Prolactinoma presenting as a failed vasectomy reversal.

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.