One of the causes of irregular, or no, ovulation is abnormally elevated levels of prolactin. Prolactin is the hormone responsible for breast milk production in pregnant women.  This action is very likely the basis behind the myth that breast feeding women cannot become pregnant because of its effects upon ovulation.

Abnormally elevated prolactin produces a condition known as hyperprolactinemia. The condition can be caused by a benign tumor on the pituitary or by many medications, including those used to control hypertension and depression/ mood disorders.

When the elevation is due to a pituitary tumor, it is often treated surgically by removal of the tumor.  Drugs such as Parlodel and Dostinex stimulate dopamine receptors at the pituitary leading to decreased production of prolactin and consequent resumption of ovulation.

Progesterone is a natural hormone that is responsible for stimulating the development of the uterine lining (the endometrium).  Estrogen also helps to increase the width and vascularization of the endometrium.  After ovulation, the remaining follicular structure is known as the corpus luteum.  The corpus luteum, located on the ovaries, is responsible for progesterone production and after pregnancy the placenta begins to produce progesterone.

When too little progesterone is produced, the condition is sometimes called a “luteal phase defect” where the endometrium does not develop properly. Without thickening and vascularization, the endometrium cannot support an embedding embryo.  Insufficient progesterone is produced during FSH ovulation induction cycles where Lupron or Ganirelix is used. These drugs interfere with progesterone’s natural production and therefore external progesterone is almost always administered during IVF cycles.

A luteal phase defect can usually be corrected with additional progesterone administered as an injection, gel, vaginal suppository, oral troche, or as micronized oral capsules.

Fertility Drug Links

• Clomid (Clomiphene Citrate)
• Letrozole (Femara)
• FSH (Gonal-F, Follistim, Repronex, Bravelle, Menopur)
• Lupron, Ganirelix
• hCG (Pregnyl, Ovidrel)
• Metformin (Glucophage)
• Antibiotics
• Birth Control Pills