Eating Disorders and Fertility

Recent research on body image indicates that dissatisfaction with weight sets in girls at a tender age of 6!!! Desire to become thin, anxiety about weight and shape, body image - these aren't common to teenage and adolescent years. The search for a 'diet' to lose weight by limiting calories or types of food begins by age 8. Irrespective of the age and gender, persons who diet are nearly 5 times more prone to developing a serious eating disorder.

Eating disorders affect a person's emotional and physical health. Not eating a good diet is denying the body nourishment and nutrition. A real, complex and devastating impact of eating disorder is fertility. The direct connection between nutritional intake and fertility cannot be ignored. Eating disorder robs a person of their talents, dreams, interests, passions and fertility as well.

Myths about eating disorders

Misconceptions and myths of eating disorders pose a hurdle to learn, unlearn and relearn. Below are a few statements which most of us have come across.

• Eating disorder is just about food and food alone.
  
  
• Eating disorders are a fad, choice
  
  
• It's a diet gone 'too far'
  
  
• Parents don't cause eating disorders
  
  
• Eating disorders are merely a 'girl thing'
  
  
• A child is too young to develop eating disorder
  
  
• It's merely a disorder. Almost everyone has it
  
  
• If he or she is not emaciated, they aren't sick
  
  
• Weight loss is a serious indicator of eating disorder
  
  
• Normal or overweight people cannot have eating disorders.
  

We have all the time in the world to learn things that need to be learned and less time to unlearn it. Understand eating disorders in a more inclusive way and it's devastating effect on fertility.

What actually is eating disorder?

Eating disorder isn't a physical illness. It is rather a mental illness that jeopardizes overall well-being. The Diagnostic and Statistical Manual of Mental disorders (DSM) have officially recognized eating disorder as Mental Disorder. Someone can be experiencing or developing an eating disorder. Generally, people do not accept and often try to hide their behavior. It's expressed as an abnormal or disturbed eating pattern or inadequate or excessive food intake.

How does one find out? Look for these physical, behavioral and psychological signs.

Physical signs:

• Fluctuation in weight - sudden gain or rapid loss of weight.
  
  
• Gastrointestinal complaints like constipation, loose stools, bloating, acid reflux etc
  
  
• Feeling too tired
  
  
• Disturbance in menstrual periods
  
  
• Sleep deprivation
  
  
• Unable to concentrate and feeling restless
  
  
• Severe lightheadedness and fainting spells
  
  
• Feeling cold even in warm environment
  
  
• A spate in dental problems (enamel erosion, cavities and tooth sensitivity)
  
  
• Dry skin, dry nails and dry hair
  
  
• Mild swelling around salivary glands
  
  
• Tooth decay
  
  
• Frequent vomiting (indicators are swollen cheeks/jaw line, damage to teeth)
  
  
• Weak immune system
  
  
• Poor wound healing
  
  
• Loss of muscle movement and strength
  

Emotional signs:

• Avoiding meals or situations where food is present for fear of gaining weight
  
  
• Always thinking of body weight, shape, size or physical appearance
  
  
• Adhering to an exercise regime even as one may be losing significant amounts of weight
  
  
• Avoiding friends and family questioning about visible physical changes.
  
  
• Equating self-image and self-esteem to body shape and weight
  
  

Behavioral signs:

• Spending more time in front of the mirror
  
  
• Measuring weight too often
  
  
• Frequent trips to washroom soon after eating
  
  
• Measuring calories of every food item
  
  
• Hiding large amounts of food
  
  
• Obsessed with exercising for several hours per day (even when ill or injured)
  
  
• Eating alone and avoiding eating in a group or public
  
  
• Decoding every food into 'safe/healthy'
  
  
• Unusual food eating habits (small bites, excessive chewing, eating slowly)
  
  
• Wearing over-sized clothes to hide weight loss
  

These are common signs. A person with an eating disorder may have one or a combination but not all. It just confirms the person's unhealthy relationship with food. Moreover, signs vary with eating disorder type.

Types of eating disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a publication of the American Psychiatric Association (APA). The DSM5 (revised) has classified eating disorders.

Anorexia nervosa: Irrational fear of gaining weight, a strong desire to be thin and taking extreme steps to be thin. Criteria for anorexia are:

• Viewing oneself as being overweight even though they are not
  
  
• Participating in extremely intense dieting behaviors
  
  
• Counting and recounting caloric intake (leading to malnutrition)
  
  
• Fixated on weight
  
  
• Checking weight daily for gain/loss
  

Bulimia nervosa: Translated from Greek, Bulimia nervosa means 'nervous ravenous hunger'. Obsessed with body and weight, persons with Bulimia take extreme efforts to avoid gaining weight often by cyclical purging following eating. Criteria for bulimia nervosa are:

• Irresistible desire to overeat
  
  
• Feeling guilty after overeating
  
  
• Punishing self by purging, fasting or exercising
  
  
• Taking laxatives, enemas or diuretics to eliminate food
  
  
• The cycle continues – bingeing and purging
  

Binge-eating disorder: Always over eating and bingeing and frustrated by weight gain. Criteria for binge-eating disorder are:

• Urge to over-eat is overwhelming
  
  
• Consuming large amounts of food very quickly
  
  
• Accepting lack of will-power to control or stop eating
  
  
• Struggling to control eating behavior
  
  
• Overeating and feeling ashamed, guilty
  

Other specified feeding and eating disorder (OFSED): It is a broader term which includes the following eating disorders such as:

Atypical anorexia nervosa: Criteria of anorexia nervosa sans low body weight.

Bulimia nervosa of Lower frequency: Criteria of Bulimia nervosa sans bingeing-purging cycles that occur less often than one time a week.

Binge-eating disorder of low frequency: Criteria of binge-eating disorder sans binge-eating episodes that occur less than once a week.

Purging disorder: Person purges without bingeing

Night eating syndrome: Person consumes low amounts of food during the day but eats a lot at night.

Avoidant/restrictive food intake disorder (ARFID): It is not body weight or shape or fear of becoming fat that influences food choice. Criteria for ARFID are:

• Avoids range of food items because of its taste, smell, texture or appearance
  
  
• Lack of interest in eating
  
  
• Worried about the consequences of eating (like choking sensation)
  

Unspecified feeding and eating disorder: Persons do not meet the full criteria of any of the eating or feeding disorder criteria. Yet the eating habit causes great emotional upset or interferes with daily life.

The connection – Eating disorders and fertility

Is there a connection between eating disorders and fertility? Yes, fertility problems are a common side effect of eating disorders. Among women with a history of eating disorders, infertility and reproductive issues are common.

Demand for energy, nutrition is at an all-time high during child bearing years. But there is a fight on the outside i.e. image concern and inside, i.e. malnutrition. The effects of eating disorders on fertility are:

• Harmful levels of weight gain and weight loss
  
  
• Absence of menstrual periods as BMI is disproportionate which is required for the onset and maintenance of ovulation and menses.
  
  
• Endocrine system suffers (affects hormone levels and fertility)
  
  
• Low libido
  
  
• Ovarian failure (No ovulation = No pregnancy)
  
  
• Reduced egg quality
  
  
• Poor uterine environment
  
  
• Unhealthy eating habits induce psychological stress and hormonal balance
  
  
• Increase in the level of stress hormones
  

Of the different types of eating disorders, the effect of Anorexia is hazardous. Anorexia affects fertility by reducing chances of conceiving. Women with anorexia do not have menstrual cycles and in many instances periods abruptly stop.

For instance, a woman developed anorexia nervosa at the age of 14. After a long wait, she conceived through vitro fertilization. Post delivery, she found it hard to care for her baby's nutrition and just couldn't carry the baby in her arms because of muscle weakness. She confessed that she had difficulty in abandoning symptoms of anorexia nervosa with which she had lived for nearly 25 years.

Close to 50 % of women with Bulimia experience irregular menstrual cycles. Here is a story of a woman living with Bulimia or bulimia nervosa for 20 years. Her body wasn't getting enough nourishment. Nutrition was only available for vital functions of the body. Menstrual cycle was hit. Deprivation of enough nutrients led to onset of irregular menstrual cycle which disrupts ovulation, or releasing an egg, each month. She had very light periods, unpredictable and irregular periods or no periods at all. The challenge was obvious. Irregular periods made trying to conceive very challenging.

Now about binge eating disorder. She was just 20 years old. But all the time she could only think of food. Once, she ate an entire ½ gallon of cookies and ice cream in one sitting. Yet, couldn't stop craving for more. She was attracted to fatty foods with little or no nutritional value. Clearly, she was denying herself vital vitamins, protein and other nutrients.

Consuming too much food puts serious stress on the organs. It can damage stomach and crush the intestine. Besides, the most common effect of binge-eating disorder is obesity and overweight. Obesity in young women can result in high levels of the male hormones called androgens. Excess androgen and the imbalance can result in abnormal menstrual cycles and blocked ovulation. A woman's ability to get pregnant suffers.

The impact on fertility of the other eating disorders, OSFED, Avoidant/restrictive food intake disorder, unspecified feeding and eating disorders cannot be ruled out. The endocrine system is vital for fertility. All types of eating disorders affect a woman's endocrine system, which controls the production of reproductive and growth hormones. It impacts menstrual cycle health. Hormonal imbalance occurs and ability to reproduce may be impaired.

On the whole, a person with eating disorder is denying the body an opportunity to conceive naturally. The struggle with stress, anxiety and depression, smoking, excessive drinking add on to the existing issue and dampens pregnancy plans.

Revive fertility. Control eating disorders

There is hope. Treatment is available for eating disorders and fertility issues. For anyone struggling with eating disorders and yearning to conceive, the road to conception and pregnancy is clear. The first step is to feel more determined to get eating disorders under control and revive fertility. 75 to 80 % of women conceive after being successfully treated for an eating disorder. Treatment regimes look at eating disorder as a 'problem' to be solved. The treatment aims at getting the mind and body back to a healthy state.

Seek appointment with a health care provider. Discuss eating habits and behaviors before planning a pregnancy. It is necessary to seek treatment for the disorder before thinking of becoming pregnant. The healthcare provider may recommend a counselor who is experienced in treating people with eating disorders and a nutritionist who can help create a healthy eating plan to get to a healthy weight. There are many habits to let go off and relearn body acceptance and how to feed and honor your body with 'normalized eating'.

When the body is well fed, menstrual periods will become regular again and there should not be trouble getting pregnant. But if a woman still continues her struggles with ovulation issues, there are oral fertility drugs like clomiphene citrate (clomid or Serophene) which might be prescribed to stimulate hormones to help in ovulation.