Abstract
In nonnursing women, pregnancy is followed by an interval of anovulation, which persists for an average of 2–3 months [1–3]. This puerperal infertility is extended if nursing occurs [1–5]. The interval of lactational anovulation and amenorrhea associated with nursing is highly variable, being dependent upon cultural practices in infant feeding and child rearing [2, 3, 5]. In Western cultures, lactational amenorrhea has been described as lasting less than a year [1, 3], while in developing countries 4-year interbirth intervals have been attributed to the inhibitory effects of breast-feeding [6]. These societal differences in postpartum infertility are specifically related to the frequency and duration of suckling [6, 8], and, in general, the cultural practices which reduce breast-feeding and thus the inhibition of the hypothalamic-pituitary-ovarian axis [4, 5]. Despite the importance of lactational anovulation in the control of population growth, the physiologic mechanisms sustaining lactational infertility are enigmatic.
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