How to discuss continuing to breastfeeding while undertaking fertility treatment with your clinic
We have written this to try to help those of you who want to be honest with your clinic about continuing to breastfeed during treatment.
From our enquiries it often seems like clinics do not have a set policy about breastfeeding. Even within the same clinic, different doctors may say different things. It can be a difficult decision to discuss on-going breastfeeding with a clinic when they often initially present as not being in favour of it. However, many members have found that, by presenting facts and showing that they are well-informed, their clinics have been happy to continue with treatment.
We know that, unfortunately, the medical profession is not always very well informed about breastfeeding. Both in the regard of which medications can be taken, but also the great importance of the breastfeeding relationship to both women and their nurslings. Doctors can tend to be quite conservative and risk averse and find it fairly easy to tell women to wean when unsure.
On a more positive note it is important to be aware that we are finding increasing numbers of clinics who are happy to treat women who continue to breastfeed and are supportive of the choice that they make. Whilst we have compiled information on what we know about whether a clinic is breastfeeding friendly or not, this is currently not publicly available, and therefore only available to members of our facebook group. If you are a breastfeeding mum personally facing this journey, you can join our group here.
There has also been a published paper by Jeanette Elliott which provides a lot of useful information and her personal experiences of breastfeeding through fertility treatments. This is not publicly available, however it can be purchased through the Australian Breastfeeding Association, and is also available to read on our group.
You can also find on our facebook group a standard letter proforma you can use to contact your clinic, or the admin team will happily contact your clinic anonymously on your behalf.
Below we discuss the most common reasons that clinics give for not wanting to treat breastfeeding mothers. We look at the facts behind it and reference the information that we have. We have also included helpful links to further information so that you can read more about the topic.
Medications can be passed to the nursling via the milk/are not safe for the child nursing
We deal with this in detail on our medications information sheets which can be found here:
In summary all of the commonly used fertility medications are safe to be used, they will not pass on to your nursling. Of all the medications we are aware of used in fertility treatments only three: DHEA, letrozole (femara) and tamoxifen, are best avoided.
Please feel free to print the medication information sheets to show to your clinic.
In producing the information sheets we worked alongside Wendy Jones BSc, MSc, PhD, MRPharmS. She is a qualified pharmacist and runs the Breastfeeding Network national Drugs in Breastmilk Help-line in the UK. You can find out more at Wendy’s website:
We also used the following resources:
Doctor Thomas Hale is a US doctor who specialises in medication during lactation. His 2014 book, Medications & Mothers Milk is a useful resource.
A useful online resource is LactMed, part of the U.S. national online database of medications with information on drugs and lactation updated monthly which can be accessed here:
Another online resource is e-lactancia, run by APILAM; the Association for Promotion and Cultural and Scientific Research of breastfeeding, which is an organisation created by Spanish health professionals
There is also the NHS online resource, although this tends not to list the less common medications:
Medications can affect milk production
Some of the medications used in fertility treatments may affect milk production. From members’ experiences this is very variable. Many have reported no obvious effect and others have noted a drop in supply which has been temporary.
For this reason we usually recommend undergoing further fertility treatment when your nursling is over one year old. At this stage breastfeeding is well established and most nurslings are much less reliant on breast milk to meet nutritional needs.
Some clinics have given reduced supply as a reason to refuse treatment or recommend weaning to our members. We believe that there is no need to wean (and therefore definitely stop the breastfeeding relationship) for a risk that milk production might be reduced. Many members have nursed through a loss of milk production (dry nursing) which has more often been related to successful treatment and pregnancy. Alternatively a loss of milk production may lead to a process of weaning which would be something which yourself and your nursling can be in control of.
Weaning should not be imposed upon you by a clinic – it is a decision for you (and possibly your nursling!) to make. When discussing with your clinic it may be enough to explain that you understand the risk on milk production but that you are making the informed decision to take the risk.
Success rate will be reduced
This is naturally the factor that is of the most interest to all of us. The short answer to the question, will breastfeeding affect my chances of success, is that no-one knows.
As frustrating as this is, it is also reassuring, as there is no evidence that breastfeeding reduces the success rate of fertility treatment. There are no published clinical studies that we are aware of. What this means is that if your clinic tells you that your chances of success are lower than if you were to wean then your clinic is being speculative. They may say they have some evidence, in which case ask to see it, but the evidence may not stand up to scrutiny. The numbers of women undergoing fertility treatment while still breastfeeding are low (but happily increasing) and furthermore we know from members of the group that many women are feeling compelled to lie to their clinics about breastfeeding. Therefore clinics might be successfully treating breastfeeding women with no idea that they are still breastfeeding.
Having looked at the available information and being in contact with our members we do not believe that success rates are significantly affected by breastfeeding. We have collected success stories and have our own personal stories (some successful and some unfortunately not). You can read a selection of these stories here (there are more available on our facebook group that members have chosen not to share publically):
The success rates we see with our members are similar to the success rates of non-breastfeeding women. Sadly, we do not currently have the scientific data to back up our convictions, although we are working on collecting data and hope to publish in the medical literature in the future.
What we do have is testimony from those successful, and those who were not so lucky, that they are glad to have continued to feed through treatment. That the decision was the right one for them and their nursling. That they wanted to make the decision of when, and how, and if to wean be something for them to decide.
If in discussions with your clinic the question over success rates is raised then our recommendation would be to ask for the evidence they have so that you may read it and consider it away from the pressures of the consultation. If they are unable to provide evidence to back up their concerns then it may be enough to acknowledge the risks and to explain that you are happy to go ahead despite these concerns.
Breastfeeding causes raised prolactin levels which reduces chances of success
Breastfeeding does suppress fertility in the initial period after giving birth; this is the basis of the natural spacing of babies. The exact mechanism of this is not entirely clear. There is evidence that infant suckling suppresses normal GnRH release which is the factor that inhibits return to cycling rather than prolactin. The gradual return to fertility is affected by many factors – some of which are well understood and some of which remain a mystery. We have had clinics report that prolactin reduces success via more mechanisms than just suppressing ovulation, for example some clinics have stated that raised prolactin reduces chances of implantation. However, the subject of prolactin is one of those areas where we need to know more and there is not any evidence to support the suspicion that raised prolactin will affect the success of fertility treatment. If your clinic says they know for a fact that raised prolactin decreases success rates then please ask them for the evidence! We are not aware of any controlled studies into this subject.
What we do know about prolactin, fertility and success rates:
- Many, many women without fertility issues get pregnant while continuing to breastfeed.
- Prolactin levels reduce gradually after the immediate post-partum period to borderline/upper normal between 6-12 months after giving birth in the breastfeeding mother.
- If you are having regular periods it is likely that you are ovulating, no matter what prolactin level you get on a blood test.
- The success rates we see with our members are comparable to the success rates among the non-breastfeeding groups.
You can find out more about prolactin here:
You will notice in the above link that it is possible to lower your prolactin result by having the test done late in the day, not eat shortly before the test, have the blood taken as long as possible from the previous feed and relax!
If your clinic raises concerns about prolactin levels affecting success rates then, apart from asking if they have any solid evidence, the best approach may again be to take the ‘informed risk’ approach.
When considering whether to be open with your clinic about on-going breastfeeding please bear in mind that a clinic may still insist you wean or refuse to treat you no matter what argument/evidence you present. If this happens to you then you may consider moving clinic (this is a choice even if you have frozen embryos as they can be moved) or taking a less honest approach with your clinic.