Lisa,
 
So glad you replied and would love to correspond with you more about this  
mom and her history.  Her prolactin level was 51.3 at 5 days PP.  Her  
endocrinologist is fearful about the dopamine antagonist effect of domperidone  
but mom is going to try it anyway, so will let you know what  happens. (Mom's 
endo left it up to mom to make decision on domperidone).  I've spent the 
whole morning and last night researching, conferring and  relaying info to 
parents.  And in her case it isn't just one possible  interference with supply, 
it's also PCOS, hypothyroid, ulcerative colitis; so  would metformin cause 
diarrhea and exacerbate colitis should PCOS cause be ruled  out.  It seems 
to me that the low prolactin level is treatable, with a  trial of domperidone 
with close follow-up.  
 
Would appreciate hearing about similar cases and outcomes.
 
Barbara Latterner
 
<I am aware of a number of similar cases, women with a history of  
pituitary adenomas requiring medications to bring down prolactin so that she can  
ovulate and conceive. While you would think that this would set a woman up for 
 lots of milk, that is not necessarily the case.  I will be very interested 
 in hearing the results of the prolactin test. It would be even more useful 
if  there could be both a baseline and a surge measurement, as a couple of 
published  case studies found very poor surges.  No one has taken the time 
to dig into  these cases and understand what is going on, but suffice it to 
say that when  there is a pathology in the picture, it has the potential to 
cause problems even  if we were able to leapfrog over the fertility impact.  

In some  cases, stimulating prolactin is the last thing the physician wants 
to have  happen, at least artificially.  But if prolactin comes back low 
and a  decision is made to try dom, it would be interesting to see what does 
or does  not happen.  Tough situation. 

Lisa  Marasco>

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