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You must be aware of what medicines you are taking and why. It's easy for doctors to prescribe medicines, but it's your responsibility to be well-informed about them, so that you know exactly what to expect.
Medicines used in infertility treatments include:
Bromocriptine is a drug which is used specifically to treat patients with hyperprolactinemia - a condition in which the pituitary produces excessive amounts of the hormone called prolactin, as a result of which ovulation is suppressed. Hyperprolactinemia is the cause of menstrual disturbance in about 10% of anovulatory women. The commonest cause of hyperprolactinemia is a small tumor of the pituitary gland, called a pituitary microadenoma. In order to ensure that the pituitary tumor is not large, many doctors will do a CT scan of the pituitary as well, but this is useful only when the prolactin level is very high - more than 100 ng/ml, and this is uncommon. While many women with hyperprolactinemia will have no symptoms, some will have a milky discharge from their breasts (called galactorrhea) and this is a useful tipoff for the doctor. However, the diagnosis needs to be confirmed by measuring the prolactin level in the blood (the normal range in most laboratories being less than 20 ng/ml). Since the prolactin level can be affected by many factors (for example, stress, exercise and certain drugs can also cause hyperprolactinemia), if the level is high, it should be rechecked. Bromocriptine lowers prolactin levels to normal and allows the ovaries to resume functioning normally.
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Side effects: The drug often causes nausea, vomiting, dizziness and constipation during the first few days of treatment but the chances of these symptoms occurring can be reduced by starting the drug at a low dose (usually half a tablet with food at bed time) and gradually building up to a maintenance dose of 1 to 4 tablets daily.
Dose: A 2.5 mg tablet is available; and the starting dose is usually 2.5 mg to 5 mg daily - taken at bedtime. After starting bromocriptine, prolactin levels can be tested (after at least one week of medication) to confirm that they have been brought down to normal. If the levels are still elevated, the dose will need to be increased. Once normal prolactin levels have been achieved (and some women need as much as 4 to 6 tablets a day to achieve this) this is then the maintenance dose. Once the prolactin blood level is within the normal range, the periods should become more regular and patients should start ovulating normally again. Remember that bromocriptine only suppresses an elevated prolactin level while it is being taken - it does not "cure" the problem. This is why the tablets must be taken daily until a pregnancy occurs, after which they should be stopped. This is expensive medication, and some pharmaceutical companies may provide it at reduced rates if the doctor requests them to do so on your behalf. For the small fraction of patients with hyperprolactinemia who cannot tolerate oral bromocryptine, alternative medications include other dopamine agonists such as cabergoline , which causes fewer side-effects because it needs to be taken only twice a week.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
