Abstract
Objective
To determine prevalence of hyperprolactinemia and prolactinoma among men presenting
for initial fertility evaluation.
Methods
We performed a retrospective review of men presenting for initial fertility evaluation
at a tertiary care, academic health system between 1999 and 2018. Men with measured
prolactin levels were analyzed to determine prevalence of hyperprolactinemia and prolactinoma.
We compared clinical characteristics of men with and without hyperprolactinemia. Univariable
and multivariable analysis were used to determine factors associated with hyperprolactinemia.
We assessed effects of hyperprolactinemia and prolactinoma on testosterone levels,
semen parameters and pregnancy outcomes after treatment.
Results
A total of 3101 men had serum prolactin level measured. 65 (2.1%) had hyperprolactinemia.
Patients with hyperprolactinemia had lower testosterone (median 280 ng/dL vs 313 ng/dL,
P = 0.038) and lower total motile sperm count (median 7.0 million vs 34.7 million,
P = 0.001) compared to men without hyperprolactinemia. 43.1% of men with hyperprolactinemia
had oligospermia vs 21.5% of men without hyperprolactinemia (P<0.001). Univariable analysis demonstrated that men with elevated luteinizing hormone
(LH) (OR 1.077, P = 0.001) and follicle-stimulating hormone (FSH) (OR 1.032, P = 0.002) were more likely to have hyperprolactinemia. Men with oligospermia were
more likely to have hyperprolactinemia (OR 2.334, P = 0.004). On multivariable analysis, neither hormone parameters nor oligospermia
were associated with elevated prolactin (P>0.05). Of the 65 men with hyperprolactinemia, 11 (17%) were diagnosed with a prolactinoma,
resulting in an overall prevalence of 11 in 3101 (0.35%).
Conclusion
The overall prevalence of prolactinoma in our cohort of men undergoing fertility evaluation
was 35-fold higher than the prevalence in the general male population.
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Article info
Publication history
Published online: March 22, 2021
Accepted:
March 9,
2021
Received:
January 18,
2021
Footnotes
Capsule: Among subfertile men, prevalence of hyperprolactinemia and prolactinoma are 2.1% and 0.35%, respectively. Hyperprolactinemia is associated with lower testosterone and TMSC. We recommend prolactin screening during initial male fertility evaluation.
Identification
Copyright
© 2021 Published by Elsevier Inc.
