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Infertility

Prolactin and Luteal Phase Defect

12/29/2008

Question:

I recently was told that I have a LPD. After having u/s done around ovulation time I have been told that I do not make a mature follicle. (Estradiol = 81 and follicle of 16 day of ovulation). I have been lactating for no reason for 15 months now - exactly the amount of time I have been experiencing infertility. (I used to experience multiple chemical pregnancies, but was told they were due to a balanced translocation I carry. We have one healthy 3yo.) I am now starting bromocriptine even though when my prolactin was checked twice in the last 1.5 yrs. it was normal. They are also rechecking prolactin and thyroid. Could the lactation whether the prolactin is elevated or not be causing the LPD? Or is the LPD causing the lactation? Or is it just a coincidence that I have both going on? Thank you for your time.

Answer:

The usefulness of bromocriptine treatment in patients with normal menstrual cycles, as well as normal prolactin levels in unclear.  If there were definite concerns about an LPD, it might be appropriate to use progesterone supplementation following ovulation.  If a patient were found to have a "low" progesterone level following ovulation, another option would be to use fertility pills to stimulate the ovaries to increase these levels. 

In patients who have persistent galactorrhea (lactation), I do not usually treat them unless they have elevated prolactin levels coupled with irregular periods or if the breast secretions are bothersome.  The LPD would not cause galactorrhea.

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Response by:

Daniel B Williams, MD Daniel B Williams, MD
Formerly:
College of Medicine
University of Cincinnati