Fertility and pregnancy in patients with prolactinoma

Prolactinoma is the most common subtype of pituitary tumor and a significant cause of infertility. Treatment with dopamine agonists, primarily cabergoline, can achieve normoprolactinemia and restoration of the gonadal axis within 6-12 months in most patients. In select cases with non-invasive micro- or macroprolactinomas, neurosurgery may be recommended as primary therapy. If the gonadal axis does not recover and fertility is desired, clomiphene citrate and other assisted reproductive techniques may be utilized. During pregnancy, the risk of symptomatic tumor growth is very low in microprolactinomas and intrasellar macroprolactinomas. Close follow-up throughout pregnancy is recommended, and cabergoline may need to be reintroduced or maintained in some patients. After delivery, prolactinoma status should be reassessed, as remission may occur. Breastfeeding is typically uneventful. This review addresses the principal mechanisms of infertility in hyperprolactinemia, in both women and men, as well as treatment approaches to achieving conception and recommendations for follow-up before, during, and after delivery.