Lea asks for input about a mother who three days ago gave birth to
twins at 35 weeks gestation.  With her previous child she had problems
with supply despite seemingly normal breast anatomy and postpartum
engorgement.  She had IVF for 'primary ovarian failure'.

I am not sure what primary ovarian failure means, but unless she used
donor ova, her ovaries must have been able to produce them with
hormonal stimulation since she had IVF. In any case, it shouldn't
affect breast anatomy or physiology as far as I know.

I wouldn't expect to see much milk three days post partum in any
woman, and would not expect these babies to be able to get supply
started unless they are exceptionally energetic at the breast. The
ones I see at this age are all being fed donor milk the first few days
until mother's supply is sufficient anyway. I would wait and see what
happens when lactogenesis II occurs.

About the Crohn's disease, I doubt it has anything at all to do with
it.  I've worked for extended periods with several mothers with
Crohn's and supply has never been the issue for any of them. The
medications used to treat it nowadays seem to predispose mothers to
mastitis because they are immune suppressed, and when they have
flare-ups they have quite a challenge staying adequately hydrated, but
their babies have been well nourished right along at the breast.

Rachel Myr
Kristiansand, Norway

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