A major goal of the Nurture blog series is education in an effort to promote health. Today’s blog focuses on the complex intersection between how we care for our bodies, and the effects it can have on fertility. As part of a timely coincidence, the media has also recently covered several interactions between celebrities who publicly commented on their private lives with regards to infertility, pregnancy, body image and nutrition. We felt the discussion generated by the media brought to light an important and relevant opportunity for much needed and more accurate education around eating disorders and fertility.
For most people, the decision to start, or grow, a family can be both emotionally exhilarating and incredibly stressful. However, individuals with an eating disorder or disordered eating can experience a particularly difficult time with this decision as they struggle to balance maternal desires with an intense fear of the physical changes that will accompany pregnancy, especially weight gain. The situation is further complicated because harmful or dangerous behaviors such as chronic or severe dieting, restricting, purging, excessive exercise, use of diet pills or laxatives and/or bingeing are common in individuals with eating disorders. While the numerous health consequences associated with these behaviors might seem obvious to some, many people remain unaware of how these behaviors can impact fertility in a negative, and sometimes irreversible, way.
In February, Whoopi Goldberg, co-host of daytime talk show The View, boldly called out a celebrity guest, suggesting that her excessive exercise and low body weight was a key factor in her inability to get pregnant. The guest publicly discussed her irregular menstrual cycle and a doctor’s recommendation that she gain weight in order to help increase her chances of becoming pregnant. An irregular or absent menstrual cycle (amenorrhea) can be a major indicator that a woman has lost too much weight or is underweight – in other words, it can be an alarm signaling us that the body does not have the basic resources (nutrients and energy) it needs to function properly. Amenorrhea is also a common symptom of anorexia nervosa (AN). An eating disorder or disordered eating can have significant consequences on all of the body’s organs and systems, including the uterus, hormone levels, menstruation and thus, fertility. Individuals with bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS), and binge eating disorder (BED) can also experience problems with fertility even if they are not underweight. Some of the specific fertility problems faced by individuals with eating disorders include:
- Irregular menstrual cycles
- Reduced egg quality
- Ovarian failure
- Poor uterine environment
- Increased risk of miscarriage
Advances in fertility treatments have made it easier to circumvent these barriers, which may be physiological warning signs that the body is in crisis as a result of an eating disorder. In a recent study of participants at one fertility clinic, 58% of the women who had irregular periods or who no longer menstruated met the criteria for a clinical or sub-clinical eating disorder.1 While there are more options and improved technology to help couples overcome infertility regardless of the cause, it is important to be aware of the potential risks and difficulties associated with getting pregnant while struggling with an eating disorder. Its also important to acknowledge that simply gaining a minimum amount of weight, in order to resume ovulation, while continuing to act on eating disordered behavior is not a safe, or effective, solution to infertility caused by an eating disorder.
Stabilizing weight only to the point of resumed menstruation, or utilizing fertility treatments without addressing the root cause of the infertility, places women and their babies at risk for health problems including malnutrition of the mother and baby, low maternal weight gain, gestational diabetes, preeclampsia, labor complications, jaundice, low APGAR scores, low amniotic fluid, placental separation, birth defects, low birth weight, problems in infant feeding, miscarriage, neonatal morbidity and increased risk for postpartum depression. Despite the risks associated with eating disorders and pregnancy, one study found that less than half of OB-GYNs assess their patients for eating disorder history, body image concerns, weight-loss practices, or current eating disorder symptoms.2 Furthermore, a recent Danish study found that a woman’s chances of having a high-risk pregnancy are still heightened as many as eight years after being successfully treated for an eating disorder. If you are currently struggling with disordered eating or an eating disorder, or if you have struggled in the past, be sure to tell your doctor about it (even if they don’t ask you!) so that you can receive the appropriate care and support you need to reduce your risks.
We recognize that recovery from an eating disorder can be a difficult and time-consuming process that takes a lot of hard work and patience, something that can be hard to come by when you are hoping to have a baby soon. However, the alternative – not addressing the underlying causes of your fertility issues – can lead to serious pre- and post-natal complications. Because of these and other serious risks, it is recommended that the eating disorder be significantly resolved before a pregnancy is attempted and that any pregnancy attempted or achieved receives appropriate medical and psychological support.
If you or someone you know is struggling and would like to find out more about getting treatment for an eating disorder before, during, or post-pregnancy, please call (410) 938-5252 to speak with an Admissions Coordinator from The Center for Eating Disorders at Sheppard Pratt. You may also email a request for more information to EatingDisorderInfo@sheppardpratt.org.
1 Resch, M., Szender, G., & Haasz, P. (2004). Bulimia from a gynecological view: Hormonal changes. Journal of Obstetrics and Gynaecology, 24(8): 907-910.
2Leddy MA, Jones C, Morgan MA, Schulkin J. (2009). Eating disorders and obstetric-gynecologic care. Journal of Womens Health. 18(9): 1395-1401.
top photo courtesy of webmd.com