are no data to suggest that breastfeeding leads to an increase in tumor size [13].
Key points
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.
Answers to questions patients ask
1 Q1 Why haven’t you checked my prolactin level before starting our IVF treatment? A1. You have regular periods, and if the prolactin is high it will make your periods irregular or absent. So, there is no need to check the prolactin in your case. Also, we know from studies that ovarian stimulation for IVF makes the prolactin slightly high, but that does not affect the success rate.
2 Q2 Will the treatment with dopamine agonists have any effect on the pregnancy or the baby? A2. There is a lot evidence confirming treatment with the dopamine agonists bromocriptine and cabergoline is safe for both mom and baby. The incidence of miscarriages, ectopic pregnancies or congenital malformations is no higher in mothers who got pregnant while taking bromocriptine or cabergoline than in the general population [1].
3 Q3 Will I be able to breastfeed? A3. In cases where treatment is stopped following conception, patients are able to breastfeed as normal, but not in cases where treatment is continued throughout pregnancy. There is no evidence to suggest that breastfeeding leads to an increase in tumor size.
References
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