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In addressing mood disorders associated with infertility, sometimes the cure may be worse than the disease.
FROM OUR READERS
An article in the December 2020 issue, “The Intertwining Effect of Mood Disorders and Infertility,” made many important points. I would like to raise to a few additional issues that seem to be often overlooked.
Women taking serotonin uptake inhibitors (SSRIs) to help them cope with infertility are actually increasing their serum prolactin to an unhealthy level. This hyperprolactinemia, in turn, blocks ovulation.1,2 Unknowingly, they are hindering their changes of conception. This is the biology underlying the common folk wisdom that one cannot usually become pregnant while lactating/breastfeeding. This is when prolactin levels are very high.
I urge all women with fertility issues, especially those on SSRIs, to get a simple blood test measuring their serum prolactin level. An elevated serum prolactin level can be corrected with oral dopamine agonists (dopamine-stimulating) medications.
Certain antipsychotic meds, whether typical or atypical, can also elevate serum prolactin levels. Risperidone in particular can cause hyperprolactinemia in female and males, which causes lactation (galactorrhea) from their breasts. A third, less common cause of hyperprolactinemia is a tumor of the anterior pituitary gland, known as an anterior pituitary adenoma. This can be detected by an MRI of the brain.
Once identified, hyperprolactinemia can be readily corrected by dopamine agonists such as bromocriptine or lisuride.3 Once the prolactin level has come back down to the normal rage, ovulation can occur. The patient can then discuss with her psychiatrist whether or not to continue the psychotropic medications at the current doses or lower, depending on the severity of her particular symptoms and stressors.
In conclusion, women struggling to conceive who are on SSRIs and/or antipsychotic medication should request that their serum prolactin levels be checked. This cause of infertility can be readily corrected. Therefore, it should be checked, especially before moving on to more invasive and uncomfortable fertility tests, such as a hysterosalpingogram, and certainly before beginning the injections to prepare for IVF.
Let’s get the word out!
Dr Mausner is a psychiatrist at the Manhattan Psychiatric Center, in the Outpatient Department on 125th St., NYC. She is the author of Jacob Weinberg, Musical Pioneer, forthcoming from Amazon, and played Dr Zalutsky on “The Sopranos.”
1. Torre DL, Falorni A. Pharmacological causes of hyperprolactinemia. Ther Clin Risk Manag. 2007;3(5):929-51.
2. Matsuzaki T, Azuma K, Irahara M, et al. Mechanism of anovulation in hyperprolactinemic amenorrhea determined by pulsatile gonadotropin-releasing hormone injection combined with human chorionic gonadotropin. Fertil Steril. 1994;62(6):1143-9.
3. Schlechte JA. Long-term management of prolactinomas. J Clin Endocrinol Metab. 2007;92 (8):2861-2865.