Is it possible to overcome high prolactin levels and conceive naturally at 42? Discover valuable insights from renowned fertility specialist and Harvard University-awarded scholar Gabriela Rosa as she addresses a participant’s query during a Free Fertility Office Hour. If you face similar challenges, this conversation provides essential guidance to help you make informed decisions about your fertility journey.

Participant:
I have a problem with high prolactin (hyperprolactinemia). I’m not breastfeeding and not having any discharge from my breast. But it’s a problem that has been there since I’ve been married for 10 years, before my separation. How am I going to tackle this problem?

Presently, I’m on Cabergoline. I’ve been taking it for quite some weeks now. And from what it looks like, it’s got to be a medication I will be on for a long time. It’s a prescription medication for me, whereby if I finished the one I had, I was to get another one. And I’ll continue to take things because my prolactin is very high. It’s like 1000 plus.

So, I don’t know if I still have the chance to conceive naturally, considering my age. Can I overcome high prolactin and conceive naturally at 42?

Gabriela Rosa:
So you’ve been trying for a very long time. Are you trying with a different partner now?

Participant:
Yes.

Gabriela Rosa:
How long have you been trying with this new partner? 

Participant:
Intensively – about two months, but we’ve been together for nearly a year. I’ll say for the last two months now. I’ve been trying consistently now.

Gabriela Rosa:
And are your cycles regular with hyperprolactinemia?

Participant:
Oh, yeah. There were months when I missed it. However, last month, I saw my menses. And then last two months, I saw my menses. So, I’ve not seen this month.

Gabriela Rosa:
And how many days? How many days long is your cycle?

Participant:
35. I have a long cycle.

Gabriela Rosa:
Okay, so you have around 35 days. All right. Have you had any tests done at this stage other than the prolactin? Are your tubes clear? Have you had any different kinds of tests done at this point?

Participant:
I haven’t checked my tubes when I’ve done smear tests. The last time I checked my tube, I was told that one was blocked, but one is capable of accepting/receiving the sperm.

Gabriela Rosa:
And how long ago was that?

Participant:
I should say it’s a long time around. 10 years ago.

Gabriela Rosa:
Okay, so a pretty long time. And has your partner had his semen tested? Has your partner had sperm tests?

Participant:
Not really.

Gabriela Rosa:
Okay. All right. There are quite a few pieces to what you’re talking about. But the critical aspect that you need to consider in this particular situation is that when it comes to overcoming fertility challenges, it’s essential to be holistic in how you look at what’s happening.

It’s also necessary to understand the underlying cause of your symptoms. For example, with prolactin, did you have a brain scan? Did you have a tumor? Is that what the situation was? Was it diagnosed?

Participant:
Nothing has been diagnosed. I’ve gone for an MRI scan. Everything is perfect. Nothing has been diagnosed.

Gabriela Rosa:
Nice, okay. So basically, it’s idiopathic. They haven’t given you a reason at this point. They just can see that it’s elevated. And that’s that.

Participant:
Apart from the high prolactin level, there is no reason, and everything else is fine. Apart from that, nothing.

Gabriela Rosa:
In our clinic, part of what we look at is how we can make the ovary’s connection with the pituitary—that conversation that goes on in the axes—how can we make that more effective? How can we ensure that communication is as unimpeded as possible? And how do we balance that communication so that the hormones are balanced as a result of that?

That’s the first thing, really understanding, what is the hormonal balance? From what you’ve told me, you haven’t been tested. We don’t know what’s happening regarding hormonal balance at this point.

There are many question marks that I can see in terms of your case that will be important to answer.

Now to answer your question, “I’m 42. Can I still have a baby?” The answer is absolutely yes. We have treated couples in a very similar situation for a long time. And it’s possible. What it does take, though, is peeling those layers that I talked about.

I always say fertility is a retrospective analysis of many things causing the outcome you’re seeing. Because whatever you’re seeing, whether it’s the inability to conceive or to keep a healthy pregnancy to term, results from many biochemical chain reactions that start all the way over there. So, to change what’s happening here and have different results, we need to change what’s happening there.

Whenever you get an unexplained infertility diagnosis or an unexplained diagnosis of any kind, what’s happening is that we haven’t taken the time to figure out what are these pieces that are getting in the way and that are impeding the result that we want to see, as opposed to the result that we’re seeing.

I often talk about how when it comes to fertility, we have a situation where we work in the enclosed system. Every system is designed to deliver a result that is currently deliberate.

So, when we have this outcome persistently, whether it’s the inability to conceive or keep a pregnancy to term, essentially, what’s happening is that you’re in a situation where really, that system is being designed to create this outcome. And if we want to create a different outcome, we must do something different.

Pinpointing what that is will be extremely important. Because unless we do that, we will continue going around in circles.

The issue you have right now is not so much about your age because there are many things we can do regardless of age. But what happens is that if we keep going around in circles, and we keep trying as if it’s a numbers game (it’s never a numbers game, but if we keep trying it that way), what ends up happening is we start to delay the time that we could use that fertility potential towards conception.

We end up in a situation where we run out of time to have a baby while trying.

The critical aspect right now is to understand what we are dealing with. And how do we address it? And understanding those gaps in those places of opportunity will be critical.

You need to have more tests. That’s going to be an absolute. Whether you go to your local doctor and have a proper assessment, have your partner also adequately assessed, chart your cycle—because if you have a lengthened cycle, what’s going to be important is that you understand the pattern within its regularity because it’s there, even though it’s prolonged. There’s still a pattern to it.

You want to understand when ovulation is most likely occurring in that pattern and time conception accordingly.

Participant:
Right now, I cannot even tell you when I ovulate.

Gabriela Rosa:
And that’s why you need to chart your cycle. I recommend basal body temperature charting. You can use an app like fertilityfriend.com. It’s free. It’s straightforward to use. Use that to take your temperature orally.

Get a thermometer in your mouth, under your tongue, close your mouth, wait until it beeps, and track your temperature every day of the week and throughout the month. And that will give you a pattern of what’s going on to understand what’s happening with your cycle. And you need to do that for several months to start seeing a pattern.