Subfertility Clinical Trial
Official title:
A Retrospective Cohort Study of Hyperprolactinaemia Management in Reproductive Services at University Hospital of Coventry and Warwickshire (UHCW)
Hyperprolactinaemia and thyroid disorders can significantly reduce fertility by causing
ovulatory dysfunction. There is no evidence to suggest treatment of hyperprolactinaemia in
the presence of regular ovulatory menstruation will improve fertility. However, anecdotal
observation of practice at UHCW NHS Trust suggested that dopamine agonists are often
prescribed irrespective of whether symptoms of hyperprolactinaemia are present.
The aim of the study was to establish the prevalence of hyperprolactinaemia and incidence of
subclinical hypothyroidism in patients undergoing subfertility investigations at UHCW NHS
Trust. Also, to examine management of patients with hyperprolactinaemia and a normal
pituitary MRI scan, and explore the trends in treatment; and finally, to explore how this
could improve reproductive services.
107 patients were identified as having a high prolactin reading between January 2014 and
January 2017. Hospital records were examined for patient demographics, relevant blood and
scan results, medical history, any treatment, and treatment outcomes.
The prevalence of hyperprolactinaemia was 23%. 20.6% of patients had suboptimal thyroid
function and were started on levothyroxine. Prolactin levels, and presence of relevant
symptoms, only had a partial bearing on whether dopamine agonists were used in those with
normal pituitary MRI results (or where no scan was performed). The use of dopamine agonists
appeared to correlate with assisted conception and a lower incidence of birth complications
(inc. miscarriage, prematurity), though the significance of this was limited by the size of
the dataset.
Dopamine agonists often appeared to be used in more complex patients, rather than exclusively
those with a higher prolactin reading and/or the presence of related symptomatology. Patients
frequently underwent a pituitary MRI scan in the absence of symptoms, contrary to evidence.
The findings suggest that less patients should be scanned and less treated with dopamine
agonists. A health economics evaluation study would be useful to elucidate the potential cost
saving this could represent. It may be better to prioritise optimisation of thyroid function,
particularly when noting the similarities in the prevalence of suboptimal thyroid function
and that of hyperprolactinaemia.
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