Anorexia, Bulimia, and Your Fertility

Eating disorders like anorexia and bulimia may negatively affect your ability to get pregnant. Fertility issues can occur in the midst of the disorder or may arise years after remission. One study found that women with a lifetime history of anorexia nervosa or bulimia were almost twice as likely compared with the general population to have sought out a doctor to discuss fertility concerns. However, other studies have found that women with eating disorders aren’t necessarily more likely to experience infertility.

While eating disorders are often associated with women, men also suffer from disordered eating and may experience reduced fertility as a result. 

What’s the connection between eating disorders and fertility? Can you get pregnant on your own even if you are currently dealing with or have previously dealt with, an eating disorder? What happens if you do get pregnant?

Types of Eating Disorders

The three most common eating disorders are anorexia nervosa, bulimia nervosa, and a third category known as Other Specified Feeding or Eating Disorder (OSFED) formerly known as Eating Disorder Not Otherwise Specified (EDNOS)

Anorexia

Anorexia nervosa is a disease where a person doesn’t allow himself or herself to eat normally, severely restricting calories in order to lose weight or maintain abnormally low body weight. The severity of anorexia is defined by an individual’s BMI. For example, someone with a BMI of 17 would be said to have mild anorexia, while someone with a BMI of 15 would be said to have severe anorexia.

Some people with anorexia nervosa maintain the excessive low-calorie diet consistently, while others may have episodes of binging. These binges are followed by either self-induced vomiting, taking laxatives, or engaging in excessive exercise.

Bulimia

Bulimia nervosa is a disorder that involves recurrent binging episodes followed by inappropriate compensation to “make up” for the binging. Most people think of self-induced vomiting when they think of bulimia, but using enemas, laxatives, excessive exercise, or periods of restricted dieting or fasting may also occur.

Men and women with bulimia may be underweight but more commonly their weight is normal or even slightly overweight. This does not, however, mean they are nutritionally healthy or that they have a healthy amount of fats and proteins in their bodies.

Other Specified Feeding or Eating Disorder

Some men and women have disordered eating that doesn’t strictly fall into anorexia nervosa or bulimia category, but they still suffer mental and physical health challenges. Labeled as Other Specified Feeding or Eating Disorder (OSFED) over 50 percent of people with an eating disorder fall into this category. The health consequences of OSFED can be just as serious as anorexia nervosa and bulimia.  

How Eating Disorders Impact the Reproductive System

Anorexia, bulimia, and OSFED come with unique physical and mental health challenges. The possible complications vary between the three, and health complications from eating disorders can be serious enough to prove deadly. For example, people with anorexia may experience serious heart problems. In fact, anorexia is considered to be one of the most deadly psychiatric disorders.

What These Disorders Have in Common

• Decreased fat stores
• Decreased protein stores
• Depleted vitamin and mineral stores

Symptoms of Individuals Who are Underweight and Suffer From an ED

• Risk of thyroid imbalance (specifically, low thyroid)
• Decreased BMI, or body-weight ratio in comparison to height

How does this relate to the reproductive system, in particular?

Body Fat and Your Hormones

Hormonal balance requires healthy fat stories in the body. Body fat—also known as adipose tissue—is frequently villainized, but you actually need fat!

One of the many roles fat cells play is the production and synthesis of hormones. For example, if you have too little fat, you won’t produce enough of the hormone estrogen. If you don’t produce enough estrogen, your reproductive system will not function well.

Fat cells also play a role in testosterone levels. Men with too little body fat will produce suboptimal levels of testosterone. This will impact sperm production and erectile function.

Nutrition and Hormones

But it’s not all about fat. For example, women with bulimia nervosa or OSFED may be at a normal weight for their height and still have irregular or absent periods.

The connection between nutrition and fertility is not well understood, but researchers have discovered connections between the quality of a person’s diet and the risk for fertility problems. This is true in both men and women.

For people with an eating disorder, they are more likely to have a diet that doesn’t meet basic nutritional needs. If a person is forcing him or herself to throw up, or using laxatives or enemas to empty their bowels quickly, their bodies won’t have the time required to absorb the nutrients from the food they eat.

Your body needs a variety of vitamins, minerals, and proteins, along with proper hydration.

If your body doesn’t get essential nutrients, then your sperm and egg cells may be poorer quality. Your body may also have more difficulty synthesizing essential hormones for reproduction. This can lead to decreased fertility.

Menstruation and Ovulation

One of the classic signs of an eating disorder in women is amenorrhea, or a lack of menstruation, and oligomenorrhea, or irregular periods. Not every woman with an eating disorder will have irregular periods, but many do.

If you’re not menstruating normally, this usually means you’re also not ovulating normally. If you’re not ovulating normally, it will be difficult to get pregnant.

According to some studies, between 66 and 84 percent of women with anorexia nervosa don’t get their periods, and between 6 and 11 percent have irregular cycles. For women with bulimia nervosa, anywhere between 7 and 40 percent experience amenorrhea and between 36 and 64 percent have irregular periods.

Women who had low BMI, low-calorie intake, and engaged in excessive exercise were more likely to have menstrual irregularities.

Shrinking Ovaries and Uterus

In some women with anorexia, specifically, those whose periods have completely stopped, pelvic ultrasound studies have found that the women’s ovaries have shrunk back to pre-puberty size. Some women also had smaller than normal uterine size.

This is likely related to the abnormal hormone levels, caused by the lack of necessary healthy body fat. 

Fertility would be severely impaired for these women.

Lower Sperm Count and Erectile Dysfunction

Unfortunately, there is significantly less research on the effect eating disorders have on male fertility. From the little research we have, we do know that the abnormally lower fat levels in these men lead to abnormally low testosterone levels, as well as other essential reproductive hormones.

When those male reproductive hormones are low or imbalanced, poorer sperm count and overall health are likely. The men may also be more likely to experience issues with low libido and possibly erectile dysfunction.

Functional Hypothalamic Amenorrhea

Functional hypothalamic amenorrhea is the medical diagnosis a woman may receive who is not getting her periods but doesn’t have a reproductive “disease” specifically causing that lack of periods. In other words, her lack of menstruation isn’t due to an organic dysfunction but may be the result of extreme dieting, excessive exercise, or extremely high levels of stress.

Diagnostic Criteria

• Lack of a menstrual cycle for three or more months
• Low blood levels of gonadotropins
• Low blood levels of estradiol (E2, a form of estrogen)
• Evidence of precipitating factors (like extreme dieting, for example)
• No evidence of another cause (other reproductive diseases have been excluded)

Pregnancy with an eating disorder has potential complications and risks to the unborn fetus. Women with a history of an eating disorder may also experience psychological distress during pregnancy, especially as they gain weight and their “baby bump” grows.

The best fertility treatment for women with an eating disorder is to treat the underlying eating disorder. In other words, the woman needs to take in more calories, exercise less, and bring their body weight up to a healthier level. This should lead to the return of ovulation, and the woman should be able to conceive normally (assuming nothing else is wrong.)

Psychological and nutritional counseling would be most beneficial. Once the eating disorder is under control, if necessary, the woman could return to the fertility doctor or gynecologist for further counseling.

Long-Term Effects of an Eating Disorder on Fertility

Can an eating disorder still affect your fertility after you recover? This is unclear.

Some research has found that, yes, those who have a history of eating disorders are more likely than the general population to have difficulty conceiving. Some studies have also found that those with a history of eating disorders may take a little longer to get pregnant.

On the other hand, separate studies have found no long-term fertility effects.

Keep in mind that the long-term impact of your eating disorder may be dependent on how severe your eating disorder was. For example, in cases of severe anorexia, permanent damage to the heart, bones, and reproductive system may occur.

Don’t assume you’ll have long-term fertility problems. It’s very possible that you’ll be able to conceive easily.

The best thing to do is talk to your gynecologist, and be honest about your history with eating disorders. He or she can do basic fertility testing and get a baseline on whether things look good or if there may be potential problems.

Pregnancy Is Possible—Even if You’re Not Menstruating

Some women with eating disorders or a history of eating disorders assume they can’t get pregnant. They fail to use contraception and then conceive unintentionally.

In fact, women with anorexia are twice as likely to experience an unplanned pregnancy than the general population. This is likely due to these women believing that they can’t conceive if they aren’t getting their periods or if their periods are irregular. This actually is untrue. While you may be less likely to conceive with an irregular period, it’s still possible.

If you don’t want to get pregnant, make sure you use some form of birth control.

How Eating Disorders Impact Pregnancy and Childbirth

Eating disorders can affect pregnancy and childbirth. A current eating disorder can put the health of the fetus at risk, and a current or history of eating disorders can put the mental health of the mother at risk.

Health Risks for Baby

• Increased risk of miscarriage
• Increased risk of preterm delivery
• Increased risk of a low birth weight baby

Health Risks for Mom

• Malnutrition
• Dehydration
• Heart problems
• Depression during or after the pregnancy

Talking to a counselor and a nutritionist can help you make better choices for you and your baby, and also help you cope with the stress of pregnancy and childbirth.

Fertility Treatments and Eating Disorders

Can you receive fertility treatment when you have an eating disorder? Ideally, you want to consult with both your fertility doctor (or gynecologist) and your mental health counselor to decide together what’s the best decision for you.

Remember that going into pregnancy with an active eating disorder puts your health and your baby’s health at risk.

When it comes to ovulation induction with fertility drugs, the current recommendation is that fertility treatments should not be used in women whose BMI is less than 18.5. If this applies to your situation, your doctor may refuse to prescribe fertility drugs. This is for the safety of you and your baby.

If your ovulation difficulties are related to the eating disorder, you should know that bringing your weight up, eating a healthier diet, and exercising less may be enough to restart ovulation. Then, you could get pregnant on your own and won't need fertility drugs.

Male Infertility

What about male infertility related to an eating disorder? It’s rare that fertility treatments are used to treat infertility associated with an eating disorder associated with men. That said, bringing your weight up and eating a healthier diet may be enough to improve your semen health and return your fertility.

A Word From Verywell

Eating disorders like anorexia nervosa and bulimia are hard on both your physical and psychological wellbeing. Having a baby—even if you start off with almost perfect health—is challenging! This is all the more reason to give you and your baby the best chance for a healthy pregnancy and birth and seek out treatment or support for your eating disorder now.

If you have a history of an eating disorder but are not currently facing this challenge, you may not have trouble getting pregnant. However, if you don’t conceive after one year of trying (or after six months of trying, if you’re age 35 or older), then see your gynecologist for a fertility evaluation.