Prolactin Levels and Its Impact on Your Fertility

A serum prolactin test is a simple blood test, used to measure the levels of prolactin in the blood. Normal level of prolactin is less than 25 ng/mL in females and less than 17ng/mL in males.

Prolactin serum test is used to diagnose problems like:

• Prolactinoma (a non-cancerous tumour of the pituitary gland)
• Fertility related problems in men like erectile dysfunction and reduced sex drive
• Fertility related problems in women like menstrual irregularities
• Production of breast milk in non-pregnant women and men. This condition is called as galactorrhea [2]

If you have any symptoms related to infertility or prolactinoma (non cancerous tumor of pituitary gland) you may need a prolactin test. Symptoms can be caused by the growth of a tumour or by the hormones produced by a tumour in the body. If you are a woman you may need a prolactin test if you have the following symptoms,

• As a fertility test, if you are not able to conceive naturally
• If you are suffering from irregular menstruation
• If you are producing milk or nipple discharge without childbirth
• If you have visual impairment and unexplained headaches

If you are a man you may need a prolactin test if you show the following symptoms:

• Erectile dysfunction
• Reduced sex drive or any other fertility issues
• Impotence in men
• Abnormal nipple discharge
• Visual impairment, unusual headaches

Serum prolactin test is a simple blood test. The blood sample is collected in the morning, within three to four hours of waking up. The doctor will collect a small blood sample from the veins of the arms, with a help of a needle. You might feel a sharp pinch at the time of sample collection. You will be allowed to go home right after the test is done.

The prolactin level changes throughout the day and is maximum at morning, so, your doctor will advise you to take the test in the morning. As it is a simple blood test, you don't have to do any preparations. The doctor will let you know if you have to stop eating or drinking a couple of hours before the test.

The prolactin test cost in India ranges between Rs 300/- to Rs 700/- depending on the city or location where you live.

Prolactin test results may vary depending on age, gender, health conditions and if you are pregnant. You can expect the prolactin test results within 24 to 36 hours after given the sample. As mentioned earlier, the prolactin test measures the level of prolactin in your blood. The level of prolactin can help your doctor diagnose various health problems.

The normal levels of prolactin in ng/mL (nanograms per millilitre) are:

There is usually no concern if a man or a woman has low levels of prolactin. But if the prolactin test results come high then there are a series of health issues it can indicate.

High levels of prolactin (also known as hyperprolactinemia) are prevalent among 10% of the population. High prolactin levels are common among pregnant women and during the period they are nursing the baby. However, high levels of prolactin can also be caused by the following conditions-

• Pituitary tumours (prolactinoma)
• Anorexia nervosa- Is an eating disorder causing people to obsess about weight gain and what they eat.
• Hypothyroidism (the condition in which thyroid gland does not make enough thyroid hormone in human body)
• Disease of an area of the human brain called the hypothalamus
• Kidney or liver disease

Furthermore, there are some medications whose prolonged consumption may also result in high prolactin levels. Medications like haloperidol, risperidone and metoclopramide can also cause the prolactin levels to increase. Spices like red clover and fenugreek are also known to increase prolactin levels. Hence if you have high levels of prolactin, you may try to avoid these spices.

Abnormally high prolactin levels can cause fertility issues or delay in conception. If your results show high prolactin levels in your blood, your doctor may suggest you to go for an MRI (magnetic resonance imaging) test to get a closer look at your pituitary gland. High prolactin levels (PRL) may be treated with medicinal treatment or surgery. If you have questions about your results, talk to your doctor.

High prolactin level in women can cause fertility issues. As discussed earlier, women who are not pregnant or breastfeeding should have low levels of prolactin hormone. Unfortunately, due to certain medical conditions the serum prolactin level may increase causing hyperprolactinemia (high level of prolactin in blood). High levels of prolactin hormone in women can cause ovulation problems ranging from irregular ovulation to no ovulation at all. If the prolactin level is not very high, it will disturb the ovulation only once in a while causing delay in conception but if the prolactin level is very high, the woman may not even ovulate (anovulation). In such cases women will not have menstruation and will not be able to conceive naturally.[3].

Furthermore, it has been found that mild levels of prolactin in women (between 25-50 ng/mL) may not cause any visible symptoms like irregular periods but it can still affect her overall infertility.

Prolactin levels between the range of 50-100 ng/mL can result in irregular periods and may also significantly decrease a woman's fertility. Higher prolactin levels over 100 ng/mL may also alter the overall function of a woman's reproductive system causing early menopause and infertility [4].

Hyperprolactinemia can cause infertility in male. Hyperprolactinaemia, both directly and indirectly, has a negative effect on sperm production of male.[5] It may cause also galactorrhea (nipple discharge), reduced sex drive and impotence (not able to have an errection or erection problem). Many studies also suggest that It can result in irreversible infertility in men, however, more research is needed to support this claim [6].

The high levels of prolactin can be treated with the help of medications. Parlodel and Cycloset are the most common medications for high levels of prolactin. They can also help in shrinking the prolactinoma tumours.

Apart from the two medications mentioned, there are many other medications for this condition. Your doctor will describe the entire course and type of medication once your prolactin test results come back.

First your doctor will start you on a low dose of one of these medications and slowly increase the dose until your prolactin level comes back to normal. Treatment continues until your symptoms lessen or you get pregnant, if you are planning for pregnancy. Usually, your doctor will stop medication once you get pregnant.

In some cases, a patient might not respond to the medications. If that is the case, your doctor may suggest radiotherapy to reduce prolactin levels or prolactinoma. If radiotherapy fails you may have to go through surgery. The surgery can be of two types depending on how severe the tumour is [7].

• Nasal Surgery: This surgery is done through the nose. The complications in this surgery are very rare. It doesn’t leave any scars.

Transcranial surgery: This surgery is done through the upper part of the skull. It is usually performed if the tumour is big.

There are some measures that you can take at home to manage your prolactin levels. Some of them are:

• Prolactin is a stress hormone and being in stress may result in high levels of prolactin. Hence try to create a stress free environment around yourself. Prefer adding yoga or meditation in your daily routine.
• Heavy workout and high intensity activities can also increase the prolactin levels hence try to avoid them.
• Avoid doing any activities that can overstimulate your nipples.
• Vitamin B6 is a proven remedy for lowering prolactin levels. You can add vitamin B6 rich foods like milk, egg, chicken liver, spinach, carrot, sweet potatoes, green peas, avocado in your daily diet.