Prolactin And Other Hormonal Profiles In Sudanese Infertile Females

Background and Objectives: Infertility is a distressing problem for couples seeking to have children. Hyperprolactinemia is one of the causes of female infertility which in itself is caused by a variety of conditions and factors. The objective was to investigate hyperprolactinemia in infertile Sudanese females and how other related hormones namely gonadotropins and estrogen interact in such a condition. The study also aimed to throw some light on the interplay of environmental, genetical and physiological factors. Materials and Methods: Seventy infertile hyperprolactinemic females patients were selected from 385 patients visiting the Reproductive Health Care Centre in Khartum. The investigations were carried out to estimate prolactin (PRL), follicle stimulating hormone (FSH), luetinizing hormone (LH) and estradiol (E2). High sensitive and highly specific enzyme immunoassay techniques were used for hormone determinations. A structured questionnaire was designed to shed light on the interplay and or the effect of environmental, genetical and some pathological conditions with respect to hyperprolactinemia and associated infertlty. Results: Infertile females were found to have high levels of prolactin ranging between 600- 1800 mIU/L and accordingly placed into three categories. These were Group 1(G1) with moderately high (670.07 + 10.4), Group2 (G2) with high (959.0 + 27.5) and Group3 (G3) with very high (1679.7 + 95.1) prolactin levels, all of which were significantly high when compared to the control (146.93 + 21.6); P=0.001 for G1and G2 and P=0.0001 G3. The mean values of FSH(G1 12.81 ± 0.8, G2 11 ± 0.16, G3 8 ± 0.14) and LH (G1 ix 8.92 ± 1.09, G2 8.45 ± 0.98, G3 6.5 ± 0.87)of the three groups were compared with mean values of FSH( 14.15 ± 1 ) and LH( 10.33 ± 0.45 ) in the control group. A consistent drop, in the levels of both FSH and LH with increasing degree of hyperprolactinemia is observed. The drop is not significant for infertile females in G1 with moderately high prolactin level. However, it is significant (P< .01) for G2 and G3 whose hyperprolactinemia is almost equal to or over 1000 mlIU/L. Checking the estrogen level (2.2433 + 0.06) in these patients showed a highly significant (P< 0.001) reduction in its levels when compared to control (29.2 + 3.0). Investigation of menstrual cycle patterns in hyperprolactinemic patients revealed three classes: patients with regular(RC), irregular cycles (IC) and those who suffered amenorrhea (AM). The amenorrheaic patients showed the highest levels of PRL (1412.6 + 9.7) when compared to control (146.93 ± 21.6) and their gonadotroins (FSH =18.36 + 2.8, LH =16.60 + 2.0) were significantly increased compared to controls (FSH 14.15 ± 1, LH 10.33 ± 0.7 ) Questionnaire data analysis showed that hyperprolactinemic patients were mostly from Central (Sinar, White Nile and Gezira region + khartoum) Sudan; 57% and Northern Sudan were 23%. From close relative incidences it was found that 25% of the patients had close relatives with infertility problems. 8.57% of the hyperprolactinemic infertile females suffered hypothyroidism and were on medication to treat hypothyrodism, 2.86% were hypertensive using antihypertensive drugs and no diabetic cases. Discussion and Conclusion: It is concluded that the problem of hyperprolactinemia is one of the causes of infertility in Sudan. The condition x is a very complex one that can be caused and affected by hormonal, environmental and genetical factors