In my practice I have seen an increasing number of women with PCOS and 
infertility issues that are being helped to conceive. As with your client, their 
pregnancy is often a rocky road with multiple complications. We are now 
having them stay on their metformin during prenancy and after. As a result 
their hormonal imbalance is improving, they are having spontaneous pregancies 
with fewer complications but they are not showing an improvement with their 
milk supply. Theoretically it would seem like a good course of action, but the 
hormonal improvement is not quick enough to solve current issues.
We have also tried herbal galactagogues like Fenugreek, without success in 
this group of women. We have not tried Domperidone. Our protocol is to try 
Reglan first, if that is successful in improving the milk supply, but not well 
tolerated, then we request domperidone from the providers. Reglan's side 
effect profile is the reason it is not our first line choice in this group of mothers 
already experiencing complications. We encourage breastfeeding as primary 
and supplement as necessary for as long as mother and infant are comfortable 
with the plan. It has been our experience that the need for increasing amounts 
of supplement ultimate leads to weaning.

Karen Doering
Glens Falls, NY

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