Restoring Fertility Through Medical Management of Pituitary Microadenoma
A 34-year-old woman (Mrs. D) and her 36-year-old partner (Mr. S) presented to our clinic after 14 months of trying to conceive without success. Mrs. D reported the absence of menstrual periods (amenorrhea), and her clinical history raised suspicion of an underlying endocrine issue. She also experienced galactorrhea, but denied any visual disturbances or headaches.
Initial blood investigations revealed a markedly elevated serum prolactin level of 4089 mIU/L (normal range: 59–619 mIU/L), which is consistent with hyperprolactinemia. Further laboratory testing confirmed that no macro-prolactin (an inactive form of the hormone that can artificially elevate prolactin levels) was present. Her thyroid function was normal, and imaging with brain MRI revealed a pituitary microadenoma—a small benign tumour of the pituitary gland that can disrupt hormonal balance.
In addition to her elevated prolactin levels, her Anti-Müllerian Hormone (AMH) was low at 10 pmol/L, suggesting a diminished ovarian reserve. However, her partner’s semen analysis was entirely normal.
Medical Management Leading to Successful Conception
Given the diagnosis of hyperprolactinemia due to a pituitary microadenoma, we commenced Mrs. D on Cabergoline, a dopamine agonist that effectively reduces prolactin levels and restores ovulatory function. Remarkably, ovulation resumed following the first menstrual cycle on treatment, and she conceived naturally shortly thereafter. Cabergoline was discontinued upon confirmation of pregnancy.
On her first pregnancy scan, performed at our clinic, a transvaginal ultrasound revealed a single live intrauterine pregnancy. The crown-rump length (CRL) measured 14.3 mm, consistent with 7 weeks and 4 days gestational age, and a strong fetal heartbeat was visualised. Her estimated due date (EDD) was calculated to be 14 June 2025.
Mrs. D’s pap smear is up to date and normal, and her pre-pregnancy blood investigations were all within normal limits, apart from a vitamin D deficiency. She was advised to commence vitamin D supplementation.
Multidisciplinary Monitoring for a Healthy Pregnancy
Given the presence of a pituitary microadenoma, ongoing care during pregnancy will involve a multidisciplinary approach. This includes co-management with a medical endocrinologist to monitor pituitary function and prolactin levels, as well as regular visual field testing with an ophthalmologist to ensure there is no expansion of the tumour affecting the optic pathways.
A Message of Encouragement
This case demonstrates how simple medical therapy can dramatically restore fertility in women with hormone-related menstrual disturbances. Despite significant biochemical abnormalities and a known pituitary lesion, this couple conceived quickly once the correct diagnosis was made and treatment initiated.
Mrs. D and Mr. S are now looking forward to welcoming their first child, and we wish them a healthy and joyous journey ahead.
