I spat the word at my reflection in the mirror, reeling off the definitions I’d just read in my head.
(of a woman) infertile
showing no results or achievements; unproductive
(of land) too poor to produce much or any vegetation
empty of meaning or value
Synonyms? "Sterile", "fruitless" and "arid". I certainly felt arid. A dry and shrivelled up version of the former me.
Sitting in the chair as the GP explained to my 20-year-old self that my eating disorder could mean I will never be able to have children, I felt myself becoming smaller and more shrunken with each word. All the talk of anorexia having the highest mortality rate of any mental illness had failed to shake me out of my obsessive, restrictive compulsions. But the idea that I might be putting my future children’s lives at risk? Suddenly the dangers felt all too real.
Over two previous years of strictness, of never letting myself go for a moment, I’d seen my skin dry up, watched my nails and the ends of my hair splinter, and felt the bone-cutting chill every time the temperature dipped below 15 degrees. But infertility was something I hadn’t seen coming... stupid of me really, considering I’d already been without a period for 21 months.
"The impact on fertility is one of the least known or researched consequences of eating disorders," Dr Sandeep Ranote tells me. She is a psychiatrist and a medical doctor who specialises in working with young women suffering from these illnesses.
According to Dr Ranote, once your body enters a "famine mode", it goes into a protective state, meaning that fertility hormones stop being produced. "Most women find their periods quickly disappear," she says. But does this automatically mean you can’t conceive?
Does having an eating disorder mean you can’t conceive?
While I don't intend on having children immediately, it's something I firmly saw in my future. But speaking to women who have lived with their eating disorder for many years, the picture looks bleak. Some have lost any hope of seeing their periods return, while others find that, even once their menstrual cycle restarts, their bodies are not able to cope with pregnancy.
"Her biggest fear is that she has done too much damage to her body to ever be able to conceive."
One woman tried, unsuccessfully, to distil into words the trauma of the miscarriage she suffered because she failed to put on enough weight before getting pregnant. When she developed anorexia in her late 30s, her periods stopped completely. But, already set on motherhood, she decided to continue with her plans to try to get pregnant via a sperm donor.
"If you are not eating enough to maintain your weight, there is no chance that you will be able to get to full term with a baby," she warned. Her biggest fear is that she has done too much damage to her body to ever be able to conceive.
Yet other stories of those who have managed to cling to recovery are more hopeful. After suffering for over 20 years from anorexia and being told she wouldn’t be able to have children, one woman explained proudly how determination to prove the professionals wrong fuelled her recovery. Despite losing her period for five years, she is now mother to a "beautiful" four-year-old and, aged 40, is expecting another child soon. "Doctors are not always right," she insisted.
"The most important thing is to get better," says Dr Ranote. "For those who fully recover, having had an eating disorder doesn’t have to mean you can never have children."
But being aware of the repercussions of an eating disorder on your fertility is not a universal motivator to get better – in some cases it is exactly the opposite. Another sufferer in her 20s confessed to me that her fear of getting pregnant has at times pushed her further down a destructive spiral. "I don’t want a baby," she explained. "My eating disorder takes care of that." She fears pregnancy because being a mother would take away from her "anorexic identity".
This is a reaction Dr Ranote encounters often, particularly with younger sufferers.
"Many of the young girls I work with are not fazed at all by the idea of being infertile when they first come to me," she says. "They’re consumed by their illness and don’t care about children at that age; but as they get older and realise how long-lasting the effects might be, many start to panic."
When pregnancy plays into eating disorder relapse
Some women find they are still able to get pregnant and, despite not being fully recovered, plough on to have a child anyway – the consequences of which can be fatal for both mother and baby. Kate Daigle, a counsellor and eating disorder specialist, has researched this area for many years and found that women battling with bulimia are 50% more likely to miscarry than the general population. "Up to three-quarters of women who've recovered from eating disorders relapse within 18 months of giving birth – putting their own lives at risk," she adds.
"Up to three-quarters of women who've recovered from eating disorders relapse within 18 months of giving birth - putting their own lives at risk"
It’s not hard to see why relapse can happen; seeing your body swell until it becomes unrecognisable and having to come to terms with uncontrollable changes to your eating habits and hunger levels cannot be an easy combination if you are only just untangling yourself from the clutches of an eating disorder. Particularly given the depressing statistic that less than half of anorexia patients are ever considered fully "cured".
The idea of relapse during pregnancy is one that terrifies me. My motivation to get better is not solely in order to make myself physically well enough to have a child, but to ensure I’m also in a positive enough state mentally to be able to raise one – and without the risk of my children picking up anorexic traits from my behaviour. There are many illnesses we can’t help but pass on, but this is one killer I will try my hardest not to let carry on down the generations.
A future - with or without children
When I first realised the implications of my anorexia on my fertility, it really helped to drag me out of the psychological rut I was in. I sought counselling and went tunnel vision into a mission to put weight on. It got to the point where I considered myself, almost, 'normal' again. But recently I’ve been plateauing, letting myself eat less than I know I should some days because I’m busy or stressed. Speaking to these women has renewed my determination.
But it has also reminded me just how unhelpful and traumatic I found the way my doctor broke the news to my barely-out-of-adolescence self. I was given no sense of how likely it was I’d be able to conceive in the future, no explanation of how my eating disorder had caused my periods to stop, and no practical advice for improving my chances other than “well, I guess you just need to eat more”.
Yes, infertility is a physical side effect of anorexia. But it’s a physical side effect of a psychological disease. The journey to getting my periods back isn’t just going to the supermarket and filling up a trolley; it is going to counselling sessions and learning how to be ok with filling up that trolley – and continuing to fill it up for years to come.
"Training for medical professionals on how to have the conversation about eating disorders and fertility needs to be much better," insists Dr Ranote. "And that conversation needs to be much more nuanced to take into account the fact that some women may find the news very distressing, while others will find it a relief and may use it as a reason not to recover."
As for men? Information is not scant so much as non-existent. Although around a quarter of the 1.25 million people charity Beat estimates are currently suffering from an eating disorder in the UK are men, research into the impact of these illnesses on male fertility has been minimal. The few studies that have been conducted suggest that, when a man's body weight is extremely low, his ability to produce sperm is reduced significantly. The abnormally low testosterone levels that male anorexics and bulimics usually show are often associated with a lack of libido and erectile dysfunction.
Whether or not it motivates them to get better, every person struggling with an eating disorder deserves to know the true consequences of what they are doing.
For me, when I think about how I'd look after I've put on all the weight the doctors say I need to to be "healthy", I can't imagine it. Who is this girl? She's a stranger.
Instead I picture myself as a soon-to-be mum, with a ballooning stomach full of life and love. She's probably much heavier than my "optimum BMI" – but she doesn't care.
Can I ever become her? Or have I done too much damage that can't be repaired?
I don't know. All I can do is to keep trying.
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