Anorexia May Inhibit Fertility
For over two years Karen and her husband tried unsuccessfully to have a baby. Finally, they sought help from a fertility specialist, and after taking a careful medical history, the doctor discovered that Karen had a past history of anorexia nervosa. Karen had thought that since her eating disorder had been under control for several years, it was no longer an issue. Much to her dismay, she learned that even though she was at a normal weight for her size, her long term battle with anorexia might have left her permanently infertile.
Over eight million Americans, 90 percent of whom are women, are believed to meet the criteria for anorexia nervosa or bulimia, two of the most common eating disorders. Anorexia is a condition characterized by self-imposed starvation and severe weight loss. Bulimics tend to indulge in eating binges, followed by self-induced vomiting and/or laxative use. Eating disorders can be fatal - between 6 and 10 percent of those with an eating disorder will succumb to it, usually from a heart problem. Some experts put the estimate as high as 20 percent.
When a woman's eating disorder reaches an advanced state, one of the most common symptoms is the cessation of menstruation, which can lead to infertility if the body remains in this state for a prolonged period of time. The human body needs a certain amount of fat in order to function properly, and when body fat percentage falls below the minimum needed, the body will lose its ability to produce the levels of hormones needed to stimulate ovulation.
"The mechanism by which anorexia affects their fertility is that they do not ovulate," says Steven Sondheimer, MD, a professor of obstetrics and gynecology, and an infertility specialist at the University of Pennsylvania Medical Center. "Many women who regain their weight and have their eating disorder under control still don't have a return to ovulation".
The return to ovulation can vary tremendously, he points out. "Sometimes it can occur fairly quickly, or it can take months or sometimes even years".
Eating disorders have become disturbingly more prevalent and are found even among children. It is estimated that about one million teenagers are afflicted with some type of eating disorder, and anorexia nervosa is the third most common adolescent illness. Many girls who develop eating disorders before they enter puberty may never even get their period, a situation which may affect their fertility later on in life.
Because loss of body fat is the key, even a moderate weight loss of 10 to 15 percent below a woman's ideal weight can result in irregular menstruation, which may also decrease fertility. And for those who engage in strenuous exercise and have chiseled away most of their body fat, infertility can also be an issue. A number of competitive athletes stop menstruating and are at increased risk for problems with ovarian dysfunction and lack of fertility.
The good news is that the situation is usually temporary, provided a woman seeks treatment. Most women will find that their menstrual periods return once they begin to gain weight, and for about three quarters of anorexic women, fertility will also return once their eating disorder has been successfully dealt with. Even if fertility does not return on its own, the condition can be treated with medication that induces ovulation.
"If a woman has her eating disorder under control, then ovulation can be induced," says Sondheimer. "The medication is almost always effective, provided that there are no other underlying causes of infertility in either the woman or her partner".
But even if fertility does return, or if ovulation is pharmacologically induced, pregnancy can present a challenge for a woman with a past history of an eating disorder. "For many women, lingering problems with food may be present even though their most acute problems may be under control," says Cheryl Rock, PhD, RD, a clinical nutritionist with the University of California in San Diego. "And thus a woman with a history of an eating disorder should pay attention that she gains weight appropriately and does not slip into some bad food and body cognitions and behavior, should she become pregnant".
While many women with eating disorders can tolerate the weight gain of pregnancy because they realize it's part of the reproductive process, a strong potential exists of slipping back into old habits after childbirth. "Because hormone changes may increase the risk for depression," says Rock, "poor body image often becomes the target, promoting the resurgence of bad eating patterns."
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