Hyperprolactinemia and infertility in male and female

Year 2025, Volume: 42 Issue: 1, 80 - 86, 28.03.2025

Abdulaziz Abouhosa , Layan Ghunaim , Ahmed Oudah , Hasan Faraj , Nur Dokuzeylül Güngör

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

References

• 1. Ioachimescu, A. G., Fleseriu, M., Hoffman, A. R., Vaughan III, T. B., & Katznelson, L. (2019). Psychological effects of dopamine agonist treatment in patients with hyperprolactinemia and prolactin-secreting adenomas. European Journal of Endocrinology, 180(1), 31-40.
• 2. Nass, R., & Evans, W. S. (2019). Physiologic and pathophysiologic alterations of the neuroendocrine components of the reproductive axis. In Yen and Jaffe's Reproductive Endocrinology (pp. 473-519). Elsevier.
• 3. Samperi, I., Lithgow, K., & Karavitaki, N. (2019). Hyperprolactinaemia. Journal of Clinical Medicine, 8(12), 2203.
• 4. O'Leary, K. (2020). Hyperprolactinemia: Effect on reproduction, diagnosis, and management. In Textbook of Assisted Reproduction (pp. 141-148).
• 5. Azeez, T. A. (2020). Hyperprolactinaemia in men: A review of clinical presentation, diagnosis, and treatment. Journal of Clinical Case Studies Reviews & Reports, 140 (2), SRC/JCCSR-170. [https://doi.org/10.47363/JCCSR/2020(2](https://doi.org/10.47363/JCCSR/2020(2)).
• 6. Badesara, S., & Jakhar, K. (2020). A cross-sectional study to find the prevalence of hyperprolactinemia in infertile euthyroid patients in a hospital. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 9 (11), 4394-4398.
• 7. Hiperprolaktineminin, Ü. B. B. E. K. (2020). Clinical profile and changing etiological spectrum of hyperprolactinemia at a tertiary care endocrine facility. Turk J Endocrinol Metab, 24, 308-313.
• 8. Auriemma, R. S., Del Vecchio, G., Scairati, R., Pirchio, R., Liccardi, A., Verde, N., ... & Colao, A. (2020). The interplay between prolactin and reproductive system: Focus on uterine pathophysiology. Frontiers in Endocrinology, 11, 594370.
• 9. Dehghan, E., Namiranian, N., Ghadiri-Anari, A., Ratki, S. K. R., & Azizi, R. (2021). Evaluation of hyperprolactinemia risk factors in infertile women referred to Yazd Infertility Center: A cross-sectional study. International Journal of Reproductive BioMedicine, 19(12), 1085.
• 10. Chen, T. Y., Lee, C. H., Yang, M. Y., Shen, C. C., Yang, Y. P., Chien, Y., ... & Cheng, W. Y. (2021). Treatment of hyperprolactinemia: A single-institute experience. Journal of the Chinese Medical Association, 84 (11), 1019-1022.
• 11. Glezer, A., & Bronstein, M. D. (2022). Hyperprolactinemia. In Endocrinology and Diabetes: A Problem-Oriented Approach (pp. 47-54).
• 12. Maiter, D. (2022). Mild hyperprolactinemia in a couple: What impact on fertility? Annales d'Endocrinologie, 83(3), 164-167. Elsevier Masson.
• 13. Petrini, A., & Chung, P. H. (2023). Hyperprolactinemia. In Problem-Focused Reproductive Endocrinology and Infertility (pp. 71-75). Cham: Springer International Publishing.
• 14. Iancu, M. E., Albu, A. I., & Albu, D. N. (2023). Prolactin relationship with fertility and in vitro fertilization outcomes—A review of the literature. Pharmaceuticals, 16(1), 122.
• 15. Urhan, E., & Karaca, Z. (2024). Diagnosis of hyperprolactinemia. Reviews in Endocrine and Metabolic Disorders, 1-9.
• 16. Varaldo, E., Cuboni, D., Prencipe, N., Aversa, L. S., Sibilla, M., Bioletto, F., ... & Grottoli, S. (2024). Are prolactin levels efficient in predicting a pituitary lesion in patients with hyperprolactinemia? Endocrine, 84(2), 670-676.
• 17. Russ S, Anastasopoulou C, Shafiq I. Pituitary Adenoma [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [updated 2023 Mar 27; cited 2025 Mar 19]. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK554451/](https://www.ncbi.nlm.nih.gov/books/NBK554451/)
• 18. Fukuhara N, Nishiyama M, Iwasaki Y. Update in pathogenesis, diagnosis, and therapy of prolactinoma. Cancers (Basel). 2022;14(15):3604. doi:10.3390/cancers14153604
• 19. Chanson P, Maiter D. The epidemiology, diagnosis and treatment of prolactinomas: the old and the new. Best Pract Res Clin Endocrinol Metab. 2019;33(2):101290. doi:10.1016/j.beem.2019.101290
• 20. Molitch ME, Drummond J, Korbonits M. Prolactinoma management [Internet]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000– [updated 2022 Jan 6; cited 2025 Mar 19]. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK279174/](https://www.ncbi.nlm.nih.gov/books/NBK279174/)