When treating patients who are dealing with infertility, you may see women with past or current eating disorders. Although research is mixed on whether there's a higher prevalence of women with eating disorders seeking fertility treatments than there are in the general population, the science is clear that there's a negative association with eating disorders and fertility. So it's important to assess patients for unhealthy eating behaviors and find ways to manage the issue before pregnancy.
Fertility Complications of an Eating Disorder
Eating disorders include anorexia nervosa, bulimia nervosa and binge-eating. These conditions are not specifically about food, but about distorted body image and are hard to overcome.
Women with severe eating disorders often have trouble getting pregnant because they may not ovulate, have irregular periods or have no period at all, according to the Annals of Medicine. If they become pregnant, these women are also at higher risk of complications like low maternal weight gain, having infants with low birth weight and a higher risk of their baby having health problems or trouble feeding.
Preventing these complications and helping women have safe, healthy pregnancies means any eating disorders need to be recognized as soon as possible. It also helps to become familiar with the signs and symptoms of eating disorders.
Talking About Eating Disorders and Fertility
A study in Fertility and Sterility recommends using an eating disorder screening tool during intake to identify patients at risk. In that study, none of the patients identified as having an eating disorder told their doctor or endocrinologist. Many women facing this issue are resistant to talking about it or receiving treatment at first, so approaching this touchy subject can be challenging.
Make sure to educate your patient about the importance of treating the eating disorder — or keeping a previous disorder in the past — before, during and after pregnancy. Some points to cover include:
- Directly state that an eating disorder can decrease the chances of getting pregnant and reduce the possible success of a fertility treatment.
- Highlight the importance of healthy eating and reasonable exercise throughout pregnancy to the baby as well as the risks of inadequate nutrition.
- Reassure them that with treatment they can have a healthy pregnancy.
- Refer them to a behavioral health specialist and nutritionist to provide guidance throughout the pregnancy and postpartum period.
Women with an eating disorder are most likely to experience infertility because they stop ovulating. However, with treatments for both the disorder and fertility, these women can still have healthy pregnancies, according to research in Obstetrics & Gynecology
When talking to these patients, speak with empathy and compassion and be sure to avoid blame. Keep the tone positive and offer actions and resources to help them recover, thereby gaining the most benefit from fertility treatments.
Following Up With Patients
Having an initial consultation or even treatment before pregnancy isn't enough. Patients at risk of falling back into damaging eating habits need continual support throughout pregnancy and after. Although normal and healthy, the weight gain during pregnancy can be emotionally challenging for these patients. They're constantly fighting the desire to lose weight, even if they know it's irrational. They need regular interaction after birth to support breastfeeding and prevent postpartum depression.
Referrals to support services and more frequent check-ups may be needed to care for these women throughout their pregnancy journey. The first step is to recognize the problem and begin an open, trusting conversation.
