The reason for repeated failed coneption might be increased prolactin production

Prolactin is a hormone that control many chemical processes in body. The most important and key process is the lactation initiation. Another not less important is during the strong mother – child bond creation which failure can cause possible mother absence for a little child. 

In normal life prolactin doesn’t play such an important role. It production is major during night time mainly in REM sleep stage. During daytime it is mainly used during the psychical balance disturbance and coming stress situation. It means that its main purpose is to get the organism ready to cope with an upcoming stress situation. The place of its origin is the hypophysis in brain.

Hyperprolactemy – it is an increased prolactin level contained in blood. This increased production mostly causes menstrual cycle disturbances where usually goes completely away. This is caused by the prolactin’s effect that blocks eggs grow process (This is a main cause in the 10% of the cases).

Precautions in hyperprolactemy

If the woman fails to conceive it is necessary to perform some examinations before the treatment process itself. These examinations include blood tests. Blood test for the prolactin level should be performed during morning time approximately 2 hours after the wake up when the physiological prolactin level is still low and does not distort results. If the high prolactin level is confirmed the treatment follows. The treatment is usually in form of pills that lower the prolactin level.

For some women it is possible to determine clear cause of the trouble. This cause is usually non-benign cancer of the hypophysis in brain. If the tumor is smaller than 10cm (3.9inch) it is the microprolactinom. Tumor bigger than 10mm (3.9inch) is called macroprolactinom. In this case the pharmacological treatment is used as well. This treatment not only leads to lowering the level of created prolactin but also the total amount of prolactin in the body. In more rare cases, where the pharmacological treatment is not successful is possible to use radiotherapy using Laksell´s gamma knife.

How to recognize higher production of prolactin? (Hyperprolactemy)

·         Menstrual disorders (total disappearance of menstrual cycle)

·         Problems in conceiving

·         Sensitivity and pain in the breast area

·         Secretion from one or both breast

How to recognize lower production of prolactin? (Hypoprolactemy)

·         Usually not even recognized

·         Troubles with the beginning of lactation (or no lactation at all)

Because prolactin is a stress hormone, it is true that the more woman is stressed out the more prolactin level increases and with longer periods of these episodes the issue can become chronic. That’s why the best prevention for the infertility caused by any reason is the calm and well balanced environment.

Another reason for infertility might be endometriosis

Endometriosis is the common reason for the women infertility. It is a chronic disease characteristic for its endometrium outside of the vaginal area. It is quite a common disease that affects approximately 5-10% of women population in reproductive age. Up to 70% is recidivist.

Endometriosis symptoms:

·         Irregular painful menstruation

·         Pain during sexual intercourse (can lead to its refusal)

·         Chronic pain of stomach

·         Fertility issues

Endometriosis and infertility

One of the complications of endometriosis is the lowered throughput of fallopian tubes and lower production of ovulocytes in ovaries that can lead to the total infertility. Endometriosis occurs in 7-10% of women in their reproductive age.  Incidence for women that are already treated for infertility is 6-8 times higher.

Endometriosis treatment

Endometriosis is hormonally dependent illness and so the primary treatment should always be hormonal. If needed the solution is always to undergo a surgical treatment or use analgesics treatment that should be just a supplementary treatment for hormonal treatment.  

Main target for the hormonal treatment is to temporarily cancel menstruation and thanks to that suppress the endometrium growth outside of the vaginal area. This will lower and eventually kill the core cells of the endometrium outside of the vaginal area. If this procedure is successful the woman health state will rapidly improve.

At present day there is no way to completely cure endometriosis. According to recent statement of American Society for Reproductive Medicine endometriosis should be assessed as chronic illness, requiring all life therapeutical plans having in mind maximum use of pharmacological means and limited repetition of surgical procedures.

The most common reasons for infertility:

·         Disturbances in menstrual cycles, with amenorrhea – when woman will stop menstruating in the time of her menstrual cycle

·         Syndrome of polycystic ovaries – excessed number of little follicles is produces in ovaries, that are not able to fully grow thanks to the hormonal misbalance

·         Hyperandrogenal syndrome – increased level of man hormone

·         Post pill amenorrhea – long time use of hormonal protection that can lead to the loss of menstruation

·         Women that are extremely thin or with excessive overweight or physical load (professional sportswomen)

Ovarian function failure

Ovarian failure is an ovarian function failure for women before their forties.

The lowered function of the ovaries tissue can be caused by the repeated ovarian operation (when removing cysts from ovaries endometriosis)

Morphologically conditioned infertility

This type of infertility is usually connected with the lowered throughput of the fallopian tubes. These are usually caused by gynecological inflammations (adnextidis), after repeated stomach operations and also for other than gynecological reasons (for example Crohn disease). Morphologically conditioned infertility can start from endometriosis.

Congenital infertility

Is usually caused by Turner´ syndrome, where the woman is missing one genital chromosome X, which causes that ovaries are not fully evolved and can´t fulfill their natural function.

Immunological infertility

Immune system of some women creates antibodies against the man´s sperm or against own ovaries. These antibodies are the main reason for infertility.

Drugs effect

Problems with conception can be also caused by some drugs. For example “The syndrome of uncracked follicle” where the egg is not released from the mature follicle. This might be caused by some painkillers (inhibitors of prostaglandin synthesis).

Breast pump

Great modern helper for many mum's around the world

Not every woman is that lucky to have her lactation as expected. For mum's who doesn't have enough of the milk the breast pump is a great help that stimulates the breast properly and helps the milk production.

The market offers several breast pump types, electric or mechanic. It is a great helper that comes in handy in the times of little because it helps to stimulate and create more milk and in the times of more where it helps to put the milk into bottles to freeze the extra milk for later use.  

Breast pump types

Pump type	Description	Image
Mechanical pump	Mechanical pump is recommended for mothers with normal lactation but needs time to time relax their breast before breastfeeding or after.
Mechanical balloon type
Mechanical leveler pump
Electrical mini pump	Mini electrical pump is recommended for breastfeeding mothers with big lactation but has so much milk that they need to squirt it out and relax the breast.
Electrical hospital pump	Hospital electrical pump is recommended for non-breastfeeding mothers but daily squirt a full dose of milk.
One phase pump	One phase milk extraction system introduces save and careful milk extraction for mothers who’s lactation is without a problem. All one phase pumps have vacuum regulation and ensure comfortable milk extraction.
Two phase pump	Two phase milk extraction system (ES) nearly fully resembles baby sucking rhythm, first stimulation phase and second lactation phase. Two phase milk ES is very careful to the breast. It is recommended for mothers that needs to start the lactation after birth so the baby can get the mother's milk as soon as possible after birth. This pump is also suitable for mothers who can't for any reason breastfeed after birth. It was tested and proven that these mothers had their own milk after 30 hours of using the two phase pump.

When to extract, when to squirt?

•   It is necessary to use the pump for premature baby that is not able to suck from the breast. An ideal type of pump to do this job is the big electrical hospital breast pump, that can perfectly simulate child's sucking reflex. It is possible to continue with smaller electrical home pumps after the lactation had started. The extraction should be regular. During the day in 2-3 hours intervals, in the night 2x, every breast 10-15minutes. If the baby was born very early or has some health issues the milk extraction can be a matter of many weeks or months. But it is definitely worth It because especially prematurely born babies needs mother's milk from their own mother, which consistency adapts to the needs of the baby.
• If it is necessary to stop the breastfeeding for some urgent reasons. For example mother's or baby's health issues. It is possible to keep the milk extraction. Milk should be still extracted in the same time intervals, as the baby was fed before and should be given to the baby in an alternative way (spoon, syringe,... ).
• Planned separation – can be for couple of hours or days or even can be regular when the mum is partially employed or study. Or if she needs go to the planned operation. It is advisable to prepare the milk for these occasions. In the time when the baby is not fed it is necessary to squirt the milk every 3-4 hours (this applies for fully fed babies, older babies that has partial solid food don't require it so often) to prevent the milk from solidification.
• Even for babies that don't corporate during breastfeeding it is possible to keep all the breastfeeding benefits. The baby is fed from the bottle. Woman can keep the lactation for a very long time, more then a year by using electrical pump (Ideal is both breast pump). Breast milk extraction frequency and interval is controlled by the woman herself. Some women collect the milk for their baby during for extractions other needs twice the amount.
• It is highly recommended to relax the breast with a milk excess, that can result in retention or breast inflammation. If even after the feeding there are solid places in the breast it is necessary to release the pressure from these places and squirt the milk out (by pump or hand). If the woman will squirt the milk every day less and less then the lactation will adapt to the child's needs.

• If the milk squirts out during first weeks very strongly and the baby is choking on it, it is recommended to squirt a bit of a milk out and that will cause the milk flow to slow down. Also when the breast are to full with the milk it is hard for the baby to catch the breast. It is recommended to massage areola and squirt the milk out.

Appropriate time to extract the milk is after the breastfeeding or in the longer pauses between breastfeeding.

There are number of breast pumps on the market these days. It depends on the need and use but generally I would recommend the brands Avent, NUK and Maleda. Good luck with or without the pump and a lot of full and happy babies.

Faithfully yours Nanny B.