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Hyperprolactinemia and Infertility

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Dr Muthu Kumaran Jayapaul, Chennai    20 November 2018

Pathological hyperprolactinemia may cause defective ovulation and reduced fecundability. Known physiological and pharmacological causes of hyperprolactinemia must be considered and a detailed medical history must be obtained. Abnormal prolactin (PRL) secretion is usually related to an idiopathic hypothalamic dysfunction or to the presence of a pituitary adenoma. Clinical examination and blood biochemistry, including tests for pregnancy and renal and thyroid function, are all important. It is also important to determine the serum FSH in order to pick up an unknown primary ovarian insufficiency in the women seeking pregnancy.

Hyperprolactinemic anovulation – Diagnostic work-up: Measure TSH, T3 and T4 (to exclude hypothyroidism); Among women with menses, measure PRL and progesterone in the supposed luteal phase (during at least 2 cycles); Among women with oligomenorrhea, measure FSH and PRL on two different occasions; MRI to be performed in all hyperprolactinemic women. For a reliable study of the abnormal luteal phase, repeated post-ovulatory plasma progesterone assays and the precise measurement of the luteal phase length are the key to treatment.

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