Eating Disorders and Fertility

According to the National Eating Disorders Association (NEDA), eating disorders affect approximately seven million American women each year and tend to peak during childbearing years. Sadly, a very common side effect of eating disorders is fertility problems. It is estimated that as many as one in five patients at a particular infertility clinic is there as the result of an eating disorder.

One of the most well-known eating disorders is anorexia, which is characterized by an extremely distorted sense of body image and obsessive dieting or starvation to control weight gain. Affecting approximately one to two percent of Americans, people often think becoming anorexic is a choice when, in fact, it is a mental illness. Even when a person with anorexia becomes dangerously thin, she will continue to believe she is fat and needs to lose more weight. Common symptoms of anorexia include erratic eating habits, purposeful food deprivation and excessive exercise. Some anorexics suffer from obsessive-compulsive disorder (OCD) and are constantly striving for perfection.

A slightly more common eating disorder is bulimia, which affects nearly five percent of Americans. Bulimia involves binge eating and vomiting or using laxatives to rid the body of excess calories. Unlike anorexia, people suffering from bulimia do not appear to have an eating disorder because they are usually able to maintain a healthy weight. Because the signs are less visible, bulimia often goes undetected.

In addition to the other potential side effects of eating disorders - fatigue, constipation, abdominal pain, anxiety, depression, hair loss, tooth decay and damage to the heart, liver and kidneys - they also have serious negative effects on the reproductive process. Because of the dramatic weight loss that occurs with anorexia, many anorexics stop getting their periods completely, making it virtually impossible for them to conceive. This absence of menstruation is usually the result of reduced calorie intake, excessive exercise or psychological stress. While the majority of women with anorexia do not have menstrual cycles, approximately 50 percent of bulimics have the same problem. Women who have suffered from anorexia for long periods of time may never start their periods again because of the permanent damage they have done to their bodies.

A poor diet, stress and depression can also contribute to the development of other fertility problems, such as low libido, reduced egg quality, poor uterine environment and ovarian failure. Each of these factors can make everything from the fertilization of an egg to carrying a pregnancy to term extremely difficult and, in some cases, impossible.

If a woman with an active eating disorder does happen to get pregnant, there are a number of ways it can put her pregnancy at serious risk. Complications associated with eating disorders during pregnancy include delayed fetal growth, placental separation, miscarriage, stillbirth or fetal death, gestational diabetes, jaundice, respiratory problems, preeclampsia, premature labor, low birth weight, low amniotic fluid and birth defects, especially blindness and mental retardation. In addition, laxatives, diuretics and other medications may be harmful to a developing baby, resulting in malnourishment for mother and baby. If a woman with an eating disorder carries her baby to term, she is more likely to have problems breastfeeding and more likely to suffer from postpartum depression.

On a positive note, 75 to 80 percent of women will conceive after the treatment and management of an eating disorder. In some cases, a pregnancy is exactly what a woman needs to help her completely overcome her disorder. However, just because an eating disorder has been treated does not mean the risks in pregnancy have disappeared.

If you have an eating disorder...

• Before you get pregnant: Seek counseling. Make a pre-conception appointment with your doctor and inform her that you have an eating disorder. Consider talking to a therapist. Meet with a nutritionist and discuss a healthy pregnancy diet. Take prenatal vitamins. Achieve a healthy weight and do your best to maintain it.
• Once you are pregnant: Try to gain the proper amount of pregnancy weight (25-35 pounds). Schedule an early prenatal visit with your doctor and be sure she knows about your disorder. Continue with a healthy diet by eating well-balanced meals that contain the appropriate nutrients. Do not purge. Both individual and group therapy can also be helpful.
• After you have your baby: Continue counseling to ensure your physical and mental health. Tell your close friends and family about your disorder if you haven't already. Inform them that you are more susceptible to postpartum depression and be sure you have their support during this time. Meet with a delivery room nurse or lactation consultant to help you with early breastfeeding.
• If you are struggling with an eating disorder and wish to have a baby, it is best to seek professional help and treatment before you begin trying. Your doctor will recommend that you wait until you have your disorder under control before getting pregnant. Once you have fully recovered and successfully conceived, remember to continue with a nutritious, well-balanced diet to ensure that you and your baby stay healthy throughout the term of your pregnancy.