Intrauterine development, feto-placental function and pregnancy outcome after induction of ovulation with bromoergocryptine

Abstract

18 pregnancies occurred after treatment with bromoergocryptine in 17 patients who wished to conceive, but who suffered from anovulation of varying aetiology. The course of 15 pregnancies was uneventful. Three pregnancies ended in abortion. Nine of the 17 women had hyperprolactinemic amenorrhea. Furthermore, one woman had normoprolactinemic post-pill amenorrhea, another normoprolactinemic anovulatory oligomenorrhea and a third normoprolactinemic anovulatory regular menstruations. With the exception of one woman, all had galactorrhea. The courses of pregnancy were monitored by frequent ultrasound measurements of the fetal biparietal diameter, maternal urinary estriol excretion and radioimmunological measurements of plasma estrone, estradiol, unconjugated and immunoreactive estriol, progesterone, and HPL. All data were within the normal ranges and all babies were healthy at birth and had no teratogenic defects. The data prove the great value of bromoergocryptine in the treatment of hyperprolactinemic anovulation, sometimes even in the treatment of normoprolactinemic anovulation. Moreover, the results indicate no adverse effect on either the course or the outcome of pregnancy.

Ovarian and Placental Hormones During Prolactin Suppression and Stimulation in Early Human Pregnancy

“…In these patients Pepperell et al (1 977) and Thomas et al (1 977) found decreased levels of urinary pregnanediol or serum progesterone and oestradiol, but only during the last weeks of the first trimester. These findings could not be substantiated by Clemens et al (1978), and since the corpus luteum is the dominant source of steroid during the first 9 weeks of pregnancy (Yoshimi e t a / . , 1969; Holmdal et a/., 1971) there is no evidence that hyperprolactinaemia can impair the corpus luteum of early pregnancy.…”

“…A clinical parallel is found in hyperprolactinaemic patients who conceive with suppressed prolactin levels on bromocriptine. Clinically these pregnancies have a normal development during early gestation (Pepperell et a/., 1977;Thomas et a/., 1977;Clemens et a/., 1978;Griffith et a/., 1978;Thorner et a/., 1979) even though serum prolactin is low during treatment, but rapidly increases above normal early pregnancy levels following cessation of therapy. In these patients Pepperell et al (1 977) and Thomas et al (1 977) found decreased levels of urinary pregnanediol or serum progesterone and oestradiol, but only during the last weeks of the first trimester.…”

“…This might be due to a direct action of prolactin at the ovarian level (McNatty et al, 1977), which suggests that abnormal prolactin levels might also inhibit the corpus luteum of early pregnancy. Bromocriptine impairs ovum implantation in the rat (Fluckiger, 1976), but in the human, bromocriptine-induced pregnancies in hyperprolactinaemic patients develop normally (Pepperell et a/., 1977;Thomas et al, 1977;Griffith et al, 1978;Clemens et al, 1978;Thorner et al, 1979). On the other hand, Pepperell et al( 1 977) and Thomas et al (1977) found decreased levels of urinary pregnanediol or serum progesterone and oestradiol during the last weeks of the first trimester in bromocriptineinduced pregnancies.The aim of the present study was to assess whether prolactin suppression with bromocriptine or stimulation with metoclopramide caused any alteration in serum levels of oestradiol and progesterone.…”

“…This might be due to a direct action of prolactin at the ovarian level (McNatty et al, 1977), which suggests that abnormal prolactin levels might also inhibit the corpus luteum of early pregnancy. Bromocriptine impairs ovum implantation in the rat (Fluckiger, 1976), but in the human, bromocriptine-induced pregnancies in hyperprolactinaemic patients develop normally (Pepperell et a/., 1977;Thomas et al, 1977;Griffith et al, 1978;Clemens et al, 1978;Thorner et al, 1979). On the other hand, Pepperell et al…”