Eating disorders and fertility

Eating disorders such as anorexia nervosa and bulimia nervosa are thought to affect around seven million women each year in the US, most of them of childbearing age. Fertility problems are a common side effect of eating disorders – in fact it’s thought that up to one couple in five who need fertility treatment are unable to conceive because of an eating disorder. In one study, 58 percent of women with irregular or absent periods had an eating disorder.

Anorexia and bulimia are the best known eating disorders, but many women also suffer from compulsive overeating. Although similar to bulimia (in which sufferers binge eat and then purge by making themselves sick and/or taking laxatives) compulsive eating differs in that people with the condition don’t purge, meaning that they tend to be overweight. Anorexia is less common than these two eating disorders, and stems from a distorted body image that means sufferers believe they are overweight (even though they may be dangerously underweight) and starve themselves to stay thin.

How eating disorders harm fertility

Depriving yourself of vital nutrients, as happens with anorexia and bulimia, or becoming overweight, as happens with compulsive eating, can damage your internal organs and play havoc with your hormones. Eating disorders also have a psychological effect: constant worrying about your appearance and the fear of putting weight on causes stress that can develop into depression, both of which can impact on fertility.

If you are anorexic and extremely underweight it’s likely that your menstrual cycle will be either very irregular or will cease altogether – a condition called amenorrhea, which happens because of reduced calorie intake and stress, although excessive exercising also can be a cause. If you develop anorexia at a young age you may not even start menstruating. These factors mean that ovulation will be sporadic or won’t happen at all and many women who have anorexia find that their menstrual cycle never returns to normal even if they recover from the disorder. Egg quality and the environment inside your uterus also can be affected, making it unlikely that you will conceive and/or successfully carry a baby to term even if you do menstruate.

The obesity that can result from compulsive overeating also can affect hormone levels and egg quality. Women who are overweight also are more likely to suffer from polycystic ovary syndrome and are at higher risk of miscarriage.

Getting pregnant when you have an eating disorder

Because bulimics are more likely to maintain a normal weight, they are more likely to become pregnant but constant purging prevents the body from absorbing vital nutrients, which puts bulimics at high risk of miscarriage, preterm labor and a low birthweight baby, and puts their baby at risk of a birth defect.

Anorexia sufferers are more likely to suffer from hyperemesis gravidarum (severe nausea and vomiting), gain less weight and also have smaller babies. And just as alarmingly, some studies indicate that your own eating disorder can affect how you feed your baby – research indicates a higher than normal instance of failure to thrive among the babies of women with active eating disorders.

Compulsive eaters who become pregnant are at high risk of gestational diabetes, pre-eclampsia (due to the fact they are more likely to go into a pregnancy with high blood pressure), labor complications and needing a cesarean to deliver their baby.

Ironically, getting pregnant often helps women recover from their eating disorder, although bulimics in particular are at risk of a relapse, particularly in the weeks and months immediately after the birth. However it’s best to get treatment for your eating disorder before you become pregnant and be upfront and honest with your OB-GYN or midwife about your problems so they can advise you on keeping both you and your unborn baby healthy.

If you can, arrange a session with a registered dietitian and work with her to draw up a healthy eating plan for pregnancy, and be sure to take prenatal vitamins.

The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.

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Last Modified: 14/06/2009

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