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

http://www.montereybayivf.com/

Monterey, California, U.S.A.

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