Abstract

Abstract: Purpose of research - To improve reproductive outcomes of women with
prolactinomas by evaluating fertility predictors. Material and methods. We examined 250
women aged 17-35 years (average age 30.5 years) with endocrine infertility (EI) and
hyperprolactinemia. Of these, 71 (28.4%) patients with prolactinoma and endocrine
infertility were selected for an in-depth study. All patients underwent a complete clinical -
hormonal and visualization examination and were divided into patients with EI with
pituitary microprolactinomas (64.7%) and patients with EI with macroprolactinomas
(35.2%). Clinical, imaging, and hormonal studies have been performed. The basal levels of
the pituitary gonadotropic hormones — LH, FSH, as well as PRL, TH, peripheral gland
hormones cortisol (C), estradiol (E) and total testosterone (T), dehydroepiandrosterone
sulfate (DHEA-S), progesterone, inhibins A and B were determined , activin, antimuller
hormone. The research materials were subjected to statistical processing using the methods
of parametric and non-parametric analysis. Results. According to the objectives, the
functional state of the HPO system and the clinical characteristics of infertility in
prolactinomas were studied, an analysis of complaints and anamnestic data of patients
with EI with prolactinomas was made, depending on the size of the formation in a
comparative aspect. The state of ovarian reserve was assessed, with the determination of
FSH, activin, AMH, inhibin A and B in the blood serum. The inhibin A level in both Me
groups was 1.30 ng/ml, which significantly differed from the control group (p₂ ˂0.0001,
p₃ ˂0.0001). The level of inhibin B underwent significant changes in both groups. A
decrease in inhibin B and an increase in FSH can prove a decrease in ovulatory ovarian
reserve. The studied women with EI in both groups showed a decrease in AMH, in the
group with microadenomas ranged from 0.12 to 2.1 and averaged 0.75 ± 0.27 ng/ml, and in
the group with macroadenomas ranged from 0.09-2.2 and averaged 0.97 ± 0.49 ng/ml,
which significantly differed from the control group (p₁ ˂0.05, p₂ ˂0.001 p₃ ˂0.001). The
conducted Spearman correlation and regression analysis showed that between prolactin
and AMH (r = -0.4; p˂0.01), between prolactin and progesterone (21dMC) (r = -0.576;
p˂0.0001) as well as between prolactin and inhibin B (r = -0.67) there is a strong “-“
negative relationship and all indicators were statistically significant. Conclusions:
Endocrine disorders in women with prolactinomas are significantly increased in patients
with macroadenoma compared with microadenoma. Correlation-regression analysis found
a negative relationship between PRL and AMH (r = -0.4, P <0.0001), PRL and
progesterone (r = -0.57, P <0.0001). With an increase in PRL by 1 unit, there is a decrease
in AMH by 0.008 units (P <0.001), a decrease in inhibin B by 0.11 (P <0.001),
progesterone by 0.04 units (P <0.0001) and the degree of hyperprolactinemia and this all
can predict EI development.