Eating disorders and infertility

The National Eating Disorders Association in the US estimates that some 20 million women a year are struggling with eating disorders. Conditions such as anorexia and bulimia are now widely covered by the media.

There is a huge amount of support information and data on this complex issue. However, the advent of social media compounds the issue with the promotion of self-image.

Going hand in hand with academic research are biographies, self-help books, TV documentaries and films. Going back as far as 1999 there was Girl Interrupted; Hunger Point in 2003 and more recently in 2017 there was To The Bone.

Without going into a deep analysis, it is possible to make a few helpful generalisations.

  • Self image plays a large part in the syndrome
  • Sexuality to make yourself attractive
  • Reproduction: sexuality and attractiveness is linked to the biological function of fertility.

So here we have two important functions of life, sexuality and reproduction both impacted by eating disorders.

So what do we know about the direct impact of eating disorders on fertility?

The good news is that a past history of eating disorders does not seem to have a major impact on future fertility.

Research carried out in 2011 in the UK on 500 women with eating disorders found that:

* These women were no more likely than other women to take longer than a year to conceive.

* A higher percentage did take more than 6 months to achieve a pregnancy: 39% vs. 25%.

IVF is more common in women with a past history of eating disorders

The report found that women with an eating disorder in the past were more than twice as likely to have received IVF. Overall 6 had IVF treatment vs. only 2.7% than those who had never reported an eating disorder.

Additional findings of the research included:

  • 41% of women with past or current eating disorders reported that their pregnancies were unplanned, compared to 28% of women with no such history
  • 71% of women reported being happy to discover they were pregnant/
  • Women with anorexia or bulimia were more than twice as likely to report feeling unhappy about their pregnancies (10% vs. 4%)

Women with an eating disorder or history of one were also more than twice as likely to consider motherhood a personal sacrifice.

Researchers said, “Many women with a history of eating disorders felt unable to inform health care professionals of their illness. We encourage women to discuss this with their doctors when planning a pregnancy.”

The researchers were also concerned that providers might fail to recognise women who have experienced eating disorders. These patients might need extra support during pregnancy and after giving birth.

As one lead investigator said, “This research shows that an eating disorder history should be seen as a warning sign. These women may have additional challenges associated with pregnancy.”

What is new?

In today’s Fit bit driven world, a new type of eating disorder is also on the rise – Relative Energy Deficiency Syndrome (RED-S).

RED-S occurs in athletic young women who go on highly aggressive diets combined with a punishing exercise regime. There is a gross imbalance between nutritional intake and the amount of energy that is expended during sports or exercise.

This causes stresses in the complex interaction between the brain and ovary. This can lead to decreased hormone levels, resulting in a lack of ovulation and decreased bone density. It may also lead to a compromised reproductive system later in life.

Often coaches, parents, paediatricians, family physicians and the women themselves are not aware of the health risks. Women can protect themselves from RED-S if they set realistic expectations for themselves. They need to understand nutritional intake and exercise. They also need to allow the body sufficient time to recover between bouts of heavy exercise.

All eating disorders require medical treatment.

The take home messages are:

  • IVF clinics should ask patients to disclose any history of eating disorders so treatment can be tailored.
  • Ensure young women are not pushing themselves too far.

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