Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 142

Challenge: Hyperprolactinemia and ART treatment.

Background:

 Hyperprolactinemia inhibits ovulation, causing infertility.

 Treatment of hyperprolactinemia restores fertility.

 Transient hyperprolactinemia during ART is not clinically significant.

 Causes of hyperprolactinemia:Physiologic: pregnancy and lactation, macroprolactin, stress, excessive exercise, nipple stimulation.Pharmacologic: antipsychotics (phenothiazines, thioxanthenes, atypical antipsychotics); antidepressants (tricyclic antidepressants, monoamine oxidase [MAO] inhibitors, selective serotonin reuptake inhibitors [SSRIs]); gastrointestinal medications (metoclopramide, domperidone, cimetidine); antihypertensives (α‐methyldopa, reserpine, verapamil); estrogens; opioids.Pathologic (i) pituitary tumors; (ii) renal failure; (iii) primary hypothyroidism; (iv) polycystic ovary syndrome; (v) liver cirrhosis; (vi) chest wall lesions and trauma; (vii) idiopathic hyperprolactinemia.

Management of hyperprolactinemia:

 Treat the underlying cause.

 If safe, withdraw offending medication.

 Dopamine agonists for pituitary tumors.

 Surgery and/or radiotherapy if dopamine agonist resistance/intolerance.

 It is safe to continue with bromocriptine or cabergoline during an ART cycle and until a positive pregnancy test.

Pregnancy and breastfeeding:

 Monitor for pituitary tumor growth during pregnancy.

 Withhold dopamine agonists in women wishing to breastfeed.