Prolactinoma presenting as a failed vasectomy reversal

Fertil Steril. 2007 Nov;88(5):1438.e3-5. doi: 10.1016/j.fertnstert.2006.12.040. Epub 2007 Jun 11.

Abstract

Objective: To present a case of prolactinoma presenting as a failed vasectomy reversal.

Design: Case report.

Setting: University-affiliated teaching hospital.

Patient(s): A 46-year-old male with severe oligospermia after bilateral vasovasostomy and his 31-year-old female partner who had normal cycles.

Intervention(s): Bromocriptine, carbegoline, and l IVF.

Main outcome measure(s): Correction of hyperprolactinoma, improved semen analysis, and pregnancy achieved by assisted reproductive technologies.

Result(s): Semen analysis showing low volume (0.65 mL) and severe oligospermia (16 sperm) with zero motility on presentation. Endocrine evaluation showed prolactin of 650 ng/mL, T 0.37 ng/mL, and FSH 2.0 mIU/mL. A head CT scan showed a 1.2 cm pituitary adenoma. This was managed initially with bromocriptine, but due to side effects he was switched to carbegoline. In 1 month his PRL decreased to 16.9 ng/mL. Testosterone and FSH normalized. Repeat semen analysis after 5 months showed a volume of 4.5 mL and a concentration of 15 million/mL with 1% motility. Antisperm antibodies were positive. Because of antisperm antibodies and oligoasthenospermia, intracytoplasmic sperm injection with ejaculated sperm and, later, testicular extraction, were attempted without success. Donor sperm was eventually used.

Conclusion(s): This is the first reported case of prolactinoma as a cause of infertility after vas reversal and demonstrates that not all cases of suspected failed vasectomy reversals are due to recurrent obstruction.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Female
  • Humans
  • Infertility, Male / diagnosis
  • Male
  • Middle Aged
  • Prolactinoma / diagnosis*
  • Treatment Failure
  • Vasovasostomy* / adverse effects