The topic of fertility with an eating disorder is a sensitive one, and to none more than myself. As a person in her late 20s who is in recovery from what I like to call the “eating disorder train,” I constantly wonder how my fertility might be affected. If I decide to have a child down the road, will my chances diminish because of the damage I did to my body through binge-eating or anorexia?
I reached out to a couple of doctors who either specialize in fertility or in eating disorders when researching this article, and the answers might surprise you.
1. Eating disorders can cause infertility, & it’s not just physical
It’s easy to assume anorexia is the only eating disorder that can cause issues both before and during pregnancy because we are malnourished, and malnourishment causes a lot of issues in the body.
However, it’s not the case. Binge-eating disorder is another eating disorder that can cause infertility, especially when associated with obesity. Obesity in young people can result in high levels of male hormones called androgens. Androgen imbalance can cause abnormal menstrual cycles and block ovulation, which can result in infertility.
People who struggle with any type of eating disorder typically have stress due to personality traits like perfectionism and control or mental disorders such as obsessive-compulsive disorder and anxiety and depression. The stress of these psychological conditions may also contribute to menstrual problems and infertility.
“Psychological stress from an eating disorder can definitely play a part in infertility issues,” said Dr. Heather Maio, a psychologist and assistant vice president of clinical and admission services for The Renfrew Centers. “We tend to look at other factors going on for an individual who either currently struggles with an eating disorder or has in the past, like work stress or emotional difficulties that have spawned either because of the eating disorder or prior to it.”
2. Anorexia, however, is more likely to affect fertility than other eating disorders
Menstruators who are diagnosed with anorexia and about 50 percent of menstruators with bulimia stop having their periods, which is referred to as amenorrhea. Extreme weight loss from a decrease in calories results in suppression of hormones from the pituitary gland that are needed to maintain normal estrogen levels.
“Without normal levels of estrogen, ovulation does not occur and infertility develops,” said Dr. Carolyn Givens, a reproductive endocrinologist at Prelude Fertility clinic.
Those who participate in compulsive exercise (otherwise known as exercise bulimia) can very well end up suppressing their periods as well. Often in this situation, they may notice their menses are lighter or further apart or may stop menstruating altogether. This causes changes to the hormone levels that occur and suppress both ovulation and menstruation.
According to an article on Eating Disorder Hope by Jenifer Harcourt, a licensed professional counselor, it is possible that if someone struggles with anorexia before menses has ever begun, they could have a harder time recovering from the damage done to their body in formative adolescent years. This can translate to someone who has missed at least three menstrual periods in a row or who has not yet begun menstruation by age 15.
3. Miscarriage & stillbirth are a reality
Someone struggling with anorexia during pregnancy (referred to as “pregorexia”) can increase the risk of their baby not making it to full term. Miscarriage occurs when a fetus is lost prior to the 20th week of pregnancy, and stillbirth occurs when the fetus is lost after the 20th week of pregnancy. Due to stress placed on the fetus as a result of anorexia-related poor diet and, as a result, a lack of nutrition for the baby, pregnant people who suffer from anorexia have an increased risk for both.
Anorexic people are also more likely to have multiple miscarriages, even while in recovery from anorexia. “It’s interesting, because we are seeing research that shows that a woman in recovery from an eating disorder who is trying to become pregnant has an equal shot at succeeding if it occurs during the first six months of trying, which is the national average,” said Maio. “However, there is some new research that shows if it takes longer than six months to get pregnant, it is harder for a woman who struggled with anorexia than a woman who didn’t.”
4. The damage on fertility can usually be reversed
The good news is that people with eating disorders who seek treatment and maintain recovery can typically reverse the damage done by their eating disorder.
“Once regular periods resume, that is a good indication of fertility returning as well,” said Givens. “Menstruation typically returns [within] six months of achieving ideal body weight.”