Fertility medications for a frozen embryo transfer

[bfmom66]

I would like to know the safety of the following medications for my breastfeeding toddler who is 20 months old. He nurses several times a day and over night. These are all medications for a frozen embryo transfer. I have a choice between a "natural" vs "medicated" cycle but all require medications. Can you explain the potential safety risk (or not) of these medications for my toddler? It will help me decide.

"natural" cycle:

- progesterone oral tablets -1x per day
- trigger injection - Ovidrel shot or HCG (human chorionic gonadotropin, Novarel or Pregnyl)
- progesterone supplements - prometrium capsules vaginally

"medicated" cycle:

- birth control pills - I do not know yet which type - is there a particular type I should request/avoid?
- progesterone oral tablets -1x per day
- estrogen supplement - Estrace (Estradiol) oral tablets
- progesterone supplements - Progestrone in Oil vial and Endometrin vaginal suppositories

[kaytlin]

Thank you for reaching out, these are great questions!

Unfortunately, we don’t have definitive answers to your questions because as it stands, there is very minimal published research on whether these medications pass into breastmilk. This is why these drugs’ manufacturers and your care team may recommend that you not breastfeed while using these medications. It’s not because these medications are known to have adverse effects on breastmilk, but rather because their effects are largely unstudied and unknown.

That being said, there are anecdotal reports of people successfully breastfeeding through embryo transfers during which they take these medications. What we do know is that hCG is a large in size with low oral absorption, so we might guess that if any amount were to pass into breastmilk, then your breastfed baby would not be likely to absorb much of it. Regarding the different forms of progesterone you’ve listed, progestin-only birth control pills (and progestin-only IUDs and implants) are often used in the immediate postpartum period, suggesting familiarity with and safety while breastfeeding. Finally, it is theorized that estrogen can potentially decrease milk supply within the first 6 months postpartum, but in small studies has shown it is not detectable in breastmilk and the breastfed neonate.

If you do choose to proceed with embryo transfer while breastfeeding, the InfantRisk Center is interested in collecting and analyzing your breastmilk for our biorepository to contribute to research and upcoming studies on this topic. Let us know if you are interested in participating and we will provide you with the instructions and materials you will need through this link: [url]https://infantrisk.com/help-infantrisk-research[/url]

We hope this is helpful!
Drs. Majdinasab and Krutsch