Clomid While Nursing 18m Daughter

[Ttcroundtwo]

I have an 18 month old daughter who I nurse 2-3 times a day when I work and 4-5 times a day when I'm home. I required fertility medication to conceive my daughter, and it's looking like I'm going to need to do this same this time around.

Wondering about the safety of clomid. I'm not worried about a potential supply drop, I'm really just asking about any possible risk to my daughter. I know there's limited research, so I'm hoping you can explain to me exactly what the risk theoretically is, why, and how large the risk is. Also, hoping you can clarify whether the length of time on clomid matters. As in, is it ok to do for 2-3 cycles but not ok to do for 8 cycles (for example)?

Lastly, with my baby being a girl, is there increased risk? And if so, in what way?

Thank you so much.

[admin]

Ttcrountwo

Clomid is an potent estrogen receptor blocker. Clomiphene citrate is capable of interacting with estrogen-receptor-containing tissues, including the hypothalamus, pituitary, ovary, endometrium, vagina, and cervix. It may compete with estrogen for estrogen-receptor-binding sites and may delay replenishment of intracellular estrogen receptors. Clomiphene citrate initiates a series of endocrine events culminating in a preovulatory gonadotropin surge and subsequent follicular rupture.

The first endocrine event in response to a course of clomiphene therapy is an increase in the release of pituitary gonadotropins. This initiates steroidogenesis and folliculogenesis, resulting in growth of the ovarian follicle and an increase in the circulating level of estradiol. Following ovulation, plasma progesterone and estradiol rise and fall as they would in a normal ovulatory cycle.

We do not know at present if the small amount present in human milk would cause problems in the ovaries of a female infant. Its probably unlikely, but unfortunately, this product has a half life of about 5 days, which means it could be present in milk for up to 2-3 weeks. Thus exposure to your infants ovaries may be potentially significant over this time period.

in some of these cases with significant risks, we always have to evaluate the benefit of the drug, to the benefit of continued breastfeeding. In this case, we simply do not know what the potential risks are, but we do know that the benefit of continued nursing is minimal after 18 months.

If this were my daughter, I would not want to expose her to this drug over this duration of time.

Tom Hale Ph.D.

[Ttcroundtwo]

Thank you for taking the time to respond, Dr. Hale.

When I originally called the infant risk line I had been told it appeared safe for at least a few cycles. But from this response, it seems like in the case of a girl, you don't feel like even one cycle would be safe enough to be comfortable. I'm assuming at this time, the potential risk to the ovaries is theoretical? I understand this would be difficult to study. And is the amount that passes through to the milk at all known?

At this point my daughter is not remotely ready to wean, so I'm trying to weigh out if it's a substantial enough risk to her to have her grow up with a sibling further apart in age. I think I could wean her down to 3 times a day when I'm home and 2 times a day when I work, if that matters as all in terms of the volume of milk she's getting. She's not taking as much as an infant under 1, of course.

I feel torn between your words of it being "probably unlikely" to cause issues in the ovaries of a female infant, and you saying you wouldn't want to expose your daughter to this drug.

And lastly, is there any other fertility medication that you believe would be a safer alternative, or is my only real alternative to wait until she's more ready to wean?

My apologies for being a pain. I'm just feeling torn about this decision (my doctor had felt there was little risk), and trying to gather as much information as I can.

[Ttcroundtwo]

Bump.

Also, one more question Dr Hale. In a previous thread, I saw you say the following regarding how long clomid stays in breastmilk: "it takes about 72 hours for it to totally be undetectable in the maternal plasma compartment. Basically, there's no way to avoid the transfer of this drug short of stopping breastfeeding for at least 3 days."

But in your previous reply, you mentioned it could be present in breastmilk for 2-3 weeks. Was hoping you could clarify.

Thank you so much.

[admin]

Ttcroundtwo:


I don't know why I would have said only 3 days, the plasma half life is 5-7 days. The onset of its ovarian effect is at least 5 days.

But some of it could still be present in human milk for 2-3 weeks.

But what I worry about is its effect on a young female ovary ???? I still suggest we be really cautious about returning to breastfeeding following the use of this potent drug.

Tom Hale Ph.d.