FERTILITY AND STERILITY Copyright e 1986 The American Fertility Society Vol. 46, No.6, December 1986 Printed in U.SA. Bromocriptine therapy in normoprolactinemic women with unexplained infertility and galactorrhea * Gary W. DeVane, M.D.t+ David S. Guzick, M.D., Ph.D.§ University of Florida College of Medicine, Gainesville, Florida and University of Texas Southwestern Medical School Dallas, Texas Forty-three women with unexplained infertility and 16 women who ovulated with clomiphene citrate therapy, yet failed to conceive, were evaluated because of the presence of expressible galactorrhea and normal random prolactin levels. The overall mean duration of infertility for these women was 5.68 ± 0.33 years (mean ± standard error) and their mean age was 30.20 ± 0.46 years. Fifty-two of these women had primary infertility. Three treatment protocols were evaluated. Twenty-five women with unexplained infertility (Group A) received low-dose bromocriptine (1.25 to 2.5 mg) at bedtime for the first 18 days of the cycle; 18 women with unexplained infertility (group B) received 100 mg of pyridoxine continuously; and 16 women receiving clomiphene citrate (group C) also received bromocriptine in a manner similar to that for group A. All subjects were followed for six treatment cycles or until pregnancy occurred. The estimated cumulative pregnancy rate after six treatment cycles was 65% for groups A and C, which is significantly higher than the 22% rate for group B (Lee-Desu statistic = 4.66, P = 0.03). Women treated with bromocriptine were 2.3 times more likely to conceive than women treated with pyridoxine. Furthermore, those infertile galactorrheic women whose random prolactin level was ;;;. 15 ng/ml were most likely to conceive. Expressible galactorrhea in women with unexplained infertility and high normal prolactin concentrations may serve as a clinical sign indicating those women who may benefit from low-dose bromocriptine treatment administered at bedtime. Fertil Steril46:1026, 1986 It has been suggested that treatment with bro- mocriptine (BCPT) in normoprolactinemic wom- en can enhance feJ1;ility in ovulatory patients 1 or restore normal menstrual function in oligoovula- tory or anovulatory, normoprolactinemic wom- en. 2 - 4 Most studies have contained either anec- dotal information or have failed to include appro- priate controls.' Received December 23, 1985; revised and accepted August 6,1986. *Supported in part by National Institute of Child Health and Human Development Clinical Investigational Award HD00473. tDepartment of Obstetrics and Gynecology, University of Florida College of Medicine. tReprint requests: Gary W. DeVane, M.D., 85 West Miller Street, Suite 301, Orlando, Florida 32806. §Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School. 1026 DeVane and Guzick Galactorrhea and bromocriptine The few placebo-controlled studies published show no improvement in either fertility 5, 6 or menstrual cyclicity7,8 with BCPT, as compared with placebo treatment. Nonetheless, the possi- bility exists that intermittent, nocturnal, or oth- erwise occult increases in serum prolactin (PRL) release may occur and be responsible for ovula- tory dysfunction in certain "sensitive" women, even though their random PRL concentrations may be norma1. 9 • 10 Thyrotropin-releasing hor- mone dynamic testing of PRL response has been used to identify those patients with an exagger- Fertility and Sterility
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