Hi Linda - thanks so much for replying.  Am beginning to wonder if I miss a
few Lactnets because I often pick up things AFTER the event, having not seen
the original posts, consequently I'm afraid to say I did not recall this
message - thanks for sending.

I was very interested to read of your two cases.  They sound very similar to
my latest one.  It seems to "fit", yes?  You bring up an interesting thought
- that lactation would not be an issue in the normal course of events,
because mothers that require fertility treatments would not usually
conceive.  My "hunch" is that these moms have hormonally related reasons for
absent lactation - could it be the pituitary??  Or the ovaries?  Something
that happens earlier, say during puberty?  I wonder if the menarche is late?
The other two mothers I have seen who did not lactate both produced a very
tiny quantity of colostrum, the first a couple of drops on days 1 - 5 or so,
then nothing; and the second literally a "glisten", which again did not
increase in spite of frequent and efficient stimulation by the baby at the
breast.  The second one was last year and is still fresh in my mind - the
baby was large and strong, but gradually became weaker over the next few
days.  Mom was not discharged until the morning of the sixth day, when baby
had lost 16% of his birthweight.  I was really worried, kept telling the
paed (whom I know quite well, *very* pro-BF) that milk just wasn't coming
in, he simply couldn't believe it.  Mom had to be discharged before she
could obtain formula.  This mom was older, 46 if I recall, first baby, large
flaccid breasts also.  The first was about 30, no reason at all I could find
why she couldn't produce milk.  Both these first two moms were prescribed
sulpiride (similar to metoclopramide, commonly used in Zim, really helpful
usually, but not in either of these two cases).  Neither of these first two
moms had been treated hormonally for infertility, the second one was single,
though in view of her advanced age it's possible that she may have had
infertility problems, but not been treated!  This may have been the "last
fling of the ovaries" that we read about??

To answer your question, is it fair to include women who need help with
ovulation in the same category as "normal" (whatever that is!) women (ie
women who don't need hormonal assistance to become pregnant).  I don't know.
But I think we will see increasing numbers of these women.  I wonder if
hormonal assistance is a red flag for the risk of lactation failure!  I have
to write a report to the referring OB about this latest mom, and I'm at a
loss to find a legitimate sounding "reason" for absent lactation.

Incidentally, I recently worked with another mom whose pregnancy was
"assisted" in much the same way - she produced some milk, but not enough,
about half of what baby required.  I put this one down to inadequate
glandular tissue (breasts smallish, flattish, not much tissue between areola
and armpit, that area that usually produces the *most* milk).  So I'm
convinced that there is a risk here.  But which hormone?  I wonder if it's
estrogen, which would cause proliferation in early pregnancy?  Or
progesterone, which would continue this later?   Or thyroid, or prolactin?
We need more research!

Thanks for your thoughts.  If anything occurs to you, please send more!

Pamela