Bromocriptine for induction of ovulation in hyperprolactinemic amenorrhea

Hyperprolactinemia is a frequent finding in infertile women with amenorrhea. Bromocriptine is the drug of choice for treatment of hyperprolactinemic amenorrhea. This dopamine agonist is very effective in normalizing raised prolactin levels. Ovulatory menstrual cycles and fertility are then rapidly restored. Bromocriptine therapy represents a major advance in the treatment of anovulatory infertility. Prolactin-secreting pituitary adenomas are common causes of hyperprolactinemia. Neither surgery nor irradiation reliably provides the definitive cure that had been hoped for in patients with prolactin-secreting pituitary tumours. Experience with medical treatment has revealed that induction of ovulation with bromocriptine is remarkably safe both in patients with microtumours and those with macrotumours without suprasellar extension. In the future, it is possible that even the larger macrotumours with suprasellar can be safely managed by medical therapy with bromocriptine. During pregnancy, pituitary tumour complications may arise in women with prolactinomas. However, data accumulated during recent years have shown that induction of ovulation and pregnancy by bromocriptine is remarkably safe in women with both micro- and macroprolactinomas. The risk of permanent sequelae due to rapid tumour enlargement during pregnancy is exceedingly small in properly investigated and carefully supervised women with prolactinomas. Bromocriptine is clearly a must for every infertility clinic. The value of bromocriptine in the treatment of normoprolactinemic amenorrhea, polycystic ovarian disease, luteal insufficiency and ovulatory infertility is not yet proven. However, bromocriptine is extremely effective in normalizing hyperprolactinemia and undoubtedly the drug of choice for treatment of female infertility due to hypersecretion of prolactin.