Breaking Barriers to Motherhood: Successful Conception and Term Delivery in Infertile Women with Hyperprolactinemia - Two Case Reports.

Purpose: Hyperprolactinemia is a common cause of female infertility, and prolactin-secreting pituitary macroadenomas pose unique challenges for fertility restoration and pregnancy management. Herein, we present two cases of primary infertility due to hyperprolactinemia with distinct etiologies. Case Presentation: Case 1: A 27-year-old woman with two years of amenorrhea and polycystic ovarian morphology did not undergo standard ovulation induction. Her serum prolactin level was 1334 ng/mL, and MRI revealed hemorrhagic pituitary macroadenoma. Dopamine agonist therapy with bromocriptine normalized prolactin to 13.09 ng/mL within six months, restored menses, and resulted in pregnancy complicated by severe preeclampsia, with successful delivery of a viable neonate requiring short-term respiratory support. Case 2: A 29-year-old woman with idiopathic hyperprolactinemia (initial prolactin 59.6 ng/mL) and a dominant right ovarian follicle received bromocriptine, achieving prolactin normalization (16.7 ng/mL) and bilateral follicular development. Adjunctive letrozole and continued dopamine agonist therapy for nine months led to conception and term vaginal delivery, without complications. Conclusion: These cases highlight that targeted dopamine agonist therapy may effectively normalize prolactin levels, restore ovulation, and achieve healthy term pregnancies in women with hyperprolactinemia, whether macroadenoma- is driven or idiopathic. Early recognition, individualized treatment, and multidisciplinary follow-up are essential to overcome reproductive obstacles in this high-risk population.