Overview
Primary infertility refers to the inability to conceive after a year of regular unprotected intercourse in women under 35, or after 6 months in those over 35, without an identifiable cause 1.Diagnosis
Evaluate basal prolactin (bPRL) levels; hyperprolactinemia (bPRL ≥15 ng/mL) is associated with infertility 1.
Assess peripheral blood natural killer (NK) cell levels, as elevated NK cells correlate with infertility, particularly in hyperprolactinemic women 1.
Consider thyrotrophin-releasing hormone (TRH) test to analyze PRL dynamics in infertile women 1.Management
Address hyperprolactinemia with dopamine agonists such as cabergoline or bromocriptine if elevated PRL levels are identified 1.
Monitor and manage elevated NK cell activity through lifestyle modifications and, in some cases, immunomodulatory therapies, though specific drug recommendations are not provided 1.Special Populations
No specific recommendations for pregnancy, pediatrics, elderly, or comorbidities are provided in the given abstracts 1.Key Recommendations
Measure basal prolactin levels in women with primary infertility to identify hyperprolactinemia (Evidence: Moderate) 1.
Evaluate natural killer cell activity in infertile women, especially those with hyperprolactinemia, to guide further management (Evidence: Moderate) 1.
Consider treatment with dopamine agonists for hyperprolactinemia identified in infertile women (Evidence: Expert opinion) 1.References
1 Triggianese P, Perricone C, Perricone R, De Carolis C. Prolactin and natural killer cells: evaluating the neuroendocrine-immune axis in women with primary infertility and recurrent spontaneous abortion. American journal of reproductive immunology (New York, N.Y. : 1989) 2015. link