Eating disorders and infertility

In our previous article, we analyzed the correlation between weight and fertility. More specifically, we wrote how BMI (body mass index) can cause problems in fertility levels, if not in the right range. But what about having an eating disorder while trying to conceive? What is the connection between eating disorders and infertility?

So, following this statement it is rather logical that eating disorders affect fertility too. According to the American Psychiatric Association, eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological, and social function. Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and others. People of all ethnicities, age, gender get affected and it is found that the age that the disorder starts has significantly lowered as years go by. Another interesting statistic is that they are more than twice as prevalent among females as males. 

Most common eating disorders:

Anorexia nervosa: It is characterized by self-starvation and weight loss resulting in low weight for height and age. BMI is typically under 18.5 in an adult individual with anorexia nervosa. Anorexia has the highest mortality of any psychiatric diagnosis other than opioid use disorder and can be very dangerous and sometimes fatal.

Bulimia nervosa: Individuals with bulimia nervosa typically alternate dieting, or eating only low-calorie “safe foods” with binge eating on “forbidden” high-calorie foods. Binge eating is defined as eating a large amount of food in a short period of time associated with a sense of loss of control over what, or how much one is eating. Individuals with this disorder can be slightly underweight, normal weight, overweight, or even obese. 

Binge eating disorder: As with bulimia nervosa, people with binge eating disorder have episodes of binge eating in which they consume large quantities of food in a brief period, experience a sense of loss of control over their eating, and are distressed by this behavior. Unlike people with bulimia nervosa however, they do not regularly use compensatory behaviors to get rid of the food by inducing vomiting, fasting, exercising, or laxative misuse. This disorder is chronic and can lead to serious health complications, including obesity, diabetes, hypertension, and cardiovascular diseases.

What do all of the above have in common? Women who experience these issues are usually malnutritioned, leading to amenorrhea (aka no menstrual cycles) or oligomenorrhea (irregular menstrual cycles), which may cause issues when trying to conceive. Also, women who have a current eating disorder may be at higher risk for adverse pregnancy outcomes like miscarriage and low birth weight. But the good news is that the overall number of pregnancies are not affected by past eating disorders. 

The most important thing you should remember is the negative impact they have on ovulation and menstruation. Ovulation is crucial when trying to conceive as it is the procedure of a developed egg being released from the ovary, and then being fertilized by sperm. Though irregular periods or lack of periods aren’t part of the diagnostic criteria for anorexia nervosa, between 70-90% of people with symptoms of anorexia report that they’ve previously stopped getting their periods for at least three months; an additional 5-10% report irregular periods. 

Two large population-based studies have found that women with current anorexia nervosa have an earlier age of pregnancy compared with women in the general population without eating disorders. Further investigation in the Norwegian Mother and Child Cohort Study found that the risk of having an unplanned pregnancy was significantly increased in women with current anorexia nervosa in the 6 months before pregnancy, with 50% reporting that their pregnancy was unplanned. In addition, women with that disorder were significantly more likely to report a past induced abortion. This finding was found to be particularly concerning, as unplanned pregnancies may decrease the opportunities those women have to establish critical nutritional and emotional support to help them manage the physical and psychological demands of pregnancy and motherhood.

Although the exact link between ovulation and anorexia hasn’t been clearly decoded, it is found that anorexia is associated with a decrease in a hormone called leptin. Though it’s typically thought of as the hormone controlling appetite and weight, it has another important power: it regulates the activity of the hypothalamus in the brain, which ultimately controls the production of hormones like LH and FSH that are crucial for ovulation. Low levels of leptin can “shut down” the hypothalamus and reduce levels of these important reproductive hormones, resulting in irregular or absent ovulation.
Across all types of eating disorders, there are certain things that make someone more or less likely to experience irregular periods and ovulation. An atypically low BMI, atypically high BMI, high levels of exercise, and low levels of caloric intake all increase the risk of amenorrhea or oligomenorrhea.

So you may experience some infertility issues during the time you live with the eating disorder but that doesn’t mean you will not be able to conceive at all. Fortunately, studies have shown that the majority of women with anorexia and amenorrhea can expect that their cycles will become typical within the first six months of them getting closer to their BMI. One large population-based study in the UK found that chances of conception in the first six months of trying to conceive were similar across people with a history of anorexia, a history of bulimia, and no history of eating disorders. Though women who have a history of eating disorders were more likely to have consulted a doctor for fertility-related issues, they weren’t more likely to have received fertility treatment after seeing the doctor. Other studies have found that people with past eating disorders aren’t more likely to undergo fertility treatment.
But are there any signs of problems after the pregnancy for those with eating disorders? 

Let’s see some scientific evidence about some pregnancy outcomes.

Miscarriage: There’s some data that suggests women who have either current or past anorexia report more miscarriages as compared to those with no such history. The fact that people with a past history of anorexia are at increased risk for miscarriage may be because people with a history of anorexia have lower BMIs on average, and low BMI is associated with higher miscarriage risk in general. Yet the findings are not conclusive, so we can’t be sure of the correlation between these two factors.

Low birth weight: Low birth weight is associated with infant mortality, and potentially with certain health outcomes in adulthood. Population-based studies find that active anorexia, but not active bulimia, past anorexia, or past bulimia, are associated with lower birth weight and others suggest that a history of anorexia may have a slight impact on birth weight, but not enough to be clinically meaningful. 

Perinatal mortality: In pregnant people with active anorexia, studies suggest no differences in perinatal mortality (stillbirths or infant mortality within the first week), and others suggest significant increases. Some also suggest that people with past anorexia, but not people with past bulimia or binge eating disorder, are also at higher risk for infant mortality. Here as well the findings are still inconclusive. 

Bottom line is that we can’t know for sure the outcome of the pregnancy or the infertility issues that will arise if you are striving with an eating disorder. What we do know is that trying to keep a steady weight and always being careful of the intake of all important nutrients will lead to a healthier life. Adding exercise too, avoiding smoking and drinking, will increase the possibilities of having a healthy pregnancy.

First things first! If you find yourself battling with an eating disorder, talk about it! Usually people with this kind of disorder feel such emotional stress that affects every aspect of their life. They feel hopeless, they have a distorted image of themselves and they don’t let anyone help. Don’t be one of those! There are people out there who care about you and want to help. There are plenty of support groups and of course doctors that can help you win this battle.

And if you also find yourself having problems conceiving, don’t give up because MEDIPASS is here to help you! By cooperating with top-notch fertility clinics and doctors in Greece we can offer you the most suitable treatment and the safest fertility journey.

This journey is not a journey you should do alone.