Eating Disorders and Infertility – Is There a Link?

Eating disorders and infertility are unfortunately closely related. These complex conditions can have significant impacts on both your physical and mental health, not to mention the physical and emotional repercussions. Fertility problems are a common side effect of many eating disorders, but plenty of women are still able to successfully get pregnant after treatment.  Anyone can suffer from an eating disorder and when the body isn’t nourished properly, it can inhibit your reproductive system from functioning.  

Hormones are the driving force behind our body’s systems, including reproduction. Since reproduction and nutrition are connected, when the body isn’t nourished properly, it can inhibit your reproductive system from functioning properly. In this post we’ll explain how eating disorders can affect your fertility and ability to get pregnant. We’ll also answer some commonly asked questions about eating disorders and infertility and give you some resources for how to seek help if you or someone you know suffers from an eating disorder.   

Can eating disorders cause infertility? 

According to statistics from the National Eating Disorders Organization, as many as “20 million women and 10 million men in America will have an eating disorder at some point in their lives.”  Among the common health consequences of eating disorders is the long term effects on the endocrine system (ie. the hormone system). Hormones are the driving force in our reproductive system and anything that affects the production of these hormones can lead to issues with fertility. Disordered eating and nutrition can affect a variety of reproductive functions including menstruation, fertility, maternal weight gain, and the wellbeing of a baby while in utero. 

Although plenty of people go on to become pregnant after treatment, eating disorders and infertility often go hand in hand. When the reproductive system is compromised, it may increase the likelihood of infertility but the research on whether eating disorders cause infertility is lacking. We can safely say that eating disorders cause disruptions to the reproductive system that may make it more difficult to get pregnant but more research is needed on the long term effects of eating disorders and fertility outcomes.       

How do eating disorders cause infertility?

Individuals who struggle with an eating disorder, regardless of the type, often experience similar complications with their reproductive health. Although the possible complications vary, many experience the absence of a period (amenorrhea), infrequent periods (oligomenorrhea), issues with ovulation, low ovarian reserve or sperm production, and reduced libido. Hormonal balance is what ties them all together and when the reproductive system is compromised, various issues can result.  

Eating disorders come with their own unique challenges, but common threads include decreased fat stores, decreased protein stores, and depleted vitamin and mineral stores.  Hormonal balance relies heavily on fat stores since these cells play a role in the production and synthesis of hormones. Without appropriate levels of body fat, you won’t produce the necessary hormones, especially estrogen, and your reproductive system suffers. Lowered sex hormones can lead to a host of problems including issues with menstruation and bone loss, among others.  

When your basic nutritional needs are not met, your body doesn’t get the essential vitamins and nutrients needed to run optimally. The energy your body does get is diverted to perform key body functions to keep you alive, rather than reproductive functions. And when you are nutritionally compromised it’s likely you will experience issues with your menstruation, either a lack of menstruation or irregular cycles.  

If you are not menstruating, you are also not ovulating. Lower hormone levels overall can impact how the hypothalamus works, which ultimately controls hormones critical for ovulation like luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Without appropriate levels, the body is unable to release an egg to be fertilized and this can ultimately lead to infertility.  Conceiving with an eating disorder is much more difficult but surprisingly, there is a high rate of unplanned pregnancies among those with a history of eating disorders.                

Can an eating disorder affect a pregnancy? 

Eating disorders not only affect the health of the mother, but can also take a toll on the health of the baby. Pregnancy brings about many body changes and requires additional nourishment to flourish. The baby will take what it needs from the mother so it’s important to eat a well-balanced diet and maintain a healthy weight to protect both the mother and baby.  

Pregnancy outcomes for those with an eating disorder include many risks such as cardiac irregularities, gestational diabetes, premature birth, labor complications, and psychological complications like postpartum depression. The risks to the baby can include poor development, low birth weight, and respiratory distress among other complications. Research in this area is limited, possibly due to the shame and secrecy surrounding such disorders.        

Getting pregnant with anorexia 

Surprisingly, women with anorexia are more likely to have unplanned pregnancies than those without the disorder. Many mistakenly believe that their lack of menstruation means they don’t need birth control and fall unexpectedly pregnant. But not everyone experiences anovulation with anorexia and there are serious risks to getting pregnant with this condition.

Individuals with anorexia are often underweight and have additional risks with pregnancy due to this. They may not gain enough weight during the pregnancy and cannot support the growing baby adequately. Steps should be taken to protect both the mother and the baby and you should be honest with your health provider so they are aware of your struggles.

Can anorexia cause infertility and can anorexics get pregnant? Although reproductive health is compromised with anorexia, some research reveals that appropriate treatment leads to a return of your reproductive functions and fertility, but more research is needed in the area.        

Getting pregnant with other eating disorders 

Eating disorders are highly unique to the individual and getting pregnant may affect them in unique ways. Anorexia and bulimia are well known, but other eating disorders like purging disorder, pica, and binge eating disorder (among others) can have serious effects on your health and ability to get pregnant. Although it’s not impossible to get pregnant with other eating disorders, it’s highly recommended that you delay pregnancy and seek treatment first. Not only can this help your reproductive health and chance of conceiving, but it will also help you establish healthy habits for your pregnancy.  

Pregnancy has distinct nutritional needs and the healthier you can be the better.  But it’s important to note that sharing your concerns with body image or weight gain with your healthcare provider is extremely important  Not only can they help you move forward with getting pregnant, but they can exercise extra caution around weighing and weight gain so you are not triggered by the experience. 

Having an eating disorder doesn’t mean you can never get pregnant, but it’s important to understand the repercussions for your own health as well as the health of the baby. For some, pregnancy is a keen motivator and helps them put their disordered eating behind them. But for others, it can exacerbate the situation and may lead to relapse.       

Fertility with a past eating disorder 

When asking the question “can eating disorders cause infertility” the answer can be complicated. With appropriate treatment, reproductive health can rebound, but that doesn’t mean you won’t have any fertility issues down the road. It is an unfortunate side effect of many disorders and research can’t say for sure that fertility outcomes are caused by eating disorders.

The evidence is mixed and plenty of people go on to get pregnant after recovering from an eating disorder.  

That being said, the physical and emotional changes associated with pregnancy may be difficult for anyone with a past eating disorder. It’s important to address these issues early on, either when trying to conceive or once you are pregnant, so there are no negative impacts on your pregnancy. Managing these issues with the proper team of healthcare professionals, like your doctor, a nutritionist, and therapist, can go a long way in helping you cope with both a pregnancy and the postpartum period.  

Seeking help for an eating disorder

There is a lot of shame and secrecy surrounding eating disorders and it prevents many from getting the help they need. An eating disorder is not a choice but a mental illness and it is never too late to seek help. Help is available but seeking it out can be a difficult first step. Recovery is not a straight line and you may go through many stages during the process.  

National organizations (like NEDA and NEDIC) provide a wealth of resources, information, referrals, and support for those affected by eating disorders. The shame and fear of judgment around eating disorders often prevents people from seeking help, and this can be exacerbated when fertility is on the line. If you are unsure where to start, speaking to your doctor is the first step. If you feel unable to do that, for whatever reason, there are a number of online resources and helplines that can get you started and provide support.  

Although not a replacement for clinical evaluation, many organizations offer online screenings to assess the warning signs of an eating disorder and help you decide if it’s time to seek professional help. Treatment for eating disorders is highly specific and often involves a team of professionals to help you manage your symptoms and maintain both physical and mental health.           

Eating disorders and fertility FAQ