Candid Patient Reviews of
Dr. Eric Daiter

Click here for more video reviews

How Can I help You?

Dr Eric Daiter has served Monmouth and Middlesex Counties of New Jersey as an infertility expert for the past 20 years. Dr. Daiter is happy to offer second opinions (at the office or over the telephone) or new patient appointments. It is easy, just call us at 908 226 0250 to set up an appointment (leave a message with your name and number if we are unable to get to the phone and someone will call you back).


"I always try to be available for my patients since I do understand the pain and frustration associated with fertility problems or endometriosis."


"I understand that the economy is very tough and insurance companies do not cover a lot of the services that might help you. I always try to minimize your out of pocket cost while encouraging the most successful and effective treatments available."

NJ Center for Fertility and Reproductive Medicine - Infertility Tutorials

Treating Ovulatory Dysfunction: Hyperprolactinemia
Hyperprolactinemia can usually be controlled. Minimal elevations usually do not need any treatment. The overwhelming majority of patients with significant excess in circulating prolactin concentrations can be effectively treated with medication alone (often Bromocriptine). Surgical excision of pituitary prolactinomas (tumors of lactotrophs, the prolactin producing cells of the pituitary gland) is currently reserved for large symptomatic tumors, patients noncompliant with medical treatment (the use of medication for treatment) or for tumors that have failed to respond to medical management. When surgery is recommended, it is usually performed as a "transsphenoidal microsurgical resection" (with a small incision made under the upper lip) which has minimal cosmetic consequences and fewer major complications than a craniotomy (opening of the skull).

Treatment depends on the fertility goals of the couple, the reason for the excess prolactin, and the woman's symptoms.


pregnancy is not desired,

the radiologic exam demonstrates either no tumor or a microadenoma (prolactinoma less than 1 cm diameter),

there is either no galactorrhea or the presence of milk is not bothersome to the patient, and

the patient does not have a low circulating estrogen concentration

then she can reasonably consider "no active treatment." That is, she can consider continuing without medication, have her blood levels of prolactin checked 1-2 times a year for a few years, and recheck the radiologic exam every 1-2 years for a few years to confirm that a tumor is not rapidly growing.


pregnancy is not desired but

the patient has bothersome galactorrhea

then this is usually effectively treated by normalizing the prolactin concentrations with medication. There are women who will continue to experience galactorrhea with normal prolactin concentrations, but the mechanism for this is not usually clear. Most likely the galactorrhea is due to the "most bioactive forms of prolactin" comprising a greater than normal percentage of the total amount of immunoreactive prolactin (the amount detected in the assays). Also, this may be due to an increase in breast cell receptors for prolactin.


pregnancy is not desired but

the patient has a low circulating estrogen concentration

then the treatment for the low estrogen should be provided. Medical management of the excess prolactin to bring it into the normal range will generally correct the estrogen abnormality. If medical management of the excess prolactin is not desired, then estrogen replacement should be strongly recommended (if not otherwise contraindicated) to protect the woman from the harmful effects associated with a lack of estrogen (such as osteoporosis and heart disease). Birth control pills or traditional hormone replacement medication (such as Premarin and Provera) can be given.


pregnancy is desired,

then an attempt to correct the ovulatory dysfunction associated with excess prolactin concentrations should be initiated. Usually medication to reduce the prolactin concentrations is most effective and all that is required. Prolactin secretion from the pituitary gland is inhibited by dopamine and medications that act similar to dopamine (dopamine agonists). The response to the medication usually results in improvement of ovulation within 1-2 months of normalization of prolactin.


a woman becomes pregnant while taking medication for excess prolactin (such as Bromocriptine),

then the physician usually discontinues the medicine during the pregnancy. One exception can be when there is a history of a large symptomatic tumor (macroadenoma). Prolactin levels generally increase and tumor growth may occur in high estrogen states (like pregnancy). In the early 1980s, a metaanalysis of the available literature reported that of 275 women with pituitary prolactinomas, 215 women had microadenomas and less than 1% of these had either visual changes or radiologic evidence of tumor growth during pregnancy (5% did have headaches), and 60 women had macroadenomas with 20% of these having visual changes or radiologic evidence of growth. Therefore, the need for treatment in pregnancy is uncommon.

Prolactin is the hormone primarily responsible for breast milk production during pregnancy and lactation, with circulating levels of prolactin typically increasing up to 10 fold greater than the nonpregnant levels by the end of pregnancy.

The size of a prolactinoma generally decreases with medical treatment. In microadenomas, reports demonstrate that 75% of patients treated with medication have a reduction in size and 40% have complete disappearance of the tumor. In macroadenomas, reports demonstrate that up to 90% have a reduction in size and most of these also have rapid relief of any symptoms (such as vision abnormalities).

The length of therapy with medication for excess prolactin is classically long term. There is a high incidence of recurrence after discontinuing medication for a macroadenoma so long term treatment is usually recommended. Women with a microadenoma can have continued normalization of prolactin after discontinuing the medication (about 10% if treated for 1 year and up to 20% if treated for 2 years) so that these women may try discontinuing the medicine to see whether they need it after 1-2 years.


| About this web page | Basic Infertility | Ovulation | The Sperm | Pelvic Factor |

Eric Daiter, M.D. - Edison, NJ - E-Mail: - Phone: (908)226-0250

Design & Hosting by BLAZE inter.NET