Rising levels of the hormone prolactin stimulate breast milk production in pregnant women. Elevated levels in non-pregnant women is termed hyperprolactinemia and can cause irregular or absent ovulation.
Abnormally high prolactin levels are often caused by a small non-malignant tumor on the pituitary gland. The tumor can sometimes be corrected by neurosurgery, although fertility drugs such as Parlodel are generally used first. Parlodel is effective in lowering prolactin levels and establishing ovulation.
Progesterone is normally produced by the corpus luteum after ovulation. The corpus luteum is the remaining follicular structure after the eggs have ovulated. Elevated progesterone levels are one indication that ovulation has occurred.
Once the embryo attaches to and invades the endometrium, the placenta begins progesterone production. Progesterone supports the growth and development of the lining of the uterus (endometrium), which must become more vascular to support the developing pregnancy.
Progesterone is administered in assisted reproductive technology (IVF) programs because the down regulation drugs (Lupron or Antagon) interfere with progesterone production. Also at the time of egg retrieval, some granulosa cells are removed from the follicle with the egg. Because these granulosa cells make progesterone and because some are removed from the body, extra progesterone has been found to be beneficial to IVF cycles. Progesterone is administered by injection, oral troches, vaginal suppositories, gels, or oral micronized capsules.
Sometimes infection is present in one or both partners. Severe female infections, known as pelvic inflammatory disease, are caused by Chlamydia, gonorrhea, or other bacteria and can permanently damage the ovaries, tubes, uterus, or other organs. In males, the testicles, vas deferens, urethra and other organs can be damaged by Chlamydia or gonorrhea.
Infections are ruled out in the male and female in the initial evaluation. If infection is present, there are many effective antibiotics available.
