Pamela,
My experience is suggesting that polycystic ovary syndrome (PCOS) may be a
risk factor for inadequate milk production. You are right that 20% of moms
with PCOS may be hyperprolactinemic and thus have the opposite problems; I
believe that an unusual proportion suffer from low production as well.

I have had very limited success improving the supply in these women. They
seem not to ever really get their milk in from the start, despite good
nursing management and/or pumping routines. Fenugreek has not made much of a
dent, and reglan has given only a very modest boost. I don't have
domperidone to work with.

My attention has turned to anti-PCOS treatments instead as an indirect way
to address the root problem, which is likely hormonal. On the herbal side,
Vitex/Chasteberry seems to be the herbal choice for PCOS, though I have
heard little of its actual efficacy and have not had any moms try it. On the
medical side, there would be anti-androgen drugs, or possibly the new
anti-diabetes drugs metformin and troglitizone that are being trialed with
encouraging results on women with PCOS. I have had one mom choose to go on
metformin (she was about 2 mos pp and milk supply nil). She believes that
her milk supply started to come, but then she became unexpectedly pregnant
almost immediately (this, for a normally infertile mom) and went off the
drug before we could get more data.

I am wondering how it is that this mom got diagnosed during the pregnancy.
PCOS is usually diagnosed only when women complain of the symptoms, such as
amenorrhea/oligomenorhhea, infertility, etc. Even then, the trend is going
away from any set diagnostic criteria, and so I wonder what symptoms would
bring about a diagnosis third trimester? Weird. I take it that retained
placental fragment has been ruled out, and that there are no meds or
hormones being taken?

I'd be happy to dialogue more if you have more questions. There is
absolutely nothing in any literature on PCOS with regards to breastfeeding,
but I have studied the syndrome extensively and also conducted online
interviews of PCOS moms suffering from similar situations.

Lisa Marasco, BA, IBCLC
Santa Maria, CA