Can high prolactin levels delay conception in women?

Question

Hello doctor,

Seven years ago, I got pregnant at the beginning of the year. After three months, I was admitted to the hospital five times for loose motion and vomiting two times. The diagnosis was primigravida with 12 weeks of pregnancy and AWD (abdominal wall defects). In the USG (ultrasound) report, missed abortion was mentioned.

After a day, D and C (dilation and curettage) were done successfully. After ten days, a follow-up was done. After a week, I did an ultrasound of the abdomen and other tests as per the doctor's advice. The USG findings showed that there was mild collection in the endometrial cavity.

After a month, the first menstrual cycle started. The second cycle started 41 days later, which was delayed compared to my usual cycle of 25 to 30 days. The subsequent three cycles came after 37 days, and one started after 30 days. In recent days, I started facing heavy bleeding during menstruation. There is weakness, motion sickness, low energy, poor appetite, and weight gain of four to five kilograms (9 to 11 pounds). There is also a loss of interest in sexual activities.

Now, I am willing to get pregnant. I am taking Folic acid one tablet in the morning; Nutriway multivitamin; Ostocal DX and Cabergoline 0.5 mg, one tablet a week for 12 weeks.

When will be the best time for me to conceive a baby?
Is my first abdominal USG report alarming? If yes, what to do?
Are high prolactin levels harmful for conception?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern. I have seen your reports (attachment removed to protect the patient's identity).

You have hyperprolactinemia, for which you have been taking medications. In the laboratory report, HSV1 (herpes simplex virus 1) IgG (immunoglobulin G) was high. It would be advisable to also test for HSV-1 IgM (Immunoglobulin M) to determine whether there is a recent or active infection.

It would be better if you tried to know the cause of high prolactin. It could be due to medications, antidepressants, hormonal imbalances, and space-occupying lesions in the brain. With high prolactin, other hormones get affected, and others can get reduced, so menstruation can be affected.

Have a proper consultation with an endocrinology specialist. Have an appropriate investigation for high prolactin. It might be possible that you would be advised to do a brain MRI (magnetic resonance imaging) to exclude space-occupying lesions. Have a proper treatment for prolactinemia. Menses should be regular. However, regarding the cause of hyperprolactinemia, it is essential to treat it, as I still do not know the cause of your case.

You can have combined oral contraceptive pills for three months cyclically to regulate your cycles. If you plan to have your period during this time, then conception will not be possible. It’s also essential to begin recurrent miscarriage investigations over the next three months, including a thrombophilia screen. If your pregnancy test comes back positive, you may need to start Aspirin or Heparin to support pregnancy viability. In the meantime, continue taking Folic Acid 5 mg daily, and make sure to undergo a complete check-up and get treatment for any existing health conditions.

Daily walking, exercise, and yoga are needed for a normal BMI (body mass index) and weight. Have food with less salt, sugar, oil, and spice. Avoid recreational activities and quit recreational drugs that you or your husband is taking substances such as tobacco, cocaine, ketamine, and alcohol, as these reduce fertility and can cause congenital anomalies in fetuses. As soon as pregnancy viability comes positive, you better consult a maternal medicine obstetrician to have Aspirin and Heparin as per your need and your investigations results, if thrombophilia is seen.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.