The influence of transient hyperprolactinemia on hormonal parameters, oocyte recovery, and fertilization rates in in vitro fertilization
A detrimental effect of transient elevation of plasma prolactin (PRL) during in vitro fertilization (IVF) has not been proven; however, treatment with a dopamine agonist has been suggested. The present study was undertaken to determine if transient, midcycle hyperprolactinemia exerted a deleterious effect on the number of oocytes retrieved or on fertilization of oocytes in vitro. Fifty-three infertile patients with midcycle hyperprolactinemia (PRL>20 μg/liter) during ovarian hyperstimulation for IVF were compared with 53 matched controls who remained normoprolactinemic. Mean (±SE) serum PRL levels on the day after hCG were significantly higher in the study group (29.5±1 μg/liter) than in the control (13.1±0.5 μg/liter) (P<0.0005), whereas the mean estradiol (E2) concentrations on the same day were not significanily different (4822±287 and 4492±269 pmol/liters, respectively). Fertilization rates (72±4 and 70±4%, respectively) and the mean number of oocytes recovered (4.2±0.3 and 3.7±0.3, respectively) did not differ between the two groups. No correlation was observed between serum PRL and E2 levels, fertilization rates, or the number of oocytes retrieved in either group. Eleven patients with elevated PRL levels as a result of ovarian hyperstimulation were treated with 2.5 mg bromocriptine daily during the next IVF cycle. Serum PRL levels were significantly lower in the treated (5.6±1.8 μg/liter) than in the untreated cycles (35.6±3.1 μg/liter) (P<0.0005), whereas serum E2 concentrations did not differ. Although the mean number of oocytes recovered was significantly higher in the treated (6.2±1.1) than in the untreated (4.7±0.7) (P<0.02) cycles, the fertilization rates were significantly lower when the patients were treated with bromocriptine compared with the previous untreated cycle (55±8.0 and 76.5±7.0%, respectively;P<0.05). Our data demonstrate that a transient elevation of PRL during ovarian stimulation for IVF does not adversely affect the endocrine response, number of oocytes retrieved, or fertilization rates. No improvement in these parameters was observed in bromocriptine-treated cycles. These results do not support the treatment of transient hyperprolactinemia with dopamine agonists in IVF patients.
Key Wordsprolactin bromocriptine ovarian stimulation oocyte recovery fertilization
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