Dear Jane-

It doesn't matter how old a child is.  If the child is nursng frequently
enough to keep estrogen and progesterone levels suppresses, it is
difficult to get pregnancy.  She  may be ovulating but be experiencing
luteal phase defect, which means that even if egg and sperm join, they
can't be supported until implantation.  For most women over 35, it takes
twice as much estrogen to ovulate as it does when they were 20--and the
average woman at 35 is "infertile".  Technically that means that  50 %
of 35 year olds will not conceive within a year of unprotected
intercourse.

In addition, about 15-20 %  of couples experience secondary
infertility.  This is infertility that occurs after one or more
pregnancies.  About 1/3 of the time it is related to male factors, 1/3
to female factors and 1/3 are a combination of factors from both
partners. These figures are for couples where breastfeeding is not a
factor.

There are several things this mother can do without weaning,  She can be
checked for physical obstructions in the tubes.  She can monitor her
cycle to see if she is ovulating and how long it is from ovulation to
the onset of menses. (There are home health kits as well as the old
basal temperature and mucus tests.) She and her partner can have a
post-coital sperm function test.  She and her partner can have full
physicals, including checks of thyroid function, diabetes, blood
pressure, etc. She can have an endometrian biopsy. In otherwords, there
are many things this mother can do BEFORE she needs to wean for hormonal
treatments. She will need a supportive OB/GYN who understands that a lot
can be done prior to weaning, just as some older women start infertility
workups prior to the wedding and to their attempts to conceive.

In my experience, it would be extremely unusual for an OB/GYN to be
willing to start hormonal treatment on a breastfeeding mother.  Of
course these formulations are not tested on nursing mothers and they are
hormones.  Were she to find someone who would prescribe these drugs,
this mother should be aware that she may see a precipitious decline in
her supply, and the child may wean or decrease frequency at that point.

This mother may also want to consider setting some limits in their
nursing relationship.  Night nursing is raises prolactin and suppresses
ovulation more than day nursing. No nursing from bedtime to sunup can be
a start--and its not a hard one during the summer. As the days get
longer, the no nursing time gets longer too.

I  work with a population of "older" mothers and I have seen this
problem a lot.  Mothers have a real dilemmia.  Should she wean the only
baby she may ever have in order to try to conceive another one or
continue nursing and perhaps miss her only chance at another child? No
one except this mother and her partner can weigh these alternatives.

Warmly,
Judy Gelman, IBCLC
Washington, DC