Morgan,
There was a time when I think the statement was true, but I no longer
believe that.  Infertility science has learned to hop scotch over issues in
order to achieve and maintain pregnancy. When there are hormonal or
undetermined roots of infertility that are bypassed, we may be overlooking
problems that continue to exist, such as inadequate hormone levels or
inadequate receptor development. The very fact that many of these
pregnancies are at high risk of complications (beyond the issue of
multiples) suggests that achieving pregnancy itself is not a guarantee for a
normal course in all aspects. There is so much more to the picture and
almost no research in regards to lactation outcomes.

In order to understand the implications more clearly, you may want to delve
more into the world of endocrinology in general and then reproductive
endocrinology. Environmental disruptors will intersect with this general
knowledge and add another layer.  My approach has been to look at research
related to hormones I know to be important to mammary gland development and
lactation. From there you can glean insights into the questions you are
asking. 

When it comes to advanced maternal age, many women do well but some women do
not. I've worked with several mothers now, often grand multips, who have
previous successful lactations but with a later, spontaneously conceived
pregnancy, suddenly have milk supply problems. My latest did fine with her
first 8 but has had problems with her last two. Each woman's situation is a
little different, and it is hard to generalize except to acknowledge that
women are by far the most fertile and well-functioning in their teens and
twenties, and then things do generally slow down after this, though they
usually work well for another 1-2 decades. The concept of the bell-shaped
curve suggests that there will always be those few on both outer edges that
do not conform to the norms, and there will be good reasons behind them. Is
the shape of this curve changing?  Maybe that is the question we should be
asking.

Lisa Marasco

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