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Too Thin To Conceive

How Anorexia Impacts Fertility

By Kelly Burgess

So if a man who is anorectic and begins to eat again can regain his fertility, is the same true for a woman? Yes, says Dr. Katz. Furthermore, although the long-term negative effects on bone mass with anorectics has been well-documented, there is no evidence that it has a long-term effect on fertility. Still, even though there's no research showing the "ideal" time between beginning a healthy diet and conception, Dr. Katz prefers that a woman has been eating healthfully and having periods for at least 6 to 9 months.

However, it's not always that simple. Women with eating disorders are extremely anxious about food, Clark says. While she may want to eat healthfully for her sake and her baby's sake, her eating disorder is part of her personal identity, and she may have difficulty giving that up.

Clark sees several types of women who are suffering from eating disorders related to pregnancy issues. In the first category is the woman who wants to become pregnant and is worried that her eating disorder will impact her fertility and/or pregnancy. The second category is the woman who may not have had a period for many years, due to a body fat-related cessation of menses, and suddenly finds herself pregnant.

When a woman with an eating disorder who finds herself pregnant is referred to Clark, she tries to ease them into the idea of increasing caloric intake. "When I get a woman who is already shocked because she's pregnant, I try not to freak them out by saying, 'Well, a normal person needs to eat 300 calories more a day, so you need to eat 500'," she says. "I prefer to encourage them to make teeny, tiny changes and to make those changes with foods they already feel are safe."

In fact, to make nutrition the issue, rather than weight, Clark doesn't even weigh her patients, figuring they get enough of that at the gynecologist's office. As her patients see that she is not going to judge them or force them to eat anything, they become more willing to make small, healthy changes.

Clark uses a similar approach with women who are not yet pregnant, and are either trying to become healthier before pregnancy or who are trying to get their body fat up to a level where they can conceive. "I'm always careful to be sure they understand that I'm not asking them to give up their eating disorder," says Clark. "Rather, I give them support and encouragement to let go of it temporarily. We're just asking them to put it on hold for a while." And maybe "a while" will turn into forever, with baby steps leading the way.

Want to see more?

• The Skinny on Weight While Trying to Conceive
• Too Toxic to Conceive: Is Your Lifestyle to Blame?
• A Weighty Issue: Trying to Conceive When You're Overweight
• Talk about it!