Monday, September 28, 2020

Results of Fertility, Body Image, and Eating Disorders Survey

Graciously re-posted courtesy of

I recently conducted a survey on Fertility, Body Image, and Eating Disorders.  As I have noted before, I am beginning to see more patients undergoing fertility treatments.  Part of this is my patients have grown with me and have the reached the developmental milestone of wanting to become parents.  I believe the other part is that people are talking more about infertility problems.

Since I am an eating disorder specialist, I see unique issues to women who have had or are currently active with their eating disorder, while undergoing fertility treatments.  I have seen that fertility treatments can often trigger eating disorder symptoms or re-traumatize someone in recovery by the intense scrutiny required during these procedures.

In researching this topic, I was not able to find a great deal of literature on this topic.  As a result, I devised a ten question survey to further help me in my clinical work, as well as help in the training of other medical professionals.

I want to summarize some interesting points I discovered in the survey.

1)  The fertility issues varied.  6 people had miscarriages, 4 had poor ovarian reserve, 2 had male factor problems, and 2 had unexplained fertility.  While none of the fertility issues mentioned were directly related to an eating disorder, I wonder if doctors were screening for eating related problems.  Were individuals getting the caloric intake they needed?  Did they have medical complications from their eating disorder that may not have been obvious to fertility specialists upon first examination?  Did their eating disorder keep them from conceiving until later in life?  These are questions for further examination.

2)  The quantitative answers did not match the qualitative responses.  In the survey, I asked if individuals had been in therapy to address body image issues.  70% of people said NO, but when I asked how they felt about their body during fertility treatments in a more opened ended question later on, some of the respondents answered they felt “Big and Bloated,” “My Body was deficient in some way.”  “Sad and disappointed in it.”  and “My Body was a Mess.”

Kim Kardashian Fertility Statue

courtesy of

There could be many reasons why the answers to the two questions did not match up.  One reason could be how I worded the questions, which could be improved upon in further research.  Second, they could have been having body image problems and did not get the support they needed around this issue through therapeutic means.  Thirdly, these women could have had feelings of shame and embarrassment about having body image issues, especially surrounding pregnancy.  Most women want to be pregnant and look forward to seeing their bodies change as their babies grow.  To admit that part of the process was difficult for them may bring up too many feelings.

I also found a similar response to the question whether one had or has an eating disorder.  77% of respondents answered NO, but when I asked if they used eating related behaviors to cope, several individuals answered they emotionally ate or binged during fertility treatments.  Since the responses differed, I believe the correlation between eating disorders and fertility treatments needs further exploration.

3)  Only 1 person admitted to notifying their doctor about their past history of an eating disorder.  This leads me to wonder whether fertility specialists are asking a detailed enough history of patients and/ or patients are afraid to disclose this information for fear they will be turned away from fertility clinics.  In future research, I would like to inquire why individuals did not disclose this information.

4)  Support Services surrounding Issues of Fertility, Body Image, and Eating Disorders are limited.  Almost all the women felt as if fertility clinics needed to improve services in this area.  The responses were as follows:

  1. Have a nutritionist and prenatal exercise options available
  2. Include questions about mental health history, including body image and eating disorders during first appointments. Ask patients during treatment if they are having any mental health issues, including eating/body image issues related to their problems.
  3. Clinics should specifically ask about issues with body image and eating related disorders – and if extra help is needed in that regard.
  4. More support around feeling your body failed you
  5. Workshops on body image, identity, eating behaviors during fertility treatment would be really helpful.  I suspect many people / women struggle and don’t necessarily know where to go for help, especially if they are not in therapy.
  6. Support groups
  7. Some women may appreciate a scientific explanation about where the weight gain is actually from. For example–that progesterone use causes constipation and then when coming off of it, there is water retention due to its effect on the kidney. Right there– there is 3-5 lbs that is not real weight gain.  Estrogen definitely has receptors on adipose tissue. So in fact, there is expansion in areas –thighs etc prone to fat in women. These explanations may help some women at least understand what is what so it’s not all catastrophized into out of control weight gain coming from random forces…
  8. I think all fertility clinics need to ask about past history of an eating disorder.  They need to be more sensitive to how fertility treatments may be impacting one’s body and how it can be a traumatizing experience.


Overall, I think more women are suffering with eating and body image issues than fertility clinics realize.  I think some women may not be disclosing out of shame and others are not disclosing because they are not being asked.  Based upon the responses that women gave, I think women need and want fertility clinics to take a more thorough mental health history, especially in regards to food and body.  I suspect if they did, they may find many more women who have had or are undergoing body image issues during this process and can provide better support services around this area.

In addition, women were very specific about the support services they want.  They asked for nutritional counseling, exercise support, and groups. I would love to see more fertility clinics offer these services to individuals suffering with infertility, body image, and eating problems.  If they are not able to, I believe the therapeutic community can begin to collaborate and offer more affordable services to females.

Most importantly, I want to thank everyone who responded anonymously to this survey.  I found your responses informative and helpful for further research.

Results of Fertility, Body Image, and Eating Disorders Survey, by Allison Jupiter

The survey was created by Allison Jupiter, LCSW-R, CEDS and was circulated to various clinicians within the eating disorder community for further feedback.  It was an internal survey that was not connected to any corporation, university, or not for profit organization.  The data from the survey will not be published and will be used to further train clinicians, doctors, and other medical professionals about the correlation between eating disorders and infertility.



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