title: Prolactinoma presenting as a failed vasectomy reversal.
abstract: OBJECTIVE
  To present a case of prolactinoma presenting as a failed vasectomy reversal.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  A 46-year-old male with severe oligospermia after bilateral vasovasostomy and his 31-year-old female partner who had normal cycles.
  
  
  METHODS
  Bromocriptine, carbegoline, and l IVF.
  
  
  METHODS
  Correction of hyperprolactinoma, improved semen analysis, and pregnancy achieved by assisted reproductive technologies.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dartmouth Medical School, Hanover, New Hampshire, USA.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Templeton
authors.forename: Kwabena K
authors.initials: KK
authors.lastname: Pobi
authors.forename: John
authors.initials: J
authors.lastname: Turco
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Nangia
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015175:Prolactinoma / Q000175:diagnosis*; D017211:Treatment Failure; D014669:Vasovasostomy / Q000009:adverse effects