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Preconception

Breastfeeding and Fertility
By Sam Thatcher, MD, Ph.D.
Sam Thatcher, MD, Ph.D.Q. I am almost 37 and am currently breastfeeding my 9 month old daughter. There is a 6 year gap between her and my middle child although my husband and I did nothing to prevent conception. My first two children were conceived very easily. I have not yet had a return of my menstrual cycle. My husband and I are currently trying for our fourth child and have been since my daughter was 2 months old. Is there anything that can be done to induce ovulation in a breastfeeding mother without weaning?

A. Lack of ovulation and poor uterine lining can often accompany breastfeeding at least initially, and have been a very important mechanism for our survival in the past. To be pregnant and breast feeding is perceived to be too taxing and therefore the body in its wisdom inhibits ovulation. The evolutionary mechanism does not take into account our capacity to go the food market and buy the food that we and our offspring need. I gave you this long introduction instead of just saying "no." There are very few drugs proven safe during breastfeeding. I guess progesterone could be used for menstrual regulation, but check with your physician. Even this natural hormone is secreted in breast milk, although in probably inconsequential amounts.

Q. We have one child who is 17 months. I nursed him until he was 14 months. We have been trying to get pregnant since he was 6 months old, right around the time my menstrual cycle returned. That is almost a year now. I am wondering what affect the nursing would have had on my fertility, and if that would be part of a reason we are having such a hard time getting pregnant this time? Last time it was really quick.

A. I would say yes, this is why you are not pregnant. One should expect a 6 month gap after feeding is completely discontinued before any concern. That is, unless you are using breastfeeding as a contraception. Then it always seems to occur immediately.

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