Kathy,
 I have a dear friend in a similar situation as the mother with PCOS you
described.  This is her 2nd baby.  She barely got any milk at all after her
first was born and a snowball effect of complications ensued to jeopardize,
and ultimately sabotage the breastfeeding relationship.  This time, she
wanted things to be different and we did a lot of research to make it so.

While she is getting  more milk than after her first baby, she still has to
supplement with donor milk through an at-breast supplementer (she is
committed to mothering at the breast so the Lact-Aid is viewed as something
positive, not a barrier).

She took metformin throughout her pregnancy this time.  There are many
theories out there, but one with regard to metformin is that it helps to
regulate the hormonal action during pregnancy to enable the breasts to
prepare for lactation after delivery.  

The same could be said of supplemental progesterone; often in these mothers
with assisted conceptions and hormonal issues, the breasts either do not
receive or do not respond to the dramatic increase in progesterone that a
woman experiences in pregnancy.  Progesterone supplements given during the
first trimester may be helpful, but they are obviously contraindicated after
delivery (as the preciptious drop in progesterone following the delivery of
the placenta is one of the factors that cues lactogenesis).

I'm sorry that I'm not answering the question you asked, whether metformin
would help her -- my friend is glad she is on the metformin long-term for
many reasons, among them a more successful breastfeeding experience this
time around, which may or may not be directly attributable to the metformin.
She is on a regular therapeutic dose for PCOS.  I can ask specifically how
much that is if you would like.

My thoughts go out to this mother you are working with!  I am always so sad
to hear of mothers who truly want to give their babies the gift of their
milk but run into obstacles like this one.  At the same time, I'm so
inspired by their willingness to persevere and keep trying.

--Diana in NY

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