Brenda,

Thyroid dysfunction can affect MER but your case is pretty extreme. There also are things that are beyond our reach right now that could affect MER at the cellular level... insufficient or abnormal myoepithelial cells (documented in obese rats), broken pathway signal between oxytocin receptor and myoepithelial cell (CX43 problems have been documented in rats)...



I have had two moms with very poor MER. The first case was never solved except to suspect possibly psychological inhibition from long-term sexual abuse. The second mother learned after her first baby that she had to "wring" her breasts to get all the milk out.  Baby was also low-tone which made things worse, so he was getting most milk by bottle and pumping would take her 30 min.  For her it was a labor of love. She's the one who made me dig deeper and I discovered CX43 issues, but it wasn't something we could test for. 



On the oxytocin spray, she should get a genuine compounded version rather than off the internet to try.  If that doesn’t work, we may be back to paragraph 1 and no solutions.



Two additional things to explore: if there is any history of nerve impingements, accidents, etc, chiro is worth a shot.  Acupuncture has points that associate with MER, and that's worth a shot if nothing else fits.



Hope this helps.



~Lisa



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