“My eating disorder commenced when I was about 13 years old and continued in various forms until I was in my early 30s,” said Hilary Smith, mum to a two-year old daughter and National Manager at the National Eating Disorders Collaboration (NEDC). 

Ms Smith’s presentation about her lived experience of undertaking IVF with a personal history of an eating disorder commenced the Health in Preconception, Pregnancy, and Postpartum Early and Mid-career Researcher Collective (HiPPP EMR-C) Quarterly Showcase on 20 July 2023. The session was facilitated by Ms Smith, together with Dr Sarah Trobe (NEDC) and Dr Christie Bennett (Monash University).

“I felt really stable in my recovery by the time I was thinking about the prospect of assisted reproductive services. But despite this, I knew I was entering into a high risk space with potential for relapse, particularly given how long-standing my eating disorder had been,” she said.

With her professional connections to a broad network of eating disorder support professionals, and a high level of health literacy around this issue, Ms Smith felt well-armed going into fertility treatment.

However, she was still surprised by the sheer number of eating disorder triggers she was exposed to throughout the process. She found that some of these were inherent to treatment, while others were present even though they weren’t integral to the procedures.

“One example would be my experience in the immediate aftermath of intrauterine insemination (IUI). In the room, my fertility specialist said to me…‘just make sure you keep your stress really low for the next couple of weeks, and do things that help you feel good.’

“But as I’m walking out of the room the receptionist says to me, ‘here’s the list of foods to avoid over the next two weeks in case you’re pregnant.’

“It was kind of like the experience of being told don’t stress, but here is a big bucket of stress.”

Ms Smith recognises that recommendations like diet modifications, which are associated with eating disorder triggers, may be important to the outcomes of fertility care. 

“However in the context of any patient really, and particularly one where there’s a well documented and discussed eating disorder history, there’s room for a lot of improvement in the way that this is done.”

Dr Christie Bennett, who is a dietitian, Credentialled Eating Disorder Clinician and lecturer at Monash University, cited research which shows a high prevalence of eating disorders among women undertaking fertility care.

A systematic review completed in 2022 found that 28% of women pursuing Assisted Reproductive Technology (ART) treatments have a history of an eating disorder. In addition, up to 48% of women seeking fertility care have disordered eating. 

Dr Bennett explained the difference between these two terms. Eating disorders are complex and potentially life threatening mental illnesses characterised by disturbances in behaviours, thoughts and attitudes to food, eating, and body weight. These include anorexia, bulimia and a number of other conditions. 

Disordered eating, on the other hand, is a descriptive term used to characterise a range of irregular eating behaviours which may or may not include diagnosis of a specific eating disorder.

These conditions affect very large numbers of fertility care patients, given that over 46,800 women undertake ART procedures annually across Australia and New Zealand. It is also important to consider that men and people who are gender diverse can be affected by these disorders.  

Dr Bennett went on to discuss the incredibly complex range of impacts that disordered eating and eating disorders have on fertility. These range from hormonal, ovulation, menstrual and endocrine system irregularities, to impacts on sperm concentration, count and motility. All of these have clear negative impacts on the chances of successful outcomes in ART.

Dr Sarah Trobe, mum to a three-year old son, Clinical Psychologist and NEDC National Manager, with lived experience of IVF, discussed the other side of this. “It works both ways…fertility treatment can (also) impact on the experience of an eating disorder or disordered eating, and the prevalence and recurrence of these,” she said. 

Common outcomes and side effects of ART treatments which can trigger eating disorders include biological, psychological and social factors. Examples include:

• Weight changes, which frequently occur with fertility treatment;
• Body shame, driven by a sense of what the body “should” be able to do naturally;
• Drive for control, led by feelings of loss of control;
• Relationship stress, as ART procedures can be difficult and confronting; and
• Compounding stigma, as eating disorders, high weight and infertility are all stigmatised in our society.

Solutions are clearly needed to address this complex area, and Dr Trobe, Ms Smith and Dr Bennett are working hard to create them. One exciting project they are currently finalising is a free self-paced online learning module on fertility care and eating disorders, which will be launched on NEDC’s website in August 2023. 

“This training presents what the problem is, more detailed information around engagement (and) having that conversation, who to refer to…It will be relevant to anyone working in the fertility care space,” said Dr Trobe. It includes input from fertility specialists, mental health professionals, dietitians and people with lived experience.

At the end of the session, HiPPP EMR-C Chair Dr Briony Hill summed up the showcase with a short conclusion. “I’m just lost for words actually, that was such a fantastic presentation.”

As well as informing participants about the important link between fertility care and eating disorders, and available resources, the showcase aimed to encourage HiPPP EMR-C members to take an interest in this fascinating research area.

The HiPPP EMR-C is a vibrant collective of over 250 early and mid-career researchers, including the Australian collective and two international networks in the UK and North America. 

The 4th HiPPP EMR-C conference will be held in Adelaide (and online) on 17 October 2023. The HiPPP EMR-C International Awards are now open for applications until 16 August 2023.  

Click here to join the HiPPP EMR-C, or to start a new research collective in your region or country, email hippp.emrc@gmail.com.

The HiPPP EMR-C is hosted by the Australian NHMRC Funded Centre of Research Excellence in Health in Preconception and Pregnancy (CRE HiPP). 

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