Doraine,

>>- Do polycystic ovaries (in and of themselves) interfere with
breastfeeding?<<

This is an area that I am investigating. I believe that I am seeing a
disproportionately high number of women with PCOS who have primary milk
supply failure. Possible mechanisms:

1) PCOS is characterized by excess androgens, which have the potential to
down-regulate prolactin and estrogen receptors. The moms I've worked with
have had only mild responses to fenugreek and reglan despite excellent
management; if this theory holds, it makes sense that pumping up prolactin
will have only a limited effect if prolactin *receptors* are being limited.

2)PCOS women also have little or no progesterone, which is why they have a
high rate of miscarriage.

3)When it comes to breast development, I see a theoretical potential for
disruption of good breast development. It takes estrogen to develop the
ducts and progesterone to develop the alveoli (I hope I didn't get this
mixed up). Considering the above, I can see a possibility of poor breast
development either during adolescence or pregnancy or both.

4)20% of PCOS women are *hyper*prolactinemic and may produce TOO much milk.

4)Most important to know: PCOS is a syndrome and each woman has her own
unique collection of symptoms. The mom you describe sounds more "classic"
(her heaviness), but because the symptoms and severity can vary, the effect
on lactation can range from none to lots, IMHO.

>>- Is there anything that could be done now to improve her situation with
hormone use?<<

That is the question I am asking, too. Logic would dictate that perhaps an
anti-androgen medication would counter the most obvious endocrinopathy, but
there is no research on this to date and I have had great difficulty getting
ANY doctor to even take this theory seriously.

The greatest difficulty *you* have, Doraine, is the fact that moms smokes.
It's hard to know how much that can impact things, and for sure if any of
the above is true, that would be the icing on the proverbial cake for her
problem. Can you find out exactly how much milk she was producing before it
"dried up"?  If she was producing plenty and it suddenly disappeared, then I
would not blame it on hormones--- look at the smoking and at management.

Lisa Marasco, BA, LLL, IBCLC
Santa Maria, CA