Breaking Barriers to Motherhood: Successful Conception and Term Delivery in Infertile Women with Hyperprolactinemia - Two Case Reports.

PURPOSE: Hyperprolactinemia is a common cause of female infertility, and prolactin-secreting pituitary macroadenomas pose unique challenges for fertility restoration and pregnancy management. Herein, we present two cases of primary infertility due to hyperprolactinemia with distinct etiologies.

CASE PRESENTATION: Case 1: A 27-year-old woman with two years of amenorrhea and polycystic ovarian morphology did not undergo standard ovulation induction. Her serum prolactin level was 1334 ng/mL, and MRI revealed hemorrhagic pituitary macroadenoma. Dopamine agonist therapy with bromocriptine normalized prolactin to 13.09 ng/mL within six months, restored menses, and resulted in pregnancy complicated by severe preeclampsia, with successful delivery of a viable neonate requiring short-term respiratory support. Case 2: A 29-year-old woman with idiopathic hyperprolactinemia (initial prolactin 59.6 ng/mL) and a dominant right ovarian follicle received bromocriptine, achieving prolactin normalization (16.7 ng/mL) and bilateral follicular development. Adjunctive letrozole and continued dopamine agonist therapy for nine months led to conception and term vaginal delivery, without complications.

CONCLUSION

These cases highlight that targeted dopamine agonist therapy may effectively normalize prolactin levels, restore ovulation, and achieve healthy term pregnancies in women with hyperprolactinemia, whether macroadenoma- is driven or idiopathic. Early recognition, individualized treatment, and multidisciplinary follow-up are essential to overcome reproductive obstacles in this high-risk population.