[Value of the metoclopramide test in diagnosis of hormonal causes of female sterility].

A retrospective study was used to assess the diagnostic value of the metoclopramide (MCP)-stimulation test for diagnosing hormonal infertility in women. 1326 couples sought help at the hormone-counselling laboratories at the University Gynaecological Hospital in Heidelberg during a six year period and were evaluated with a standardized diagnostic program. The patients were grouped as manifestly hyperprolactinaemic, normoprolactinaemic or functionally hyperprolactinaemic, according to their basal serum prolactin (Pr)-level, and the results of the MCP-stimulation test. The number of patients in the normoprolactinaemic group varied from 894 to 1188 and functionally hyperprolactinaemic varied from 263 to 19 patients, depending on the cut-off value selected. We used cut-off values of 200, 250, 300 or 400 ng/ml in evaluating the MCP response. During a two year follow-up, 40% of the women conceived. Increasing Pr-levels, at stimulation, were associated with significantly more spontaneous pregnancies. Thus more women conceived in the functional hyperprolactinaemic group than in the normoprolactinaemic group. 281 women had used a dopamine agonist (21%). Women in the bromocriptine group (except manifestly hyperprolactinaemic patients) had significantly higher pregnancy rates than those not treated with bromocriptine. This results was particularly significant for women with normoprolactinaemic. It was caused by higher bromocriptine induced conception rate. 60% of the therapeutic pregnancies occurred in normoprolactinaemic women receiving the dopamine agonist therapy. Our results suggest that MCP-stimulation induced functional hyperprolactinaemia is not required for a successful approach. In sterility of unknown origin with normal basal Pr serum levels, a three month trial with low-dose dopamine agonist can be tried.