I’m a 35-year old mother of two. I delivered my first precious baby (now 2-1/2 years old) when I was 32 after more than a year of trying naturally. I delivered my second precious baby (now 10 months) at 34 years old after 5 months of trying naturally unsuccessfully and two cycles of IUI with fertility injectables (conceived on 2nd cycle). I would LOVE to have 2 more babies before I’m 40. I’m still breastfeeding my 10-month old (only 2-3 times per day for very short durations) and am pumping once or twice per day. I was never a big milk producer and have had to supplement with formula since day one. My baby enjoys breastfeeding, however, so it’s something I don’t want to give up just yet. I got my period back 4 months ago, when my baby was 6 months old. My cycles have been back to normal for me…I ovulate around day 15-16, and my cycles are 33-34 days long. I think my cycles have gotten longer over the past 5 years. I’ve been using an ovulation monitor, and the positive indicator on the monitor is also backed up by my Mittel-schmerz every cycle without fail. I've had labs done a couple years ago when we were TTC #2, and everything was within normal limits (e.g, progesterone, FSH, etc.) except I remember my estradiol being on the low side. No one ever really discussed that with me though. My husband, who is 36 years old, has a history of bilateral varicoceles (repaired close to 5 years ago), poor motility, and morphology. I recall during one of the inseminations when TTC baby #2, my husband’s motility was in the 30% range “pre-wash”. The urologist that did the varicocele repair did a sperm analysis and told us the same thing 5 years ago. We’ve been trying for baby #3 for the past 3 cycles unsuccessfully. Due to my age and my husband’s history, we don’t want to wait several more cycles before seeing a specialist. So, we went ahead and made an appointment with the RE that helped us conceive our sweet baby #2. Given our history and age, would you say that seeing a specialist on our 4th cycle of trying is too soon? Besides my husbands poor motility, is my low estradiol a factor that has played in our past infertility? Also, I’ve read that breastfeeding can delay or throw off ovulation. I’m fairly confident that I’m ovulating regularly and am confident that I know when I’m ovulating, thus we're timing natural “efforts” correctly. Does breastfeeding/pumping, however, interfere in any way physiologically with the egg being fertilized (e.g, hormones, etc.)? Aside from the timing aspect, could breastfeeding/pumping decrease our chances of conceiving with IUI compared to if I was not breastfeeding/pumping during IUI? Thank you in advance for your response.

Breastfeeding may or may not interfere with conception even when cycles have been reestablished and ovulation is confirmed. The exact mechanism is not known, but may involve changes in estrogen production or elevations in Prolactin (the hormone that controls milk production) that can affect conception. It is best to discontinue breastfeeding if one wishes to conceive right away. Couples with subfertility, ie: low sperm counts, altered morphology or motility,etc. are always better off working with a Reproductive Endocrinologist to expedite their chances of conceiving quickly. Estrogen levels in women continue to decrease over time starting as early as age 30, so that can play a role in fertility as well by decreasing the thickness of the uterine lining or affecting ovulatory function and egg health. When a couple has required reproductive "help" in the past, it is reasonable to assume that as the couple ages they are even more likely to need reproductive assistance to conceive. Good luck.

Answered by Dr. Lynn Friedman, M.D.