Last year, I wrote an article for Vogue that was potentially the most vulnerable thing I’d ever put out into the world. My husband and I were embarking on an in vitro fertilization (IVF) journey in order to—hopefully—freeze embryos. My doctor had suggested the proactive measure as a sort of insurance policy in case we wanted a second child. In retrospect, this all sounds a bit presumptuous because we hadn’t even had a first child. But because of my “advanced maternal age,” we were planning ahead—after all, we didn’t know what the future might hold for us given my history of an eating disorder and the repercussions from that.

I lost my period in high school following significant anorexia-fueled weight loss. For many people, restoring weight in eating disorder recovery is enough to resume regular menstrual cycles and ovulation. For me, it wasn’t. The Vogue story was published before we discovered that the IVF was unsuccessful—we didn’t get any viable embryos from the process. This only escalated my fears around fertility and my guilt that I had caused all of this with my eating disorder.

I’ve written it before and I’ll write it again here—both as a reminder to myself and an important point for everyone reading—eating disorders are not a choice, and neither is infertility. About 14 million people worldwide experience an eating disorder each year, and 1 in 6 worldwide experience infertility. But those facts didn’t necessarily make me feel less alone, or stop me from worrying about whether my own eating disorder had cost us our potential future as a family.

Writing this now, it’s surreal to admit that I’m currently eight months pregnant and expecting a baby girl next month. Getting here wasn’t easy and it certainly wasn’t without stress, tears, and serious recommitment to all the strategies and principles I learned in recovery. And even writing these facts out is somewhat uncomfortable because I know that luck was also on my side—not every person who struggles with infertility will get to this point.

But what’s essential to know is that while a past or current eating disorder diagnosis can pose fertility challenges, it doesn’t need to dictate whether or not you can get pregnant. Here’s everything I wish I’d known about the relationship between eating disorders and fertility, and what to do if you’re concerned that an eating disorder is standing in the way of you becoming a parent.

Why can eating disorders negatively impact fertility?

According to one study on the long-term effects of eating disorders on fertility and pregnancy, 21% of women with anorexia and 20% of those with anorexia and bulimia had been seen by a physician for lifetime fertility problems, compared to just 11% of the general population. Women with eating disorders were also more likely to have received medical assistance in becoming pregnant and had lower rates of intentional pregnancies. In a recent survey conducted by Equip, we found that 45% of women with a history of an eating disorder or disordered eating struggled with infertility. But why this connection?

“At the very root, eating disorders cause hormonal imbalances that negatively impact menstruation and ovulation—both of which are required to conceive,” says Equip physician assistant Alicia Karagianes, MHS, PA-C. According to reproductive endocrinologist Dr. Aimee Eyvazzadeh, MD, MPH, eating disorders can significantly impact fertility through several mechanisms:

• Menstruation and ovulation disruption: “Low body weight, malnutrition, or excessive exercise can lead to hypothalamic amenorrhea, where menstruation stops due to hormonal imbalances,” Eyvazzadeh says.
• Nutritional deficiencies: “Deficiencies in essential nutrients such as iron, folic acid, and vitamin D can affect ovulation and implantation,” Eyvazzadeh says. In addition, Karagianes adds that eating disorders can also deplete vitamin B, zinc, copper, selenium, and calcium, which are all necessary for healthy pregnancies.
• Hormonal imbalances: “Conditions like polycystic ovary syndrome (PCOS), which is common in patients with binge eating disorder (BED), can further complicate fertility,” Eyvazzadeh says.

That eating disorders would decrease fertility also makes sense from an evolutionary perspective. In many cases, eating disorders can disrupt or halt the systems necessary to conceive because the conditions for conception aren’t adequate or safe. In other words, eating disorders force our bodies into survival mode, and reproduction just isn’t an essential function for survival, so it’s pushed to the back burner.

In its infinite complexity and wisdom, your body not only prioritizes its own survival, but is also aware of the safety of any potential offspring. If you’re not adequately nourishing your body, it receives the message that there’s not enough food to go around, and it wouldn’t be wise to bring a baby into a famine. Similarly, the anxiety and dysregulation that often goes hand-in-hand with eating disorders can signal to your body that your environment is not safe, and thus not a good place to introduce a brand new life. Indeed, research shows that stress and anxiety can impair fertility, and that fertility rates drop during times of famine.

It’s also worthwhile to call out the psychological component: many people struggling with eating disorders may be—consciously or subconsciously—scared of the body and lifestyle changes that pregnancy will require, and delay trying to conceive because of those fears. In the survey we conducted, we found that in 10 women delayed trying to conceive due to disordered eating habits, such as intermittent fasting, eating in a calorie deficit, or skipping meals

Do certain eating disorders impact fertility more than others?

So it’s clear that eating disorders have an effect on the body’s ability to become pregnant, but do the specific eating disorder behaviors matter? Are some diagnoses worse than others? In general, no—but there are some nuances.

“Overall, eating disorders can impact hormone production and therefore fertility,” Karagianes says. “Though this is done through various mechanisms depending on the specific eating disorder type, the extent of impaired hormone production has more to do with the severity of the eating disorder and less to do with the specific type of eating disorder.”

There are, however, some slight differences in just how different eating disorders impact fertility. “Anorexia primarily impacts fertility through significant weight loss and malnutrition, leading to amenorrhea and anovulation,” Eyvazzadeh says. “While patients with bulimia may maintain a ‘normal’ weight, repeated purging can lead to electrolyte imbalances and hormonal disruptions that affect ovulation.” Eyvazzadeh also adds that BED’s association with PCOS and other hormonal conditions can reduce fertility, and those with avoidant/restrictive food intake disorder (ARFID) may also experience nutritional deficiencies that affect overall reproductive health.

When talking about the effect that eating disorders can have on fertility, Karagianes divides them into “low energy intake” disorders and disorders not associated with low energy intake. Low energy intake (i.e., not eating enough) is the primary cause of low energy availability (LEA), a state when the body doesn’t have enough calories to support all of its functions.

“In low energy intake eating disorders, your body is in a state of malnutrition,” Karagianes says. “This causes the body to begin to shut down systems in an attempt to save energy expenditure and make sure vital organs, like your heart and lungs, continue to run. During this process, the reproductive system and hormone production from the brain is often turned down or off, causing lack of menstrual cycles and inhibiting ovulation.”

But even when the body is not deprived of essential energy, eating disorders can still have a significant impact on fertility. “Eating disorders that aren’t associated with a low energy intake state can still create a state of stress, impacting the brain’s hormone production,” Karagianes says. “This is often seen in irregular menstrual cycles and lack of ovulation.”

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Is it possible to become pregnant if you've had an eating disorder?

While every single person and situation is different, it’s important to know that women who’ve had eating disorders can, in fact, become pregnant. In my case, because I’d been missing my period and not ovulating since high school, I knew I would require some kind of medical intervention whenever I was ready to try to conceive. And, luckily, the medications my doctor prescribed were actually effective. While that may not be the case for every single person who experiences an eating disorder, it’s a myth that all women who have experienced these illnesses will never be able to conceive.

“The majority of people fully recovered from an eating disorder will not face infertility as a result of their eating disorder,” Karagianes says. “Ideally, patients will have sought eating disorder treatment, be in recovery, maintain weight restoration and thus have their regular ovulation and menstrual cycles reinstated.”

Even with an infertility diagnosis—which is defined as failure to achieve pregnancy after 12 months of trying to conceive—there are options. “Typically, an initial medical workup will be done, which varies based on individuals,” Karagianes says. That initial workup generally involves a number of different tests and labs to get to the root of the problem, and then identifying next steps based on the results. Those next steps might be medications, intrauterine insemination, or IVF, among other interventions.

Eyvazzadeh agrees that it is possible to become pregnant after having an eating disorder, but points out that those in recovery may require specific interventions to ensure a healthy pregnancy, including:

• Nutritional rehabilitation and counseling: Working with a registered dietitian trained in eating disorders may be necessary to help achieve a healthy weight and nutritional status before becoming pregnant.
• Psychological support. Ongoing therapy can be critical to address any residual or persistent body image issues or disordered eating behaviors.

What to do if you’re struggling with infertility and an eating disorder (past or present)

Both infertility and eating disorders can be incredibly sensitive issues to discuss with others, but being open and honest with loved ones and medical professionals can pave the way for permanent recovery. “Seeking help for an eating disorder is a critical first step when struggling with infertility,” Karagianes says. “There are such unique stressors that exist when eating disorders and infertility intersect, causing an increased medical, emotional and psychological demand. Being in eating disorder treatment before or during fertility care can mitigate some of the potential complications from eating disorders that can so drastically impact infertility.”

The type of treatment you or a loved one seeks out matters too. While I came across plenty of social media influencers who promised they could help women recover their lost periods and become pregnant in months, I only really moved the needle on my own recovery when I sought out a team of experts who deeply understood the nuances of eating disorders and their impact on fertility.

“If someone is struggling with an eating disorder and infertility, it's essential to seek support from a multidisciplinary team that includes a reproductive endocrinologist, a dietitian with expertise in eating disorders, and a mental health professional,” Eyvazzadeh says. “This team can provide a comprehensive approach to both fertility treatment and eating disorder recovery, ensuring the best possible outcomes for both mother and baby. Encouraging open communication and seeking early intervention can help manage both conditions effectively.”

There are so many individual differences when it comes to eating disorder recovery and infertility, but it’s important to know that there is hope for those who have experienced an eating disorder and wish to become parents one day. My personal journey hasn’t been easy or predictable, but committing to recovery opened up a world of possibilities that may not have been available otherwise—including the chance to meet my daughter next month.

If you or a loved one are facing fertility challenges and think a past or current eating disorder might be contributing, don’t wait to get the help you need to build the family you want.