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The Effect of Eating Disorders on Fertility

The Effect of Eating Disorders on Fertility

Kindara | August 18, 2021 | trying to conceive
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According to ANAD (National Association of Anorexia Nervosa and Associated Disorder), at least 30 million Americans live with an eating disorder (ED) (1). (Folks of color are half as likely as white people to be diagnosed and treated for EDs.) (2).  You aren't alone if you're living with an eating disorder, or if you know someone who does.  In this piece, we'll give you the facts about types of eating disorders, and tackle what you should know about how EDs can impact trying to conceive, as well as fertility and pregnancy. Let's get to it. 

 

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What is an eating disorder? 

The American Psychiatric Association defines eating disorders as "behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions"(3). Those with eating disorders may also have other mental health conditions, such as anxiety, depression, and obsessive compulsive disorder, and may also use drugs and alcohol, and there's some research suggesting that this co-occurrence could have some genetic basis (4). That being said, anyone can develop an eating disorder. 

Types of eating disorders

The most commonly known EDs are anorexia nervosa and bulimia, but that's not the extent of the eating disorder lexicon. As you'll see, many EDs include behaviors that overlap, such as use of laxatives and exercise. 

    • Anorexia Nervosa is characterized by weight loss and calorie restriction. A person with anorexia may use exercise, laxatives, and/or diet pills in order to lose weight, and they may also binge (eat a large amount of food in one sitting, during which they feel a lack of control) and then purge via vomiting or other means. 
    • Bulimia Nervosa involves a cycle of binge-eating, followed by purging, in order to undo the effects of eating. You might also fast, use laxatives, or exercise after binge-eating.  
    • Binge Eating Disorder is a relatively new eating disorder in terms of its formal recognition in the DSM-V. Those who have Binge Eating Disorder engage in binge-eating (see definition above), and this can involve eating more rapidly than usual, continuing to eat beyond the point of being uncomfortably full, eat even when they're not physically hungry, and doing so alone due to feelings of shame and embarrassment (5). 
    • Orthorexia isn't a formally recognized ED according to the DSM, so it's hard to say how many people have it. It has been shown in studies to be associated with obsessive compulsive disorder (6). Folks with orthorexia demonstrate a fixation on "healthy" or "pure" eating, which may or may not be accompanied by an obsession with body image. They may check ingredients compulsively, cut out entire categories of food from their diets, and become distressed with foods they consider "healthy" that aren't available.
    • Other Specified Feeding or Eating Disorders (OSFED) is a category of ED that represents eating disorders that don't meet the diagnostic criteria for anorexia, bulimia, or other EDs (7).  This includes Purging Disorder, in which purging takes place without binge eating, as well as Atypical Anorexia Nervosa, when one exercises the behavior that comes with Anorexia, but doesn't experience significant weight loss. 
Eating Disorders and TTC 

It's impossible to overestimate how important it is to consistently nourish your body when you're trying to conceive.  Not getting the appropriate amount of calories, vitamins, and proteins can impact your ability to get pregnant. There are several reasons EDs can impair fertility, one of which is that when underweight, there's a decrease in a hormone known as leptin. Leptin levels are dictated by body weight and caloric intake, so not having enough of either can have a negative impact (8). Leptin's job is to regulate your hypothalamus, the part of your brain that controls luteinizing hormone and follicle-stimulating hormone, those all important chemicals that dictate ovulation. And of course, we know that without ovulation, pregnancy is essentially impossible. Also, having irregular periods can make getting pregnant more difficult.

Amenorrhea, or the absence of menstruation, sometimes due to excessive exercise and/or low caloric intake in the case of an eating disorder, is an aspect of the diagnostic criteria for anorexia nervosa, and in a 2011 study, 68 - 89% report absence of menstruation for at least 3 months during the course of their eating disorder (9).

Other eating disorders, such as bulimia, don't necessarily involve the absence of periods to the degree anorexia can,  but your period might become irregular due to the cycles of binging and purging (10).  In a study of 82 women who had been diagnosed with bulimia, 45 percent reported irregular periods, associated with frequent vomiting, low thyroxine (also known as hypothyroidism) and low dietary fat intake (11). 

 If you're currently living with an eating disorder, trying to conceive can be difficult due to the fact you likely aren't taking in (and in the case of purging, aren't keeping in) the necessary amount of nutrients, water, proteins, and other elements essential to maintaining health.  

It's not entirely clear that eating disorders have a long term impact on one's fertility, but it may have a modest one, depending on the severity of the ED and how long one has been living with it.  If you're recovering from an ED, you may not be able to conceive until you gain enough weight to be able to sustain a pregnancy and your period and hormones regulate  "normal" fertility can be delayed in up to 30% of women with anorexia who regain weight (12). 

A study published in 2011 indicated that women with eating disorders were more likely to see a doctor for assistance in getting pregnant than those in the general population, and rates of intentional pregnancy were 58% in those with an ED, versus 72% in those without one (13). 

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Eating Disorders and Pregnancy 

Here's a fact that might surprise you: People living with eating disorders are more likely to have unplanned or unwanted pregnancies than the general population, possibly because folks associate irregular periods with an inability to get pregnant (14). So getting pregnant while you have an eating disorder isn't impossible. 

Pregnancy, with all the demands it places on one, physically and mentally (cravings, weight gain, feeling like you have no control over your body, etc), can trigger more intense behavior if you have an eating disorder. While you may have the urge to restrict, binge, or both, it's vital that you have and maintain enough body fat, as well as vitamins and nutrients to sustain the pregnancy. Being pregnant with an eating disorder impacts both the pregnant person and the fetus. 

Risks to the pregnant person:

  • Dehydration
  • Cardiac irregularities
  • Gestational diabetes
  • Severe depression during pregnancy
  • Labor complications
  • Difficulties nursing
  • Postpartum depression
  • Miscarriage

Risks to the fetus: 

  • Birth defects, such as neural tube defect from lack of Vitamin B12 and folic acid, and iron to prevent low birth weight (15). 
  • Premature birth
  • Respiratory distress 
  • Low Agpar scores. Agpar tests are performed after birth to assess how well the newborn has endured the birthing process (1 minute after birth)  and how well they're tolerating being outside the womb (5 minutes after birth).  Scores were found to be lower in mothers dealing with eating disorders at the time of birth (16). 

If you are pregnant and have an eating disorder, you might be reluctant to share this with your healthcare provider for fear of judgement. The National Eating Disorders Association (NEDA) recommends sharing your concerns with your doctor, as well as consulting a nutritionist, and seeking individual counseling and support groups. 

Treatment 

Living with disordered eating and healing from it can seem like intimidating and lonely work, but you are not alone. 

Not everyone starts in the same place when asking for help. You can begin by talking to a trusted loved one, your primary care provider, or a therapist who specializes in EDs, or a helpline. Treatment may involve a nutritionist, medical specialists who can address any health issues that may have arisen as a result of an ED, and a psychiatrist, to prescribe medication to assist with co-occuring mental health conditions, like anxiety or obsessive compulsive disorder. You might also be given the option of residential treatment to support your need for long term care. 

The National Eating Disorders Association can help you take the first steps in feeling better. You can text, chat, or call their helpline. And check out their COVID-19 forum for support if you're feeling triggered by isolation and anxiety brought on by the pandemic.

About the author:

Chanel Dubofsky's writing on gender, reproductive health, popular culture, and religion, can be found in New York MagazineLilith, RewireModern Fertility, Cosmopolitan, and others. She lives in Brooklyn, New York. Follow her on Instagram at cdubofsky.

References +
1

National Association of Anorexia Nervosa and Associated Disorders. (n.d). Retrieved August 7, 2021 from https://anad.org/

2

Eating Disorder Statistics. (n.d.) Retrieved August 7, 2021, from https://anad.org/get-informed/about-eating-disorders/eating-disorders-statistics/

3

What are Eating Disorders? (2021, March). Retrieved August 7, 2021 from https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders

5

Binge Eating Disorder. (n.d.) Retrieved August 6, 2021, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed

7

Other Specified Feeding or Eating Disorders (OSFED). (n.d.) Retrieved August 13, 2021, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed

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