Last update: May 13, 2019

Assisted Reproductive Techniques (ART)

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

Normal fertility cycle (ASRM 2018 and 2012):
The gonadotroph cells in the anterior part of the pituitary gland secrete two gonadotrophin hormones: the follicle stimulator, follitropin or follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The FSH regulates pubertal maturation. In women, it makes the ovarian follicles that secrete estrogen grow as the egg they contain matures. A surge of hypophyseal LH causes the follicle to break and release the egg.
The egg is fertilized by a sperm in the fallopian tube and ends up nesting in the endometrium, conveniently prepared by the ovarian follicle estrogens with the ovule and the progesterone from the residual follicle or corpus luteum.

In assisted reproduction treatments (ART) for infertility, two issues must be taken into account:

1. THE POSSIBLE EFFECTS OF ART ON THE INFANT OR BREASTFEEDING:
The various techniques used in the ART process (MedlinePlus 2019, ASRM 2018 and 2012): intrauterine insemination, in vitro fertilization, ovule collection, gamete or embryo transfer, etc., are physical-mechanical procedures that can not cause alterations in the infant or breastfeeding. The possible anesthetics used to apply them are compatible with breastfeeding.

However, two ART techniques use medication:
- for controlled ovarian stimulation (COS), clomiphene or letrozole are used and if they fail, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to mature the follicle and human chorionic gonadotropins and human menopausal gonadotropins (HGC and HMG) to cause ovulation. Gonadotropin-releasing hormone (GnRH) agonists and antagonists can be used to control that stimulation.
- Progesterone and estrogens are used to favour the nesting process.

Many of these drugs are found naturally in the body, have high molecular weight and protein nature, so they do not trasfer into breastmilk in significant quantities and are not absorbed in the intestine of the infant when ingested. It has not been proven that they reduce milk production.
They can be consulted one by one by clicking on the ones that appear at the end of this entry.
In general, they do not interfere with breastfeeding and do not affect the infant, who in these cases is usually older than 6 months and even 1 or 2 years old.

2. THE POSSIBLE INTERFERENCE OF BREASTFEEDING WITH ART Breastfeeding, especially when frequent, could have a negative effect on ovulation. This is the main reason why assisted reproduction services recommend stopping breastfeeding before starting treatment which is usually emotionally costly as well as often from a financial perspective.
To date there is no published evidence that breastfeeding interferes with infertility treatments.

A whole series of data should be taken into account:
- Breastfeeding mothers have periods of amenorrhea and infertility of between two months to two or more years (Diaz 1990), but it is also true that pregnancies occur in breastfeeding mothers.
- Exclusive breastfeeding and frequent suckling are essential for maintaining amenorrhea. Once the first postpartum menstruation appears, fertility is restored, although the frequency of pregnancy is lower in menstruating mothers who are breastfeeding (Diaz 1990).
- Breastfeeding mothers have high levels of prolactin and FSH and low levels of inhibin (Kremer 1994), estradiol (Burger 1994) and LH (Glasier 1983).
- The exact mechanism by which breastfeeding hinders ovulation is not known, but it does not seem to depend on the increase in prolactin, which is only at maximum at the beginning of breastfeeding (Battin 1985), but on the suppression of the pulsatile rhythm of LH secretion (McNeilly 2001, Tay 1991), which is complete during early breastfeeding and only partial during late breastfeeding (Kremer 1991). For some reason, the ovary does not respond to FSH and does not produce estrogen (Bonnar 1975).
Stimulus on the breasts has to be very frequent for this to happen (McNeilly 2001) and breastfeeding, with regard to older infants, is no longer exclusive nor as frequent.

There is no published data that demonstrates that breastfeeding is incompatible with assisted reproduction processes.

In the last 10 years, three mothers have told us that they had continued to breastfeed while on ART, which included COS, without there being problems for breastfeeding or the infant and they had a successful pregnancy.
You can see and hear personal testimonies at Bernal EM 2014.


See below the information of these related groups:

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Assisted Reproductive Techniques (ART) belongs to this group or family:

References

  1. MedlinePlus. Assisted Reproductive Technology (ART). Health information for you 2019 Full text (link to original source) Full text (in our servers)
  2. MedlinePlus. Tecnología de reproducción asistida (TRA). Información de salud para usted. 2019 Full text (link to original source) Full text (in our servers)
  3. ASRM - American Society for Reproductive Medicine. Assisted Reproductive Technology (ART). A Guide for Patients. 2018 Full text (link to original source) Full text (in our servers)
  4. Bernal EM. ¿Es compatible la lactancia con la Reproducción Asistida? Creandounafamilia.net 2014 Full text (link to original source)
  5. ASRM - American Society for Reproductive Medicine (Sociedad Estadounidense de Medicina Reproductiva). Tecnologías de reproducción asistida (TAR). Guía para pacientes. 2012 Full text (link to original source) Full text (in our servers)
  6. McNeilly AS. Neuroendocrine changes and fertility in breast-feeding women. Prog Brain Res. 2001;133:207-14. Review. Abstract
  7. Díaz S, Seron-Ferre M, Croxatto HB, Veldhuis J. Neuroendocrine mechanisms of lactational infertility in women. Biol Res. 1995;28(2):155-63. Review. Abstract
  8. Kremer JA, Schellekens LA, Segers MF, Thomas CM, Rolland R. Circulating inhibin levels in lactating and nonlactating women. Fertil Steril. 1994 Dec;62(6):1150-6. Abstract
  9. Burger HG, Hee JP, Mamers P, Bangah M, Zissimos M, McCloud PI. Serum inhibin during lactation: relation to the gonadotrophins and gonadal steroids. Clin Endocrinol (Oxf). 1994 Dec;41(6):771-7. Abstract
  10. Kremer JA, Borm G, Schellekens LA, Thomas CM, Rolland R. Pulsatile secretion of luteinizing hormone and prolactin in lactating and nonlactating women and the response to naltrexone. J Clin Endocrinol Metab. 1991 Feb;72(2):294-300. Abstract
  11. Tay CC. Mechanisms controlling lactational infertility. J Hum Lact. 1991 Mar;7(1):15-8. Abstract
  12. Diaz S. Lactancia e infertilidad en el periodo postparto. Instituto chileno de medicina reproductiva. 1990 Full text (in our servers)
  13. Battin DA, Marrs RP, Fleiss PM, Mishell DR Jr. Effect of suckling on serum prolactin, luteinizing hormone, follicle-stimulating hormone, and estradiol during prolonged lactation. Obstet Gynecol. 1985 Jun;65(6):785-8. Abstract
  14. Glasier A, McNeilly AS, Howie PW. Fertility after childbirth: changes in serum gonadotrophin levels in bottle and breast feeding women. Clin Endocrinol (Oxf). 1983 Oct;19(4):493-501. Abstract

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