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 *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome