High Prolactin and Hyperprolactinemia Infertility

What Is Prolactin?
Prolactin is a hormone produced by the pituitary gland, a small gland located at the base of the brain. Its primary role is to promote breast development and milk production in women after childbirth. However, prolactin isn’t just limited to reproductive functions—it also plays a role in regulating immune function and metabolism, even in men.

Under normal circumstances, prolactin levels in the blood remain relatively low in both men and non-pregnant women. The body increases prolactin secretion primarily during pregnancy and breastfeeding, which is when its function becomes critical. But when prolactin levels are abnormally high in individuals who are not pregnant or nursing, this condition is called hyperprolactinemia.

Does a High Prolactin Level Cause Infertility?
Yes, it absolutely can. Elevated prolactin levels can interfere with the reproductive system in both women and men. While the effects are more frequently diagnosed in women, men can also experience fertility problems tied to hyperprolactinemia.

In Women
High prolactin levels can disrupt the normal function of the ovaries. Here’s how:

1. Suppressed ovulation: Prolactin inhibits the secretion of gonadotropin-releasing hormone (GnRH), which reduces levels of the key reproductive hormones LH and FSH. These hormones are essential for ovulation. Without ovulation, there’s no egg for fertilization.
2. Irregular or absent periods: Many women with hyperprolactinemia experience amenorrhea (absence of periods) or oligomenorrhea (infrequent periods), making it difficult to conceive naturally.
3. Low estrogen levels: As prolactin increases, estrogen can decrease, leading to vaginal dryness, mood changes, and a disrupted menstrual cycle—all of which compound fertility issues.

In Men

Though less common, high prolactin in men can lead to:

4. Decreased libido
5. Erectile dysfunction
6. Low testosterone levels
7. Decreased sperm production
8. Gynecomastia: Men may also develop breast tissue growth, which is another red flag for hormonal imbalance.

Causes and Diagnosis

What causes hyperprolactinemia?

• Pituitary tumors (prolactinomas)
• Certain medications (antipsychotics, antidepressants, blood pressure meds)
• Hypothyroidism
• Chest trauma or irritation
• Chronic stress

How is it diagnosed?

Diagnosis typically involves blood tests to measure prolactin levels and imaging studies, like an MRI, to rule out pituitary abnormalities.

Treating High Levels of Prolactin

Medical Treatment

The first-line treatment for high prolactin is usually dopamine agonists—medications that mimic dopamine, a brain chemical that naturally inhibits prolactin production.

• Cabergoline: Preferred due to fewer side effects and longer half-life. It's taken once or twice weekly.
• Bromocriptine: An older option, taken daily, and more likely to cause nausea and dizziness.

These medications not only lower prolactin levels but can also shrink prolactin-producing tumors, improving both hormone balance and fertility outcomes. If a prolactinoma is resistant to medication, surgery may be necessary, although this is rare.

Treating Underlying Conditions

Sometimes, hyperprolactinemia is secondary to other conditions—like hypothyroidism. In such cases, treating the thyroid disorder (usually with levothyroxine) can bring prolactin levels back to normal without the need for dopamine agonists.

In drug-induced cases, a doctor may adjust the current medication if clinically appropriate. Never discontinue prescribed meds without medical supervision.

Lifestyle and Monitoring

Although lifestyle changes alone won’t normalize prolactin levels caused by tumors or endocrine disorders, managing stress and getting enough sleep may help improve hormone regulation. Regular follow-ups with an endocrinologist are crucial to track hormone levels and overall health.

Resources

For additional official resources on hormone health and pituitary disorders, the following U.S. government websites provide up-to-date and medically reviewed information:

https://www.nih.gov
https://www.cdc.gov
https://www.ninds.nih.gov
https://medlineplus.gov

Conclusion

Hyperprolactinemia is a common but often overlooked cause of infertility in both women and men. Fortunately, it is also one of the most treatable causes. The key is early diagnosis, appropriate testing, and individualized treatment, which can restore hormonal balance and significantly improve fertility outcomes.

Whether you're planning to conceive naturally or exploring assisted reproduction options—such as IVF or surrogacy—knowing your prolactin levels is a crucial part of your reproductive health puzzle.

If you suspect symptoms or are struggling to conceive, talk to a healthcare provider and get tested. When managed correctly, high prolactin doesn't have to be a permanent obstacle on your fertility journey.