Can women with gonadotropin levels diagnostic of polycystic ovarian syndrome benefit from therapy with dopamine agonists?
On the basis of LH and FSH data the incidence of PCOS in a series of 33 infertile women with hyperprolactinemia due to differing causes was found to be 39%. Where the elevations of prolactin were intermittent (spikers), the incidence was 44%, compared to 33% in a control population and 23% (9% histologically confirmed) in a 1991 Dublin general infertility clinic population. Androgen levels were uninformative, as were TRH stimulation test results. All 33 infertile women were treated with dopamine agonists. Four pregnancies occurred in the PCOS group. Two were hyperprolactinemic spikers on dopamine agonists plus antiestrogens. Four of the 10 pregnancies in the non-PCOS group were also on dopamine agonists plus antiestrogens. Two of these were spikers. The use of dopaminergic drugs to lower circulating prolactin is established. The addition of an antiestrogen in a concomitant PCOS situation is rational. There appears to be little justification, however, to use them in any anovulatory situation, including PCOS in the absence of hyperprolactinemia.