>>Is there any evidence to suggest that mums who have undergone IVF or other
reproductive assistance (because they were not able to conceive), are likely
to have more difficulty establishing lactation (excluding husband reduced
infertility and possible same sex partner IVF).

At the private hospital where I work, we have a slighty higher than the
state average rate of ART and have noted a trend, such that we are not
really surprised if full lactation is not achieved in these mums.

We will be working to find if there is a real link rather than just working
on a hunch. Maybe it is a stress factor or that these mums are used to
intervention so do not trust their bodies to do what comes naturally. Maybe
there is a physical reason so their bodies just don't want to do what comes
naturally to most. We may be looking to introduce early intervention for
mums who fit the category rather than adopt the 'wait and see' approach.

Cath,
No one has formally studied this to date as far as I know, but it stands to
reason that a body that struggled to conceive might also struggle to
lactate. The prevailing belief has been that if we can get a woman pregnant
and help her to carry a baby to viability, then lactation should follow, but
it has not been my observation or belief that this is necessarily the case.
We've gotten quite good at overcoming fertility road blocks, but we have a
long ways to go in overcoming lactation road blocks. What I mean is that we
can help a woman to conceive and maintain a pregnancy, but the breasts do
not always respond to that pregnancy, and we have not developed the
technology to analyze this, let alone treat this. Nor have we even addressed
the women whose breasts never developed appropriately during puberty, before
even reaching pregnancy! The underlying pathology that interferes with
fertility may also interfere with lactation, yet we specialize only in how
to overcome the pregnancy issues. I am currently reading an article
entitled, "Windows in early mammary development: critical or not?" that is
one of the first to address the topic of identifying and treating during
crucial periods of mammary gland development. But we are so far away from
having anyone care about breastfeeding enough that our medical system would
monitor this development and intervene when it isn't happening correctly. 

I am absolutely convinced that you will find a real link-- what you are
seeing is not just stress. The question is what the rate will be. Obviously
things DO work for many of these women, but I believe the "failure" rate is
higher. Population-wise, the women who are most likely to have problems are
the ones with hormonal rather than mechanical issues. It will be important
to compare these mothers to controls and observe for normal mammary tissue
entering pregnancy, and the response of mammary tissue during pregnancy.
Another issue is the rate of premature deliveries, as that will affect the
outcome of milk supply (the stress of an ill baby, how often the mother
pumps, if her breasts developed enough, etc). And, of course, comparable
breastfeeding management overall. 

Regarding trust issues: my experience is different from what some others
have said; the moms I've worked with mostly expect breastfeeding to work-
not having enough milk is the last thing they expect, not the first. It
tends to blindside them. I don't see lack of trust in their body as a
starting issue, though by the time they have gone through the struggle of
infertility treatments and then they have problems with lactation, they can
certainly feel traumatized and devastated about their bodies! 

What a great study to under take-- this needs to be done!

~Lisa Marasco

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