Dear Jane,

I will first introduce myself.  I am a new subscriber to LACTNET and a LLL
Leader in Laurel, MD.

I would like to offer another perspective regarding the mother of the
nursing four year old who is experiencing infertility, but has been told she
needs to wean before she can receive treatment.

I know of no studies, but I can offer anecdotal evidence that should
encourage her to "continue nursing while exploring her fertility issues".
All the studies I have seen have looked at relatively young nursing children
(under age one).  Studies such as you describe are badly needed.  If they
exist, I would love to see them.

She deserves the same thorough infertility workup that a non-lactating woman
would receive, as Judy described.

This mother should know that other nursing mothers have used Menotropins
(Pergonal, Humegon), Clomiphene (Clomid), Chorionic Gonadotropin (Profasi),
and natural progesterone (all meds commonly used in infertility treatment)
under a doctor's care, while nursing an older baby/child, and successfully
gotten pregnant and continued nursing through pregnancy.  These medications
are not necessarily incompatible with breastfeeding.  According to Hale,
Clomid suppresses milk production in early lactation, but its effect would
be minimal in the woman whose lactation is well established.  Hormones are
large molecules which do not pass easily into breastmilk (Menotropins MW:
34,000, Profasi:  MW:  47,000, Clomid: MW:  406).  These medications are
typically used for only short periods (9-12 days).

Lactating mothers are often told they must wean or wait for treatment.  She
needs to ask her Dr. what his or her concerns are - for the nursing child?
Look up the med's and their effect. For the success of the treatment?  Check
hormone levels.  Most likely they are normal at this stage of their nursing
relationship.  Many other things can cause prolactin spikes, but women are
not told to refrain from those while under infertility treatment.  For her
milk supply?  Most nursing mothers seeking treatment for infertility value
their nursing relationship and do not want it to end abruptly or
prematurely, however, many are willing to risk the decreased supply that
would come with pregnancy anyway.  If there is any effect on milk supply and
mom doesn't get pregnant, the avid older nurser can take care of that.  If
she gets pregnant and baby weans, well, that's always a possibility
regardless of how the mother gets pregnant.

There is a tendency to deny lactating mothers with infertility the same
range of treatment others would get.  Why?  Because the hormone treatments
"oppose" lactation?  Pregnancy hormones also "oppose" lactation.

Sometimes it is the infertility itself causing the infertiltiy - not the
nursing.

I am hoping that as this issue gets raised over and over we consider that
the infertile mother should have the same "right" to practice extended
nursing while being offered treatment.  As Judy pointed out, many of these
moms are older, compounding their infertility.  Time is of the essence.  I
think they shouldn't have to wait for the child to wean, or wean prematurely.

She needs your help to become informed, look for an open-minded physician
and be persistent.  Thanks for offering her that.

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