High Prolactin Levels and Infertility: Seeking Guidance for Pregnancy Challenges

Infertility for over a year with elevated prolactin levels?

I have several questions for the doctor and hope you can help me.
I had a blood test at the hospital, and my prolactin level seems to be 23.6 (or 25.6), but I'm not sure.
The doctor prescribed medication to lower my prolactin levels.
I have undergone a hysterosalpingography, which showed no issues.
Here are my questions:
1.
Is my prolactin level considered high or just slightly above the normal range?
2.
If I don't take the medication, will it affect my ability to conceive? My menstrual cycle is consistently between 33 to 38 days.
When I take ovulation medication, the cycle shortens a bit, but after a while, it gets longer again.
Is this related to high prolactin levels?
3.
I had six follicles observed during the ultrasound while taking ovulation medication, and the ovulation test strips showed positive results.
Does this mean I definitely ovulated? (I did not take the medication to lower prolactin during this time.) Is there a high chance of a "false positive"?
4.
My husband has diabetes, which has affected his sexual function.
He had a semen analysis done, showing a count of 17 million with 85% motility.
However, he had taken a supplement before the test, so I'm unsure if his motility and count would decrease without it.
5.
The doctor who examined me does not recommend artificial insemination, stating that the success rate is similar to natural conception.
However, doesn't artificial insemination involve selecting sperm and directly placing it into the uterine cavity? Given my husband's sperm condition, wouldn't the chances of conception be higher than with natural conception if the sperm are placed directly into the uterus?
6.
When the doctor advised against artificial insemination, I felt lost and left the office in tears.
I really don't know what to do.
Should I go straight to in vitro fertilization? However, the cost is quite burdensome.
Should I patiently take the medication to lower prolactin for another month and try natural conception, and if that doesn't work, consider another clinic for artificial insemination? I would appreciate any guidance you can provide.

Youyu, 30~39 year old female. Ask Date: 2008/07/16

Dr. Zhuang Zhijian reply Obstetrics and Gynecology

Hello, thank you for your inquiry.
I would like to respond to your questions and provide the following suggestions: Generally speaking, based on your concerns, I sincerely recommend that you visit an obstetrics and gynecology clinic for further examination and consultation with your physician.
This will allow for a more in-depth investigation and discussion of the relevant issues.
As for your husband, it is advisable to manage his blood sugar levels effectively and follow up with a urology clinic.
Lastly, I wish you peace and happiness!

Reply Date: 2008/07/16

More Info

High prolactin levels can indeed pose challenges for fertility, and it's understandable that you're seeking guidance on this matter. Let's break down your questions and concerns regarding your situation.

1. Prolactin Levels: Normal prolactin levels typically range from 5 to 25 ng/mL, but this can vary slightly depending on the laboratory and the specific assay used. A level of 23.6 or 25.6 ng/mL is on the higher end of the normal range, but it may not be significantly elevated. However, if your doctor has prescribed medication to lower your prolactin levels, it suggests that they believe your levels may be contributing to your fertility challenges.

2. Impact on Pregnancy: Elevated prolactin can interfere with ovulation and menstrual cycles, potentially leading to irregular periods and difficulty conceiving. If left untreated, high prolactin levels could hinder your chances of becoming pregnant, especially if they are affecting your ovulation. It’s essential to follow your doctor’s advice regarding medication, as lowering prolactin levels can help restore normal ovulation.

3. Ovulation Confirmation: The presence of multiple follicles and positive ovulation test results generally indicates that ovulation is likely occurring. However, the quality of the eggs and the overall hormonal environment are also crucial factors. Even with multiple follicles, there is a possibility of anovulation (not releasing a viable egg), which can lead to a "empty follicle" situation, often referred to as a "empty follicle syndrome." Monitoring your menstrual cycle and any symptoms of ovulation can provide additional insights.

4. Partner’s Fertility: Your husband’s diabetes and its impact on his sexual function can complicate matters. The sperm count of 17 million with 85% motility is within a reasonable range, but factors like recent supplementation (like the shellfish extract) can affect sperm parameters. It’s advisable for him to have a semen analysis done without any supplements to get a clearer picture of his fertility status.

5. Artificial Insemination vs. Natural Conception: While artificial insemination (IUI) does allow for the selection of healthier sperm and can increase the chances of conception, it is not a guaranteed solution. The success rates can vary based on multiple factors, including the underlying fertility issues of both partners. If your doctor believes that natural conception is feasible, it may be worth trying for a few more cycles, especially if your prolactin levels are managed.

6. Next Steps: It’s understandable to feel overwhelmed and emotional about your situation. If your doctor is not recommending artificial insemination, it may be beneficial to follow their advice and try natural conception after addressing your prolactin levels. If you find that you are not successful after a reasonable period, seeking a second opinion from another fertility specialist could provide you with more options, including the possibility of exploring IVF if that becomes necessary.

In conclusion, managing your prolactin levels is crucial for improving your chances of conception. Continue to work closely with your healthcare provider, adhere to the prescribed treatment, and monitor your progress. If needed, don’t hesitate to seek additional opinions or support from fertility specialists who can guide you through this challenging journey. Remember, emotional support is also vital during this time, so consider reaching out to support groups or counseling services if you feel overwhelmed.

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