Fertility Treatments and Weaning
From NEW BEGINNINGS, Vol. 24 No. 5, September-October 2007, pp. 214-216
"Toddler Tips" is a regular feature of the magazine NEW BEGINNINGS, published bimonthly by La Leche League International. In this column, suggestions are offered by readers of NEW BEGINNINGS to help parents of toddlers. Various points of view are presented. Not all of the information may be pertinent to your family's lifestyle. This information is general in nature, and not intended to be advice, medical or otherwise.
My partner and I are hoping that I will get pregnant again in a year when our daughter is two. To get pregnant with our daughter, I had to take Clomid and progesterone supplements and will more than likely need to do so again. The fertility doctor wants me to have my daughter weaned by the time we try again, but I don't think she will be ready. How have others dealt with this situation?
When my first son, Ethan, was about a year old we tried to conceive. After nearly a year, I consulted my obstetrician/gynecologist (ob/gyn) who suggested Clomid. However, my son was breastfeeding and he wouldn't prescribe it. The ob/gyn's wife had breastfed and after some discussion he agreed that if my pediatrician was okay with it, he would prescribe it. So I talked to Dr. Paul Fleiss (my pediatrician at the time) and he suggested that I also speak with Dr. Jay Gordon. Together we determined that when Ethan was down to one nursing a day, I could take the medication. (I also had used progesterone to maintain my pregnancy with Ethan since I'd miscarried early on before and I used it again, just in case it was a contributing factor).
I worked with Ethan to wean when he was two and a half years old. I took my time with the weaning process, beginning with not offering/not refusing and being sure that I had plenty of food and water with me so I could offer that instead. I focused on reducing the number of nursing sessions and also decreasing his time at the breast. We began to skip the naptime nursings, and then the in-between meals nursings, and I made sure he had a bedtime snack to cut down on the nighttime nursings, too. I found all sorts of tricks to make the weaning go well. After about six months, he was down to the one nursing before bed and I called my doctor, reconfirming with both pediatricians, and went on the medication. Four or so months later, when Ethan was over three, I conceived his brother and Ethan nursed only through that first month then stopped. I repeated a similar process with my second son, who weaned before I conceived even using Clomid. I eventually conceived my daughter and she nursed until she more or less self-weaned.
I've spoken to other mothers about this. The key seems to be that if you decide to wean for this reason, it is critical that you not be ambivalent about your choice, and certain that this is the path you want to take. Otherwise, it will be more difficult to see it through. Some mothers choose to wait and have their children spaced farther apart so they can continue to breastfeed their first child longer.
I believe that there are advantages to having children spaced several years apart as well as closer together. It has to be the right timing for you! Also, your daughter might be more ready than you think. At two or two and a half, the weaning might be a more natural process than you anticipate. You will know when it gets closer to that time. I wish you the best in following your heart.
S CA/NV USA
I faced the same situation a couple of years ago. It took several cycles of Clomid and human chorionic gonadotropin (hCG: a peptide hormone produced in pregnancy that is made by the embryo soon after conception and later by the placenta) shots to get pregnant with my son, and the fertility doctor didn't want me to attempt to get pregnant again until my son was weaned. My husband and I decided to wait for fertility treatments and give the old natural way a try and, what do you know, I was pregnant in two months! It seems having a baby can really straighten out your hormones. Just in case, I did some investigating and a hCG shot as you're about to ovulate is compatible with nursing (check with your health care provider first). HCG is the "pregnancy hormone" and helps an egg ripen and release from its follicle. Your health care provider will also warn you that nursing will reduce fertility, but as long as you're getting a regular period, you can be pretty sure that you're ovulating regularly.
I continued to nurse throughout my second pregnancy and have been tandem nursing my son and daughter for over a year and a half. Good luck!
Waterford MI USA
My gynecologist also advised me to take Clomid to become pregnant with my second child. I had always had irregular periods, every four to five months, and had been trying for 10 months to conceive.
I also did not feel that my son, who was a little over two years old, was ready to completely wean. In addition, I wasn't really sure if I was ready to wean him. We had been weaning gradually.
After much deliberation, I wrote to my doctor and expressed my desire to focus first on my overall health and conception efforts before attempting medication. I made sure that I was getting adequate water intake. I limited saturated fats, totally removed trans fats, and limited sugars in my diet. Limiting sugars was not successful for me. However, guaranteeing whole grains, colorful vegetables, lots of fruit, and 25 grams of fiber each day was a step in the right direction. I started to exercise daily, whether I did yoga, sit ups, or worked with weights.
I had been monitoring my basal temperature for four months. Taking Charge of Your Fertility by Toni Weschler was a fantastic resource to read while I was trying to get pregnant. The book provided details of how to monitor fertility using basal temperature readings and monitoring cervical fluid. I also used www.fertilityfriend.com, which analyzed my basal temperatures and gave me specific information on optimum times to conceive. I believed, and still do, that focusing on overall health and intimacy is the key to increasing the chance of conception.
It seems that you really are focused on the needs of your child, which is wonderful. Remember, you know your child best. Just follow what your heart is saying with regard to weaning and welcoming another child into your lives. You'll make the right decision.
This is an issue that is near and dear to my heart. I have dealt with recurrent pregnancy loss, at nearly all stages of pregnancy, unfortunately. My husband and I saw a fertility specialist in an attempt to determine the cause of our secondary fertility issues and went through the whole experience of testing and so forth. One thing I know for certain is that there are never any guarantees when it comes to pregnancy.
When thinking of getting pregnant in the future, I find myself concerned about getting pregnant and potentially losing my milk supply, and then also losing the pregnancy. Ending up with a toddler weaned prematurely and then no new baby is not something that I want to experience. I waited so long for my daughter, and I treasure being able to nurse her. It is something I never thought I'd have the chance to do!
Pregnancy is never a certainty. I have decided that it is more important to honor the needs of the child that I have than to risk losing what is so important to my daughter. As my daughter gets a little bit older, I may start gently encouraging weaning and testing her readiness. It is a very emotional and personal decision to make.
I, too, had to deal with an infertility issue with both of my pregnancies. It took me six years to get pregnant with my daughter and I knew that I wanted to try for a second child, but of course was unsure how long it would take to get pregnant a second time. I also had to use fertility drugs, including Bromocriptine, which stops all milk production. I listened to my daughter when I was trying to determine when to stop breastfeeding. Between 12 and 13 months old, she became more independent and started eating and drinking a greater variety of foods. I slowly stopped nursing her during the day when other things were going on. Then I had her father put her to bed every night so that I was not feeding her then. The hardest feeding for us to give up was the one first thing in the morning, which is when we had our best cuddling time. I just used her natural energy and got her up for the day with a cup of juice. I admit that I cried—it was hard for me. I am happy to say that, after a year and a half of fertility treatments, I did get pregnant again with my little boy, who happily breastfed with his sister by his side as she "nursed" her dolls.
Monroe CT USA
I could have written your letter two years ago. I had a 13-month-old daughter whom I had conceived after 10 months of trying and at least five different fertility drugs. I was shocked when the reproductive endocrinologist told me I would have to wean her before he would treat me. My daughter, who was sitting on my lap, acted as if she understood and demanded a nursing as if in protest. The doctor explained that the medications he prescribed would enter my milk and pose a danger to my toddler. He also told me that I should wean my first child before getting pregnant with my second because it wouldn't be healthy to expose her to the "hormones of pregnancy" through my milk. Fortunately, I had been an LLL member for a year, and I knew several moms who tandem nursed without problems, so this gave me cause to doubt what the doctor said. Sure enough, when I looked up Clomid in a medical reference book, I found that the primary concern was that it had a tendency to dry up the milk in women who had just begun lactating—hardly an issue for a one-year-old. Consult the book Medications and Mothers' Milk by Thomas Hale to look up the exact medications your doctor wants to prescribe.
You don't mention the nature of your fertility problem, but there's no guarantee it will repeat itself. Why not give yourselves some time and see what you can do on your own before enlisting the doctor's help? In our case, my husband and I decided we would try on our own for a year, but that we would start weaning by our daughter's second birthday and then begin treatment.
I left the doctor's office in a funk that afternoon, but my depression turned to joy only weeks later when I realized I was pregnant. Apparently, breastfeeding had balanced my hormones, and I was able to conceive naturally. Sadly, I miscarried, but I conceived again six weeks later and remained pregnant. I now have two beautiful girls 25 months apart who hold hands when they tandem nurse.
Stoughton MA USA