Unexplained very low milk supply

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Hi all, PTP: Mom is 36, has (fraternal) twin sister who has had exact same symptoms/problems re: milk supply with her baby.  Their Mother had a great supply for them as babies – nursed for 6 months.  Mom is currently 9 days pp.  Baby has structural issues and is unable to breastfeed well at all.  Mom is nursing for comfort, and using Symphony pump.  I tested the pump, evaluated flange fit – all is fine there.  Mom has nice veining on breasts and absolutely no signs of IGT.  Breasts grew a full cup size during pregnancy (with both babies – she is having a repeat of supply issues with 2nd baby).  She experienced her milk coming in on day 3 – 4 with extreme fullness but never pumped more than drops at that time – even with pumping q. 2 hrs.  Mom started fenugreek 3 caps (610mg ea) 3 times per day.  By day 6 was pumping no more than ½ - 1 oz q 2 – 2.5 hrs around the clock.  And that is where she is today. We did blood work:  Thyroid, prolactin, and iron - ALL is absolutely FINE.  The only hormone I am unsure of is testosterone which came in at 32 (range 14 – 76) – but I don’t know what a lactating mom’s testosterone levels should be and cannot find any information on that.   Dr (thankfully) is willing to rule out retained placenta with ultrasound – but moms prolactin levels are high (180.3, day 7 pp, not sure if before or after pumping) so I am thinking retained placenta is not the issue and Dr checked her bleeding and said all is normal there.  Moms labor and delivery were uncomplicated and .  Baby born full term.  Mom on IV Fluids for approximately 15 hours, given Pitocin at lowest levels for approx. 10 hours, then an (light – Anesths words) Epidural for approximately 6 hours – 1 bolus and then a 2nd dose just before delivery when they increased the Pit and then 30 min later, after 10 min. of pushing baby was born.  Epidural had Fentanyl.  Mom busted her butt with last baby taking herbs and pumping like a mad-woman (q 2 hrs around the clock) with no more than 2 oz MAX able to be pumped and only once in a while (typically in the morning).  She did this for 6 months before quitting.  She is clearly looking at the same situation this time.  I am at a loss.  Everything points to the fact that she should have milk and lots of it.  No other medications are being taken, no other complications – I did the Assessing for Insufficient Milk Supply a la Marasco – and nothing.  Everything points to being just fine.  I have her contacting her mother to see if mom took any medications during pregnancy with her twin daughters since both women have had the same problem.  My client has done everything ‘by the book’ right to ensure no mismanagement and the best possible outcome, she has no history of abuse, hormonal issues, no signs of hormonal issues, got pregnant very easily, is on no medications (now or during pregnancy), no history of breast surgeries or injuries of any kind.  In my nearly 18 yrs I have only had one other case where it all looked perfect, all the tests, and everything – but still very little milk.  Thoughts?  Thank you! Jaye Simpson, CLE, IBCLC, CIIM, MoMBreastfeeding Networkwww.breastfeedingnetwork.net