It seems to be "conventional wisdom" that a woman has to wean for fertility tx, but as with most things, it's not black and white, and there's not one right approach for every situation.
I faced this dilemma myself while trying to conceive my second child.
There are 2 aspects of BFing which could affect fertility.
First is the effect of prolactin on ovulation. However, prolactin levels decrease over time and most women do return to ovulation and fertility eventually without weaning. Plenty of women spontaneously conceive while BFing, we know that. Some women do not ovulate as long as they are BFing, so this subset of women may need to wean to become fertile. Since ovulation is something which can be monitored, this potential effect of BFing on fertility can be observed. (in my case, measured prolactin levels were actually on the lower end of normal, and I ovulated like clockwork once cycles returned at a year postpartum).
The second potential effect is less well studied and not as easily monitored. That is the potential effect of oxytocin-induced uterine contractions on implantation. This is more theoretical. I couldn't find any real information on it when I searched while trying to make up my mind about my course of action.
In the end, I chose not to wean before IVF; if my cycle were unsuccessful after weaning, then I would have lost both my wished for baby, but more importantly my nursing relationship with the child I already had. Other women may feel that they need to do anything possible to up their chances of success, and for them, weaning might make sense where for me it did not.
I did however limit nursing following transfer. We had to travel for the transfer, so I was separated from my 2y 9m old daughter for 48 hours post transfer. After we returned home, I discouraged nursing and kept sessions short for the next week. That was the extent to which I "did everything to up chances of success." This may have sped up the weaning process a little, but my daughter did continue to nurse 1-3 times a day until she stopped right around her 3rd birthday, when my supply rather abruptly nose dived in the early 2nd trimester.
I will defer to Dr. Hale as far as the effect of the medications on the BFing child or the milk supply, but I felt comfortable nursing with the meds I was on for my cycle, and my nursling was old enough that I didn't feel the potential effect on my milk supply was critical. (keep in mind , pregnancy generally has a negative effect on supply, so if baby is young enough that loss of supply is a reason not to take the meds, then pregnancy should also be avoided.)
Here is a link to an excellent podcast on the topic of IVF and BFing by a mother who has 3 children, 2 of whom were conceived via IVF while still nursing. She talks about the need for mothers to weigh risks and benefits rather than make a blanket recommendation.
http://mumsright.libsyn.com/index.php?post_year=2007&post_month=11
Hope this will give your client some food for thought!
Spencer Joslin, MD, LLLL, IVF mom!
------------------------------
Date: Tue, 1 Feb 2011 10:16:06 -0500
From: Sonya Shaver < [log in to unmask] >
Subject: fertility treatments
Hello all,
I have permission to post about this client. She tried for a long time to
get pregnant with her first child, and finally was successful with the help
of some fertility treatments. The baby is now 18 months old and still
breastfeeding, but also eating lots of solids too. The mom would like to
start trying to have another baby, and was told that she needed to wean
because she needs to take FSH and LH. She does not really want to wean, but
on the other hand she really wants to have another child and doesn't want to
wait much longer because of her age.
Hale lists FSH as an L3, but says it is very unlikely to enter milk or be
orally available to the baby. However, it may alter milk production because
of the hormonal changes in estrogen and progesterone. It does not list LH,
but I called the Infant Risk Center and they the LH also will not affect the
baby, but that of course continuing to breastfeed can affect her ability to
become pregnant.
So, I am just trying to help her navigate this decision. Have they told her
she needs to wean because the FSH and LH might not work as well if she is
still breastfeeding? Because breastfeeding is still affecting her
hormonally and therefore to give it the best chance, she needs to wean? Or
is it because it might decrease her supply? Or something else? Just trying
to help her make an informed decision.
Thanks for any information!
Best,
Sonya Shaver, BS, CHES, IBCLC
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E. Spencer Joslin-Montlick, MD
[log in to unmask]
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E. Spencer Joslin-Montlick, MD
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