Jan, my "hunch" coincides with yours. Regarding attempts to increase milk output later in lactation you wrote, "It seems as though regardless of what you do, supply won't go up. I think that at that point, if the prolactin receptors aren't there (laid down) in the beginning, then the fenugreek, reglan, blessed thistle, etc. won't work. If they were laid down initially, and mom bf frequently to start with, but then tapered off, you have those receptors, and using something that stimulates prolactin will increase milk supply. But that's just a hunch, not based on anything specific. It certainly does point to the importance of breastfeeding early and often in the first few weeks, however. Also pumping a lot for those moms that can't breastfeed." Could it also partly be keeping all the milk-producing alveoli intact? - draining very well as the milk comes in, and maintaining the breasts in as soft and comfortable a state as possible so that nothing becomes damaged, and they all just keep on producing milk - more and more efficiently - which brings in your prolactin receptor theory. I'm wondering if, during later lactation, when the prolactin levels are much lower, if the increase in the prolactin receptors has the effect of making the breasts equally responsive, but to lower and lower levels of prolactin. Now, just to put a spanner in the works, what about the receptor theory during induced lactation and re-lactation? I had a client about a year ago who re-lactated for her 8 month old baby, having weaned him at 2 months. She achieved an amount of 360ml EBM per day after about 3 months. She used sulpiride, which increases prolactin levels. Would this lay down prolactin receptors in the breast too? Pamela Morrison IBCLC, Zimbabwe mailto:[log in to unmask]