Page 1 of 3

Breastfeeding and Fertility

PostPosted: Mon Mar 15, 2010 5:32 am
by blue-eden
Breastfeeding and Fertility
Some information about the LAM for preventing pregnancy, and methods to bring back fertility while breastfeeding. I tried to include sources from the internet, as well as my textbooks and journals.

The single most important element in suppressing ovulation while breastfeeding is starting early with demand feeding and a proper, deep latch. Research suggests that a mixture of hormones (growth hormone, leutinizing hormone, follicle-stimulating hormone and estrogen) play a key role – more on this later.

After birth, most women experience a period where they do not menstruate. How long this lasts is relative to each woman, from several weeks to up to a year or more. After this period of amenorrhea, some women do get their periods back, but they are anovulatory. By 6 months PP, 19-53% of women will get AF if they are EBF. Some get it back as early as 6 weeks, and some do not get AF back until weaning is complete. Some women experience bleeding around 42-56 days PP. This may be lochia or it could be a change in activity level, rather than a return of AF.
In contrast, a bottle feeding mother averages 10 weeks after birth for a return to fertility. Levels of FSH and LF return to normal.

So what is going on with Bfing mothers, that contributes to this absence of fertility?
The following info is adapted from “Mechanisms Controlling Lactational Infertility” by Clement C.K. Tay.

At the beginning of the menstrual cycle, the follicle growth is due to the increase in the Follicle Stimulating Hormone (FSH). Growth is dependent on the secretion of oestradial from the follicle, in response to the leutinizing hormone (LH). The LH is released from the pituitary in response to the gonadotrophin-releasing hormone (GdRH) from the hypothalamus. This in turn is regulated by ovarian steroids. Oestradial increases the GnRH and around midcycle, an increase leads to the ovulatory surge of LH. Very important here is the LH secretion from the pituitary. In clinical studies, during periods of amenorrhea, the LH secretion is abnormal, absent or reduced.
For breastfeeding women in the early weeks, the FSH levels return to normal, but the LH levels do not. Studies suggest that this is the result of the reduced secretion of GnRH, which is in turn caused by infant suckling. The inability of the hypothalamus to maintain the GnRH secretion results in ovarian inactivity during breastfeeding, a conclusion which was then supported by a study in Edinburgh. Some studies suggest that suckling-induced opiads might contribute to the GnRH suppression.

Prolactin might also play a role. Some studies suggest that prolactin is higher at night, which means that night feeding contributes to lactational infertility. However, other studies suggest that there is no real difference, especially before the post partum mother starts menstruation. An overabundance of prolactin doesn’t seem to interfere with ovarian activity, nor does it appear to reduce GnRH output.

So what is a BFing mother to do, when she wants to start the process of TTC another baby?
*ALWAYS discuss with your doctor before you take anything*

Here are some suggestions from LLLI:
http://www.llli.org/NB/NBMayJune04p114.html
And from Kellymom:
http://www.kellymom.com/nursingtwo/reso ... ile-bf.pdf

More on Breastfeeding and Fertility here:
http://www.llli.org/NB/NBSepOct06p196.html

Some women have success with fenugreek. Fenugreek is considered an emmenagogue. Here is more information about Fenugreek, with some precautions.
http://www.breastfeeding.com/all_about/ ... tions.html

Other women talk to their doctors about Vitex, or chasteberry.
Here is some information about Vitex :
http://www.aafp.org/afp/2005/0901/p821.html
And about it’s possible efficacy and safety:
http://docs.google.com/viewer?a=v&q=cac ... ZfoQvcYePg



And if you don’t want to get pregnant …


The Lactational Amenorrhea Method of Contraception (LAM)
For women who practice this method, it’s 98% effective. Three conditions are necessary:
1) Woman has not yet menstruated
2) Woman must breastfeed around the clocks, without significant supplemental foods
3) Baby is younger than 6 months old

Avoiding the use of bottles and pacifiers is recommended. This is also known as “ecological breastfeeding”.


Cultures which have a high success rate with this method also keep their babies close, feed their babies at night, and sleep with their babies. They also “demand feed” much more than our culture does. Some cultures have been reported to bf as much as FOUR times PER HOUR. This drastically increases their chances of having LAM work for them, compared to our culture which still (while not precisely scheduling nursing sessions in a rigid schedule) still divides up nursing into “feedings” spaced much further apart, a concept foreign to other cultures.

More information here:
http://www.infactcanada.ca/bfchild.htm
And a downloadable PDF here:
http://www.bfmed.org/SearchResults.aspx ... =fertility


This is just scratching the surface of this topic, and I'll add more when I come across more information.
Please feel free to add your own information, and your TTC while BFing stories and successes~ :)

PostPosted: Mon Mar 15, 2010 5:42 am
by blue-eden
I also wanted to address fertility drugs. Clomid is one of the most popular methods that women use to induce ovulation.

According to Dr. Thomas Hale, who is the foremost authority on breastfeeding pharmacology, there is no reason to believe that Clomid is not compatible with nursing.

One issue is that it might contribute to drying up the mother's milk supply, which is a moderate risk.

Dr. Jack Newman has written this on that subject:

Clomiphene (Clomid) is not contraindicated during breastfeeding, but it
could cause the milk to "dry up". I have had a few mothers far along that
did not seem to be affected by it, when it was taken far along, as in this
case, but it could, at least in theory, decrease the milk supply
considerably.


More information about Clomid here:
http://toxnet.nlm.nih.gov/cgi-bin/sis/s ... /~EBxlzl:1

PostPosted: Thu May 13, 2010 11:34 am
by blue-eden
bump

PostPosted: Thu May 13, 2010 12:47 pm
by Susy07
Thanks blue. Lots to read through. :)

PostPosted: Thu May 13, 2010 8:06 pm
by victoria_1024
Thanks Blue! Very interesting info. I am starting clomid in a few days even though I am still nursing 3x a day. My OB said that was just fine. So happy I don't have to wean!!

PostPosted: Thu May 13, 2010 8:07 pm
by Susy07
Yea William still nurses a ton. like 6, 7 times a day. Didn't affect anything :)

PostPosted: Thu May 13, 2010 8:16 pm
by dee12h
I'm ttc now while BF so we'll see how it goes. :)

PostPosted: Thu May 20, 2010 9:47 am
by la
My daughter is 10 months and is still EBF. This past week i have gotten her to drink some juice/water from a sippy cup though. She was concieved on clomid and I just went to the dr. and he prescribed me 100 mg. I've had some really light periods and two major periods but no ovualation thus far. I'd love to hear from anyone else who is going through the same type of situation.

PostPosted: Thu May 20, 2010 10:39 am
by Susy07
Yup. I mean. Not the EBF thing but I've had 4 real periods and 2 bouts of spotting. DS was a clomid baby 100 mgs. But doc gave me 50 to start, this time. Adn I o'd cd 16!! I think the extra bottles helped. :)

PostPosted: Thu May 20, 2010 12:13 pm
by la
Yay for the ovulation bcblondie! Hopefully this is the month for you! So how often does your son breastfeed? I think I should clarify that my daughter does eat meals with us so I guess that she is not exclusively breastfeed anymore! So is this your first clomid cycle?

PostPosted: Thu May 20, 2010 12:21 pm
by Susy07
Thanks! I hope this is our month too. Clomid is expensive here. lol. And also, af sucks. haha.
William still breastfeeds a lot. We nightweaned him but in teh day he breastfeeds like 6 times. Some days he eats a ton of solids but some days not much. so.
Yep first clomid cycle TTC #2. Hope we don't have to do 5 rounds like last time. lol.

PostPosted: Thu May 20, 2010 1:01 pm
by la
That's a bummer that your dr. wouldn't just start you off at the dosage that worked for you last time, but if you ovulated on 50 mg thats a great sign!
Last time I didn't ovualte on my first two clomid cycles of 50mg it took the third cycle of 100mg to work and I got pregnant.
I'm just waiting now for my period to start. I am cycle day 29 right now and my cycles have always been a bit wonky so hopefully something starts up soon.

PostPosted: Thu May 20, 2010 1:06 pm
by Susy07
Ummmm.... poas! lol.

PostPosted: Thu May 20, 2010 1:21 pm
by la
I don't temp since I don't ever get 3 hours of sleep in a row for one reason or another, lol but I was taking opts and never seemed to get a positive. I am terrible at reading them though. But I did have EWCM from cycle day 20 to 24 and on day 23 it was gobs of it with a tinge of blood. sorry if tmi :oops:
So there is no way it would show up. At least that's what I'm gonna keep telling myself to keep me from spending a fortune on tests! :lol:

PostPosted: Thu May 20, 2010 3:57 pm
by Missbollinger
We nurse 5-6 times a day but Henry has STTN 5-6 hours since 5 months old and now 12-13 hours.

I didn't chart, we just guessed the time period when I normally ovulate even tough my cycles were all over the place and caught the egg either earlier this month or late last month LOL Not sure yet :oops: