From the Guidelines
Anorexia nervosa (AN) can indeed cause infertility due to its impact on hormone production and reproductive health. The condition's effects on the body, particularly the hypothalamic-pituitary-gonadal axis, can lead to amenorrhea in women and reduced testosterone in men, making it challenging to conceive 1. Some key points to consider include:
- Severe caloric restriction and significant weight loss can disrupt normal hormone production
- The body prioritizes essential functions for survival over reproductive capabilities when in a state of starvation
- Amenorrhea and reduced testosterone are common consequences of anorexia nervosa
- Fertility issues related to anorexia are often reversible with proper treatment and weight restoration, as noted in the context of relative energy deficiency in sport (RED-S) 1. When considering treatment options to restore fertility, it is essential to focus on restoring energy and oestrogen-dependent mechanisms of bone loss, rather than relying on pharmacological agents that may have adverse effects, such as bisphosphonates, which are not recommended for women of reproductive age due to their potential teratogenic effects 1. A comprehensive approach to recovery, including nutritional rehabilitation, psychological therapy, and medical supervision, is crucial for regaining normal reproductive function.
From the Research
Anorexia Nervosa and Infertility
- Anorexia nervosa (AN) can have a significant impact on reproductive health, including fertility 2, 3, 4, 5, 6.
- Studies have shown that women with AN may experience difficulties with fertility, including reduced fertility rates and increased risk of miscarriage 4, 6.
- However, research suggests that appropriate treatment of AN and weight restoration can lead to the normalization of reproductive function, including fertility 2.
- A systematic review and meta-analysis found that the pooled odds of childbirth rates between women with AN and the general population were not statistically significant, suggesting that AN may not have a long-term impact on fertility if treated properly 2.
Reproductive Health Outcomes in AN
- Women with AN may experience a range of reproductive health complications, including amenorrhea, oligomenorrhea, and reduced sex drive 6.
- Pregnancy outcomes may also be affected, with increased risk of low birth weight infants, premature birth, and neonatal morbidity 4, 6.
- It is essential to provide intensive prenatal care for women with AN to ensure adequate prenatal nutrition and fetal development 4.
Importance of Early Diagnosis and Treatment
- Early diagnosis and treatment of AN are crucial to reduce maternal and fetal complications 6.
- Recognition and treatment of AN prior to conception can minimize obstetric risks to the woman and potential long-term adverse effects on the offspring 5.
- Multispecialty collaboration in primary and secondary prevention programs is necessary to address the complex needs of women with AN and their infants 6.