I wonder if it's similar to insulin resistance - one of the theories of 
type 2 diabetes was that chronic high levels of insulin secretion may 
downregulate receptors. It's probably much more complicated than only 
that, but perhaps the chronically elevated prolactin in the absence of 
other hormones that work with prolactin to produce trophic effects on 
the breast (progesterone particularly) might cause a reduced number of 
receptors? Or even that there is a certain proportion of prolactin and 
progesterone needed during pregnancy to have normal breast development, 
and if there's too much prolactin, maybe it's like there is too little 
progesterone? Just speculating. I wonder if Laurie Shornick knows , I'll 
bcc her on this. Laurie?

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com

On 3/14/2014 2:02 AM, Lisa Marasco IBCLC wrote:
> Barbara,
> 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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