are they going to postpone the transfer to allow the lining to get thicker?

      As an example, I usually will check my recipients on cycle day #9. If the lining is adequate at that point, then we proceed as schedule in which case the progesterone sets the date for transfer (4 days prior to ET if D#3 embryos or 6 days prior to ET if D#5 embryos). If the lining is not ready, I increase the estradiol and recheck the lining again 3 days later.

      Delete
  8. Dr. Ramirez

    I just want to ask some important question, I had been on ivf treatment last month but unluckily it was unsuccessful. My treatment started on the 2nd day of my period with injections.
    Before the treatment started I told to my physician about my history that for 2 months my period becomes irregular and previously I had high prolactin level which is 55ng/ml and my previous physician put me on dostinex.

    My physician didn't order for hormonal test and sperm analysis. He continued the treatment. Before egg retrieval he order for blood test to check my cbc and for hepa b, c and hiv and turns to be negative.

    After long waiting for beta hcg test. The period came on the exact day of my LMP.
    and he didn't even say anything. We went to my previous physician on the 2nd day of my period where she checked my prolactin and it was 62ng/ml.
    My question is could it be implantation of 3 grade a embryo was not successful due to high prolactin level without medication.

    Thank you so much and it will be great help.

    ReplyDelete
  9. Hello Doctor,
    Im 24 years old. While checking prolactin, i found that I'm having high level of prolactin of 35. Will it cause infertility?

    ReplyDelete
    Replies
    1. An elevated prolactin can have an effect on the chances of pregnancy. You should have it redone as a fasting level. If the level is still over 20, then an evaluation of the pituitary gland should be done.

      Delete
  10. Hello I just had a frozen egg transfer on the 28 of January 16 which failed, I did a blood pregnancy test on Tuesday 9th and stop the oestrogen (8mg) and Progesterone support that day. On my day one period 13 th of February 16 I run different hormones test by myself and I found out a very high level of Prolactin 2199 mIU/L when normal range is (102-496).
    First I am a bit concerned by this high level of Prolactin and second this was my number 4 failed transfer of grade 1 quality embryos and first as a frozen cycle, do you think that not monitoring the Prolactin level and ended up with that high level of Prolactin could explain my failed implantation and actually all those failed implantation ? Thank you in advance for your answer

    ReplyDelete
  11. Sir i m 40 and i have a high level of prolactin of 34...can i concieve??

    ReplyDelete
  12. Hello Dr.Edward ramirez,
    my age is 29 and i am trying to conceive for 8 months
    I had my blood test done on day 3 and day 21 results as below
    Day 3
    FSH:5.7 IU/L
    LH:5.3 IU/L
    Oestradiol:132 pmol/L
    Prolactin:659 mIU/L

    Day 21
    Progesterone:1.2 nmol/L

    The above cycle was quite long of about 42 days. Usually I have 30-35 days cycle
    so I assume that the day day 21 progestron was low coz i ovulated very late in this cycle.


    My prolactin levels are high, could this be the reason for not conceiving?

    ReplyDelete
  13. Hello doctor.. I did my embryo transfer 4days ago and I'm currently on folic acid, progynova, vasoprim, cyclogest pessary and bromergon but I'm worried about the bromergon hope it won't interfere with that success of the ICSI

    ReplyDelete

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