Secondary resistance to bromocriptine and cabergoline therapy in hyperprolactinemia: One case of pregnancy with IVF-ET

Abstract

Background: For patients with hyperprolactinemia, primary dopamine agonist resistance occurs in 10-15%, secondary resistance following initial biochemical and anti-proliferative response is very rare and has only been described in five previous cases. For women of childbearing age, hyperprolactinemia affects follicular development, potentially causing infertility. Currently, reports on pregnancy outcomes of secondary dopamine resistance in patients with unexplained hyperprolactinemia are scarce. In this paper, we report one case of pregnancy with unexplained bromocriptineand cabergoline-resistant hyperprolactinemia, with follow-up data for four years after birth. Case report: The 32-year-old patient had been diagnosed with primary infertility for four years.She has been treated with dopamine agonist therapy for 3 years. At first, she was initially treated with bromocriptine, marked reduction in prolactin concentration. After one years her prolactin concentration began to rise despite escalating doses of bromocriptine up to six tablets/day and cabergoline up 6mg weekly(two tablets each time, three times per week). Hypothalamic-pituitary lesions and other lesions were ruled out. After ovulation induction, the development and ovulation of dominant follicles were observed only occasionally. The patient failed to become pregnant after intrauterine insemination (IUI) . However, after one cycle of IVF-ET(in vitro fertilization-embryo transfer)the patient became pregnant. She delivered a baby girl at full term, and the baby was normal over the course of the four-year follow-up. Conclusion: While the mechanism of secondary resistance remains unknown and not possible to predict, the woman can become pregnant after IVF-ET, even if the PRL level remains higher than normal. *Correspondence to: Hangsheng Li, Reproductive Medical Center, the Affiliated People's Hospital of Zhengzhou University, Zhengzhou, China, Tel: +8613523585116; E-mail: xiaohongfan0617@126.com