Infertility and Autoimmune Diseases – Hyperprolactinemia

Hyperprolactinemia is a known cause of infertility, and it is also one of several autoimmune diseases that have been identified as causes of recurrent IVF failure.

In this article, we find out what exactly hyperprolactinemia is and what causes it; which symptoms it produces and how it affects fertility in women and in men; as well as what treatment is available, especially if you are trying to conceive, whether naturally or through an assisted reproductive therapy (ART) such as IVF (in vitro fertilization).

The article below is based on a live webinar in which Dr Antonio Rodrigues, a reproductive medicine specialist and a founder and director of Medfem Fertility Clinic in Sandton, Johannesburg, South Africa, explained the impact of hyperprolactinemia on IVF success. You can also click here to watch the full hour-long webinar.

The two essential factors for a successful IVF cycle are: healthy embryos; and a hospitable uterine environment in which embryos can implant successfully.

Too much prolactin – or hyperprolactinemia as it is called in medical terms – negatively affects both these necessities for a healthy pregnancy.

What Is Prolactin?

Prolactin is one of four hormones that are critical for falling pregnant. It is produced in the pituitary gland, where the other three critical hormones – follicle stimulating hormone (FSH), luteinizing hormone (LH) and thyroid stimulating hormone – also originate.

Prolactin is a hormone naturally produced by a woman’s body when she is pregnant and breastfeeding. So, under normal circumstances, prolactin will go up only when a woman is pregnant, and when she is breastfeeding, it goes up very high. This is because prolactin acts like a natural contraceptive that ensure women who are pregnant and breastfeeding have a low fertility rate.

However, prolactin levels can also be raised in men.

Generally, people don’t have prolactin levels that are too low. The levels can, however, fluctuate and have a negative effect on the body and on fertility.

So, what could cause prolactin to be elevated in women who are not pregnant or breastfeeding, and in men? There are four known factors in this respect.

The first is stress. In both men and women, stress plays a big role. In addition, there is a correlation between high prolactin and the patient having underlying endometriosis.

Secondly, certain medications can cause raised prolactin levels. These include psychiatric drugs and, notably, antidepressants. However, any central nervous system drugs such as ADHD or anxiety medication will also impact prolactin levels. Fertility patients who are taking such medications should ensure their prolactin levels are checked and controlled.

Thirdly, scaring in the breast area can also promote high prolactin levels.

Lastly, another cause of very high prolactin levels is a prolactin tumour in the pituitary gland. This is not a common cause, but among patients who have such a tumour, prolactin levels can be as much as 45 times higher than normal. The treatment is usually medical.

What Are The Symptoms?

The most common symptoms hyperprolactinemia produces are headaches, breast tenderness and a milky discharge or secretion from the breasts.

Hyperprolactinemia is a known cause of infertility and is also one of several autoimmune diseases that have been identified as a cause of recurrent IVF failure.

How Does Prolactin Affect Fertility in Men and Women?

As mentioned, the majority of failed IVF treatments are related to abnormal embryos and an inhospitable uterine environment which prevents embryos from implanting. The same is true for failed natural conception or other assisted reproductive therapies.

Too much prolactin – or hyperprolactinemia as it is called in medical terms – negatively affects the quality of the embryos and the uterine environment – both necessities for a healthy pregnancy.

For healthy embryos, healthy eggs and healthy sperm are required.

In reality, healthy eggs are not the norm, even in healthy women and men. In fact, under usual circumstances, an astounding 60% and more of a women’s eggs are abnormal. The same applies to men: large amounts of abnormal sperm are found in every semen sample. Autoimmune conditions such as hyperprolactinemia will further reduce the possibility of producing healthy eggs and healthy sperm.

The correct levels of prolactin – in both the male and female partner – are critical for healthy sperm and healthy eggs, and therefore for healthy embryos.

In women, raised levels of prolactin changes FSH and LH levels, results in irregular menstruation or a lack of ovulation, as well as poor eggs and embryos.

Prolactin levels can also be raised in men, and this causes abnormalities in the semen, such as lower sperm motility counts.

For a hospitable uterine environment, a thick and nutrient dense uterine lining is required. Raised prolactin levels also cause problems in terms of thinning in the lining of the uterus.
From a fertility point of view, to achieve a pregnancy and ensure a healthy embryo, the prolactin levels in both partners must be checked and corrected, even if these levels are only marginally raised.

Correctly treating prolactin levels will ensure chromosomally normal embryos that have a good chance to implant in a hospitable environment in the uterus.

Fertility Treatment For Hyperprolactinemia

The good news is that treatment for hyperprolactinemia is really simple – even if you are trying to conceive.

At Medfem Fertility Clinic, we use what is called dopamine agonists (DA). These are medications that work by imitating the actions of dopamine when levels of dopamine are low. These medications improve condition-related symptoms by making the brain think dopamine is available. Acting like dopamine, the dopamine agonists start to inhibit the prolactin and the physical environment returns to normal.

In cases where high prolactin levels are the result of a prolactin tumour in the pituitary gland, the treatment is usually medical.

Patients who experience headaches and other symptoms should seek medical advice and we believe that any couple who are planning IVF treatment should have prolactin levels checked as standard procedure.

Autoimmune diseases like hyperprolactinemia have a significant role to play in the quality of the embryos and the uterine environment, the likelihood of recurrent IVF failures can be reduced by addressing autoimmune diseases prior to IVF treatment to ensure both healthy embryos and a healthy womb.

For this reason, our team at Medfem Fertility Clinic goes to great lengths to ensure we cover every eventuality to ensure you have a positive outcome. Understanding the impact of autoimmune diseases on IVF success rates, we test both male and female partners for autoimmune diseases and aggressively manage these issues before any IVF treatment commences, to ensure the highest chance of conception.

At Medfem Fertility Clinic we believe in making world-class fertility treatments available for everyone. It is our joy and commitment to give you a positive outcome to your fertility journey, so you will have a fond memory of feeling empathy, caring and being part of the Medfem Fertility Clinic family.

If you would like to know more about hyperprolactinemia and its effect on fertility, or if you are concerned that you have an autoimmune disease that is affecting or could affect the success of your IVF treatment, we would be happy to answer your questions.

To meet one of our fertility specialists at Medfem Fertility Clinic, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

We look forward to meeting you!



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