Expert Q&A

	By Mary Kay Smith IBCLC, Lactation Consultant

I am nursing my toddler and have been trying to get pregnant. My doctor says I am probably ovulating but that my prolactin levels are keeping my uterine lining from growing enough to implant an embryo. He suggests complete weaning, but I don't think my son is ready. I am 42 years old. Do you think weaning is necessary?

Prolactin can be an indirect culprit in infertility. Prolactin inhibits progesterone, causing short luteal phases and preventing a newly conceived embryo from implanting in the endometrium. If ovulation is occurring, progesterone suppositories used vaginally can assist in providing an environment conducive to implantation of an embryo.

One of the concepts related to breastfeeding amenorrhea involves the relationship between estrogen and progesterone. If the child is nursing frequently enough to keep these levels suppressed, it can be difficult to ovulate or conceive. Some women report that an interval of six to eight hours between nursings can encourage ovulation. For most women over 35, it takes more estrogen to ovulate than it does for a 20- year-old.

It would be helpful to do some simple blood tests to confirm whether or not you are actually ovulating before "forced weaning" is necessary. There are also some simple methods to determine whether or not ovulation, such as tracking basal body temperature and cervical mucus. Over-the-counter tests also available for home use to confirm ovulation.

Perhaps your child is old enough to "bargain" with and you can limit nursings to stretch time intervals in hopes of conceiving. Limiting night nursing may be especially helpful. Nursing can be a comfort to a child experiencing the stress of being a toddler and it would be a shame to take that away if not needed.

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