Leah,

Your post comes at an interesting time for me as I have fielded two inquiries of similar situations this week and have been dialoguing with a researcher about the cases.  I don't yet know exactly what leads to this sudden "failure," assuming that all other reasonable explanations (including poor infant suck) have been ruled out. I've not seen this specifically with PCOS; rather, the fact that she has a history of hormonal problems is certainly suspect.  I am really surprised to hear she felt depressed after one day on domperidone; was she already heading down that path because of the breastfeeding problem?  



So her milk comes in well but then "dies" off?  One thing you both might consider is requesting prolactin checks... In my perfect world (I can dream, right?), it would be awesome to document about day 2 and then every 2 wks thereafter, baseline and surge. Because of the costs of the test, however, it is highly unlikely to happen. But whatever tests you can get would help to know whether the drop in supply is related to a failure of prolactin to sustain normally, ie, message not getting back to pituitary (subluxations?), or pituitary response sluggish/refractory, or something else (unspecified). Until we start documenting these things, we will not move forward in our understanding of these mystifying situations. 



Proactively speaking, the best you can do is to optimize management with this next baby. Extra pumping might buy her more time, if she feels up to that effort. Make sure she doesn't have any pinched nerves or other such subtle body issues. If domperidone seems too scary, there are many good herbal galactogogues that could be part of the back-up plan. 



I would love to hear how this case goes.



~Lisa Marasco



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