Can I take fertility drugs while I’m nursing?

Ask Anne…

Question: I’m 36 years old and my daughter just turned one. We have breastfed for 12.5 months and are still going strong!

I’ve truly enjoyed nursing and know there are many benefits to breastfeeding more than a year. Unfortunately, I am afraid I may have to wean her in order to get pregnant again sooner than later. My husband and I would like to have one or two (or even three!) more children and due to my age we would like to get pregnant again by the end of this year.

I offer my daughter food, snacks, and water throughout the day but she has little interest in solids. She nurses at least 4-5 times a day and would nurse more if I’d let her. Honestly, she would be totally content not eating any solids at all and just nursing!

We also bed share which I know can also delay fertility. But we love our sleeping arrangement, it works for our family, and we’d prefer not to change it.

I haven’t started my period yet, and I’ve been spending a fortune on ovulation kits, but no luck. The company that makes them claims breastfeeding doesn’t affect the tests but do you think that could be the problem?

Thankfully I got pregnant easily the first time, and didn’t need any medical intervention to help, but have read online that some women take Clomid while breastfeeding to induce ovulation.

I called my OB today and asked him if he’d prescribe Clomid while I’m breastfeeding and he said “No, because it’s unsafe.” What are your thoughts on this? Would a drug like Clomid even help my situation if ovulation wasn’t happening due to breastfeeding and not an underlying medical condition?

Obviously I don’t want to do anything that’s unsafe for myself or my children but my clock is ticking and I’m just kinda at a loss about what to do. As I stated, I love breastfeeding and am hoping there’s a way to get pregnant without having to wean my daughter so soon!

Do you have any suggestions on how I can get my fertility to return without weaning my daughter?

Answer: I understand wanting to get pregnant again when your biological clock is ticking – my last three kids were born when I was in my ’30s, with the sixth born when I was 38.

I went for a ten year stretch of time when I was either pregnant or breastfeeding constantly. I planned all my pregnancies and never had any problems conceiving, but they were spaced 2 1/2 – 3 years apart, and I never started trying until my babies were almost two. They were defintely nursing a lot less at two than they were at a year.

As far as your return to fertility goes, there are a few things I can tell you.

if you haven’t had a period at all by now, then you probably aren’t ovulating yet. Breastfeeding can do some wacky things to your hormones, and it’s hard to predict ovulation patterns while you’re lactating.

The ovulation kits should theoretically work just as well at predicting ovulation during lactation as they would any other time. You have a couple of options here. You can try the natural fertility awareness option (http://americanpregnancy.org/preventing-pregnancy/natural-family-planning/), which some moms swear by, and this method has the bonus of not costing money.

I don’t know how much you’re paying for the kits, but I know they can be crazy expensive, so you might want to shop around for the best deal. The tests measure a specific chemical reaction, so the generic ones work just as well (same thing with pregnancy tests). Several local Dollar Stores here carry them. I know this because I bought a ton of ovulation kits and pregnancy tests and mailed a box full to a friend who was trying to get pregnant and couldn’t afford to buy them at the pharmacy.

As far as the Clomid goes, it works by stimulating the ovaries so that they release an egg, which apparently isn’t happening in your case because your baby is still nursing enough times in 24 hours to inhibit ovulation.

The hormones it contains occur naturally in your body when you’re ovulating and having normal periods. The reason for concern about taking Clomid while you’re breastfeeding isn’t that it will adversely affect your baby, but that it may decrease your milk supply. When you’re nursing a young baby, that can be problematic. When you’re nursing an older baby who is eating solid foods, the effect is minimal. If your supply goes down, your baby can get her nutritional needs met from other sources.

It sounds like she really loves to nurse, and the number of feedings is apparently enough to inhibit ovulation. For moms who don’t want to get pregnant, not having periods while they’re nursing is a breastfeeding perk. For someone trying to get pregnant, not so much.

The best way to start ovulating is to cut back on the number of nursing sessions in a 24 hour period.
I understand your desire to continue your sleeping arrangement and on demand feedings, but you might have to make some adjustments if you want to encourage ovulation. It isn’t easy to wean a baby who still really wants to nurse, but you can try to cut back a bit. There are some suggestions about how to gradually cut back on feedings and nudge your baby toward weaning in the article on Weaning.

It sucks to have to start the process sooner than you would like, but sometimes you just do what you have to do. I’m not saying it will be easy, but your baby will be fine with fewer nursing sessions each day, and cutting back won’t cause any lasting emotional trauma. There is no way to tell exactly how much nursing per day will inhibit lactation because every woman’s body is different, but if you can cut back to 2 or 3 sessions instead of 5 or 6, that might do it.

Most doctors are leery about prescribing Clomid to women who don’t have fertility issues related to medical problems, but if your doctor is willing to try it, I don’t see any reason not to give it a shot, especially if cutting back on the number of nursing sessions isn’t enough to stimulate ovulation naturally.

I don’t agree with your OB when he stated it was ‘unsafe’, but I’m not surprised. I taught at a medical school for several years, and was shocked to find out how little doctors actually learned about breastfeeding. There are resources you can share with him regarding drugs and lactation that he might not be aware of. One is Dr. Thomas Hale’s book “Medications and Mother’s Milk” (every doctor should have a copy of this in his library) and another is the InfantRisk Center (Open Monday-Friday 8-5 CT: (806) 352-2519. Here’s the direct link to the thread about Clomid.

The concentration of Clomid in your milk peaks about six hours after you take a dose, so if you want to minimize exposure, you could avoid nursing at around that time. However, with a toddler who’s eating other foods and isn’t solely dependent on breast milk for nutrition, that shouldn’t really matter. Your supply dropping a bit might not be a bad thing, because some babies aren’t interested in nursing as often if they aren’t getting as much milk as they’re used to.

Here’s an article with some good info about Clomid, as well as fertility charting. http://www.babymed.com/fertility-problems/making-clomiphene-clomid-work-you#

Here’s one more thing to consider: when you get pregnant, hormonal changes will almost always cause a dip in your milk supply. Many toddlers will lose interest in nursing as the quantity and taste of the milk changes during the pregnancy, and often wean themselves during that time.

So, one way or the other, she is probably going to have to wean earlier than you might have planned if another baby wasn’t in the picture.

Just a thought.

I do wish you all the best as your family grows. Whenever your nursing journey ends, your baby has gotten off to a wonderful start by nursing for a year. That’s a milestone that many mamas don’t reach, so she is one of the lucky ones.

Anne Smith, IBCLC
Breastfeeding Basics