Hyperprolactinemia and infertility in male and female

Abstract

Hyperprolactinemia is characterized by elevated, often pathologic serum prolactin concentrations affecting the reproductive health of both men and women. Prolactin is a hormone the anterior pituitary gland produces that serves numerous reproductive functions. In elevated amounts, prolactin interferes with the hypothalamic-pituitary-gonadal (HPG) axis, causing reproductive dysfunction. In women, hyperprolactinemia manifests with irregular menstruation, anovulatory cycles, or galactorrhea, while in men, low libido, erectile dysfunction, or oligospermia may ensue. Such effects are often linked to infertility and impaired conception. Diagnosis begins with measuring prolactin levels in the serum to confirm hyperprolactinemia and MRI imaging for suspicion of pituitary adenomas, a common cause. Most cases could be managed by dopaminergic treatment, such as bromocriptine and cabergoline, to help restore gonadal function, while surgical intervention would be resorted to in cases of large or resistant prolactinomas. To effectively frame treatment approaches, one has to understand the pathology behind hyperprolactinemia and infertility. This review discusses the etiology, pathophysiology, clinical presentation, and management of hyperprolactinemia, focusing on its reproductive health and fertility consequences.

Keywords

• hyperprolactinemia
• prolactin
• hypogonadism
• prolactinoma
• gonadal
• dysfunction
• dopamine
• agonists

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