Hyperprolactinaemia Management in Reproductive Services at University Hospital of Coventry and Warwickshire
Hyperprolactinaemia Management in Reproductive Services at University Hospital of Coventry and Warwickshire
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.
Inclusion Criteria:

 -  Undergoing care through subfertility services at UHCW

 -  Referred and seen in subfertility services between January 2014 to October 2017

 -  Identified as having had at least one episode of hyperprolactinaemia within the study
 period (Jan 2014 to January 2017)

 Exclusion Criteria:

 -  Referred outside of study period

 -  Hyperprolactinaemia reading outside of study period