SFEEU2017 Clinical Update Workshop E: Disorders of the gonads (4 abstracts)
A 37-year-old lady with complete androgen insensitivity syndrome (AIS, 46,XY) presented with the desire to breastfeed her first child during the pregnancy of a surrogate mother. Her past medical history included thyrotoxicosis initially treated with block-and-replace regime, followed by multiple relapses, and definitive treatment with radioactive iodine ablation. There was a family history of complete androgen insensitivity syndrome (two sister out of four) and one sister had been treated for a malignant seminoma. Our patient had undergone a bilateral gonadectomy and has been on oestrogen replacement treatment since the diagnosis of AIS was made. One month prior to the babys delivery date, the patients oestrogen replacement treatment was switched from oral to transdermal and the dose was doubled to simulate the latter stages of normal pregnancy. After detailed discussion and counselling, the patient was also started on treatment with domperidone, initially 10 mg three times daily to induce hyperprolactinaemia, and was advised on the use of a manual breast pump. The dose of domperidone was gradually increased to 20 mg three times daily. She was advised to remove the transdermal oestrogen patch as soon as the surrogate mother went into labour. Such treatment allowed the patient to breastfeed the child upon arrival, essential in the emotional and physical bonding between infant and mother. Though the patient cannot be the genetic mother nor experience firsthand the gestation and labour of the child, breastfeeding the child for a month after her birth was of utmost importance to her. Oestrogen replacement treatment after the babys delivery was switched back to the normal dose and oral formulation. Prolactin level measured during breastfeeding was 1416 munits/l. After breastfeeding her baby for a month, treatment with domperidone was stopped. We describe the case of a phenotypically female patient with compete AIS who was able to breastfeed her child, obtained via IVF and surrogate mother, for a month after delivery, allowing the patient to physically and emotionally bond with the baby.