Skip to main content
SpringerLink
Log in

Disordered eating and eating disorders among women seeking fertility treatment: A systematic review

  • Review Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

The purpose of this systematic review is to evaluate the prevalence of disordered eating and eating disorders among women seeking fertility treatment.

Observational studies were searched in Ovid MEDLINE, Web of Science, Embase, and PsycInfo. Studies published prior to September 2020 when the search was conducted were considered. Inclusion criteria included (1) original and empirical research, (2) published in a peer-reviewed journal, and (3) reported on disordered eating among women seeking fertility treatment in the sample or reported on prevalence of eating disorders among women seeking fertility treatment in the sample. Independent screening of abstracts was conducted by two authors (LH and AH). Ten studies met the inclusion criteria. Sample size, study location, measures, and results for each study in this review were reported.

Among women pursuing fertility treatment, rates of current eating disorders ranged from 0.5 to 16.7%, while past eating disorder prevalence rates ranged from 1.4 to 27.5%. Current anorexia nervosa or bulimia nervosa was reported by up to 2% and 10.3% of women, respectively, while history of anorexia nervosa or bulimia nervosa was reported by up to 8.5% and 3.3% of women, respectively. Binge eating disorder or other eating disorders were reported by up to 18.5% and 9.1% of women, respectively. Disordered eating pathology was endorsed by 1.6 to 48% of women seeking fertility treatment. Endorsement of pathological eating attitudes was generally higher among women seeking fertility treatment with current or past eating disorders as compared to community samples, with the exception of dietary restraint. Rates of current and past eating disorders are higher among women seeking fertility treatment than in the general population. Providers treating women with infertility should be cognizant of these prevalence rates and consider screening for eating pathology in their patients as this may contribute to their likelihood of successful conception and/or subsequent pregnancy outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Allison S, Kalucy R, Gilchrist P, Jones W (1988) Weight preoccupation among infertile women. Int J Eat Disord 7(6):743–748

    Article  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub

  • Arnold C, Johnson H, Mahon C, Agius M (2019) The effects of eating disorders in pregnancy on mother and baby: a review. Psychiatr Danub 31(Suppl 3):615–618

    PubMed  Google Scholar 

  • Baechle C, Castillo K, Straßburger K, Stahl-Pehe A, Meissner T, Holl RW et al (2014) Is disordered eating behavior more prevalent in adolescents with early-onset type 1 diabetes than in their representative peers? Int J Eat Disord 47(4):342–352

    Article  PubMed  Google Scholar 

  • Barbosa-Magalhaes I, Corcos M, Galey J, Perdigao-Cotta S, Papastathi C, de Crecy M, Nicolas I, Lamas C, Christin-Maître S, Pham-Scottez A (2021) Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity 26(2):709–715

  • Berg KC, Stiles-Shields EC, Swanson SA, Peterson CB, Lebow J, Le Grange D (2012) Diagnostic concordance of the interview and questionnaire versions of the eating disorder examination. Int J Eat Disord 45(7):850–855

    Article  PubMed  Google Scholar 

  • Boutari C, Pappas PD, Mintziori G, Nigdelis MP, Athanasiadis L, Goulis DG et al (2020) The effect of underweight on female and male reproduction. Metabolism 107:154229

    Article  PubMed  CAS  Google Scholar 

  • Bruneau M, Colombel A, Mirallie S, Freour T, Hardouin JB, Barriere P et al (2017) Desire for a child and eating disorders in women seeking infertility treatment. PLoS One 12(6):e0178848

    Article  PubMed  PubMed Central  Google Scholar 

  • Carter JC, Aime AA, Mills JS (2001) Assessment of bulimia nervosa: a comparison of interview and self-report questionnaire methods. Int J Eat Disord 30(2):187–192

    Article  PubMed  CAS  Google Scholar 

  • Cavalcante MB, Sarno M, Peixoto AB, Araujo Junior E, Barini R (2019) Obesity and recurrent miscarriage: a systematic review and meta-analysis. J Obstet Gynaecol Res 45(1):30–38

    Article  PubMed  Google Scholar 

  • Chan CY, Lee AM, Koh YW, Lam SK, Lee CP, Leung KY et al (2019) Course, risk factors, and adverse outcomes of disordered eating in pregnancy. Int J Eat Disord 52(6):652–658

    Article  PubMed  Google Scholar 

  • Cousins A, Freizinger M, Duffy ME, Gregas M, Wolfe BE (2015) Self-report of eating disorder symptoms among women with and without infertility. J Obstet Gynecol Neonatal Nurs 44(3):380–388

    Article  PubMed  Google Scholar 

  • Cunningham J (2017) Infertility: A primer for primary care providers. JAAPA 30(9):19–25

    Article  PubMed  Google Scholar 

  • Diagnostic and Statistical Manual of Mental Disorders (2013) (Fifth, edition. American Psychiatric Association, Arlington, VA

    Google Scholar 

  • Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17

    Article  PubMed  Google Scholar 

  • Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16(4):363–370

    Article  CAS  PubMed  Google Scholar 

  • Fairburn CG, Beglin SJ (2008) Eating disorder examination questionnaire. Cogn Behav Ther Eat Disor 309–313

  • Fedorcsák P, Storeng R, Dale PO, Tanbo TOM, Åbyholm T (2000) Obesity is a risk factor for early pregnancy loss after IVF or ICSI. Acta Obstet Gynecol Scand 79(1):43–48

    PubMed  Google Scholar 

  • First MB, Gibbon M (2004) The structured clinical interview for DSM-IV axis I disorders (SCID-I) and the structured clinical interview for DSM-IV axis II disorders (SCID-II). Comprehensive Handbook of Psychological Assessment 2:134–143

    Google Scholar 

  • Fitzgerald M, Frankum B (2017) Food avoidance and restriction in adults: a cross-sectional pilot study comparing patients from an immunology clinic to a general practice. J Eat Disord 5:30

    Article  PubMed  PubMed Central  Google Scholar 

  • Freizinger M, Franko DL, Dacey M, Okun B, Domar AD (2010) The prevalence of eating disorders in infertile women. Fertil Steril 93(1):72–78

    Article  PubMed  Google Scholar 

  • Galmiche M, Dechelotte P, Lambert G, Tavolacci MP (2019) Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. Am J Clin Nutr 109(5):1402–1413

    Article  PubMed  Google Scholar 

  • Garner DM (2004) Eating disorder inventory-3 (EDI-3). Professional manual. Psychological Assessment Resources, Odessa

  • Gaskins AJ, Chavarro JE (2018) Diet and fertility: a review. Am J Obstet Gynecol 218(4):379–389

    Article  PubMed  Google Scholar 

  • Greil AL, McQuillan J, Lowry M, Shreffler KM (2011) Infertility treatment and fertility-specific distress: a longitudinal analysis of a population-based sample of U.S. women. Soc Sci Med 73(1):87–94

    Article  PubMed  PubMed Central  Google Scholar 

  • Grilo CM, Pagano ME, Stout RL, Markowitz JC, Ansell EB, Pinto A et al (2012) Stressful life events predict eating disorder relapse following remission: six-year prospective outcomes. Int J Eat Disord 45(2):185–192

    Article  PubMed  Google Scholar 

  • Henderson M, Freeman CPL (1987) A self-rating scale for bulimia the ‘BITE.’ Br J Psychiatry 150(1):18–24

    Article  PubMed  CAS  Google Scholar 

  • Herman C, Polivy J (1980) Restrained eating. In: Stunkard AJ (ed) Obesity (pp. 208–225). WB Saunders, Philadelphia

    Google Scholar 

  • Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) (2019) Cochrane handbook for systematic reviews of interventions. John Wiley & Sons

  • Hilbert A, De Zwaan M, Braehler E (2012) How frequent are eating disturbances in the population? Norms of the eating disorder examination-questionnaire. PloS one 7(1):e29125

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Keel PK, Brown TA, Holm-Denoma J, Bodell LP (2011) Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: reduction of eating disorder not otherwise specified and validity. Int J Eat Disord 44(6):553–560

    Article  PubMed  Google Scholar 

  • Le Grange D, Loeb KL (2007) Early identification and treatment of eating disorders: prodrome to syndrome. Early Interv Psychiatry 1(1):27–39

    Article  PubMed  Google Scholar 

  • Lindsay TJ, Vitrikas KR (2015) Evaluation and treatment of infertility. Am Fam Physician 91(5):308–314

    PubMed  Google Scholar 

  • Luck AJ, Morgan JF, Reid F, O’Brien A, Brunton J, Price C et al (2002) The SCOFF questionnaire and clinical interview for eating disorders in general practice: comparative study. BMJ 325(7367):755–756

    Article  PubMed  PubMed Central  Google Scholar 

  • Makino M, Tsuboi K, Dennerstein L (2004) Prevalence of eating disorders: a comparison of Western and non-Western countries. MedGenMed 6(3):49

    PubMed  PubMed Central  Google Scholar 

  • Martin K, Santoro N, Hall J, Filicori M, Wierman M, Crowley WF Jr (1990) Clinical review 15: management of ovulatory disorders with pulsatile gonadotropin-releasing hormone. J Clin Endocrinol Metab 71(5):1081A-1081G

    Article  PubMed  CAS  Google Scholar 

  • Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  • Morgan JF, Reid F, Lacey JH (2000) The SCOFF questionnaire: a new screening tool for eating disorders. West J Med 172(3):164–165

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Moskowitz L, Weiselberg E (2017) Anorexia Nervosa/Atypical Anorexia Nervosa. Curr Probl Pediatr Adolesc Health Care 47(4):70–84

    Article  PubMed  Google Scholar 

  • Paslakis G, de Zwaan M (2019) Clinical management of females seeking fertility treatment and of pregnant females with eating disorders. Eur Eat Disord Rev 27(3):215–223

    Article  PubMed  Google Scholar 

  • Pereira RF, Alvarenga M (2007) Disordered eating: identifying, treating, preventing, and differentiating it from eating disorders. Diabetes Spectrum 20(3):141–148

    Article  Google Scholar 

  • Reba-Harrelson L, Von Holle A, Hamer RM, Swann R, Reyes ML, Bulik CM (2009) Patterns and prevalence of disordered eating and weight control behaviors in women ages 25–45. Eat Weight Disord 14(4):e190-198

    Article  PubMed  CAS  Google Scholar 

  • Resch M, Szendei G, Haasz P (2004) Bulimia from a gynecological view: hormonal changes. J Obstet Gynaecol 24(8):907–910

    Article  PubMed  CAS  Google Scholar 

  • Rodino IS, Byrne S, Sanders KA (2016) Disordered eating attitudes and exercise in women undergoing fertility treatment. Aust N Z J Obstet Gynaecol 56(1):82–87

    Article  PubMed  Google Scholar 

  • Rodino IS, Byrne SM, Sanders KA (2017) Eating disorders in the context of preconception care: fertility specialists’ knowledge, attitudes, and clinical practices. Fertil Steril 107(2):494–501

    Article  PubMed  Google Scholar 

  • Sbaragli C, Morgante G, Goracci A, Hofkens T, De Leo V, Castrogiovanni P (2008) Infertility and psychiatric morbidity. Fertil Steril 90(6):2107–2111

    Article  PubMed  Google Scholar 

  • Smink FR, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14(4):406–414

    Article  PubMed  PubMed Central  Google Scholar 

  • Stewart DE, Robinson E, Goldbloom DS, Wright C (1990) Infertility and eating disorders. Am J Obstet Gynecol 163(4 Pt 1):1196–1199

    Article  PubMed  CAS  Google Scholar 

  • Sundgot-Borgen J, Torstveit MK (2010) Aspects of disordered eating continuum in elite high-intensity sports. Scand J Med Sci Sports 20(Suppl 2):112–121

    Article  PubMed  Google Scholar 

  • Suthersan D, Kennedy S, Chapman M (2011) Physical symptoms throughout IVF cycles. Hum Fertil (camb) 14(2):122–128

    Article  CAS  Google Scholar 

  • Sylvester C, Menke M, Lopa S, Gopalan P (2020) Disordered eating and distress in women seeking in vitro fertilization. J Psychosom Res 128:109880

    Article  PubMed  Google Scholar 

  • Tabler J, Utz RL, Smith KR, Hanson HA, Geist C (2018) Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters. Int J Eat Disord 51(2):102–111

    Article  PubMed  PubMed Central  Google Scholar 

  • Thannickal A, Brutocao C, Alsawas M, Morrow A, Zaiem F, Murad MH et al (2020) Eating, sleeping and sexual function disorders in women with polycystic ovary syndrome (PCOS): a systematic review and meta-analysis. Clin Endocrinol (oxf) 92(4):338–349

    Article  Google Scholar 

  • Vander Borght M, Wyns C (2018) Fertility and infertility: definition and epidemiology. Clin Biochem 62:2–10

    Article  PubMed  Google Scholar 

  • Volpe U, Tortorella A, Manchia M, Monteleone AM, Albert U, Monteleone P (2016) Eating disorders: what age at onset? Psychiatry Res 238:225–227

    Article  PubMed  Google Scholar 

  • Ward ZJ, Rodriguez P, Wright DR, Austin SB, Long MW (2019) Estimation of eating disorders prevalence by age and associations with mortality in a simulated nationally representative US cohort. JAMA Netw Open 2(10):e1912925

    Article  PubMed  PubMed Central  Google Scholar 

  • Warren MP (2011) Endocrine manifestations of eating disorders. J Clin Endocrinol Metab 96(2):333–343

    Article  PubMed  CAS  Google Scholar 

  • Wilfley DE, Schwartz MB, Spurrell EB, Fairburn CG (1997) Assessing the specific psychopathology of binge eating disorder patients: interview or self-report? Behav Res Ther 35(12):1151–1159

    Article  PubMed  CAS  Google Scholar 

  • Wolk SL, Loeb KL, Walsh BT (2005) Assessment of patients with anorexia nervosa: interview versus self-report. Int J Eat Disord 37(2):92–99

    Article  PubMed  Google Scholar 

  • World Health, O. Composite International Diagnostic Interview (1990) Geneva. World Health Organization, Switzerland

    Google Scholar 

Download references

Acknowledgements

We wish to acknowledge the work of Brianna Andre, MLIS, AHIP, Henry Ford Health System, and Steven J. Moore, MLIS, Henry Ford Health System, who assisted with identifying citations for the systematic literature review.

Author information

Authors and Affiliations

  1. Henry Ford Health System, Center for Health Policy and Health Services Research, 1 Ford Place Suite 3A, Detroit, MI, 48202, USA

    Leah M. Hecht, Amy Loree, Brian K. Ahmedani & Lisa R. Miller-Matero

  2. Henry Ford Health System, Behavioral Health, 1 Ford Place Suite 1C, Detroit, MI, 48202, USA

    Ashley Hadwiger, Shivali Patel, Brian K. Ahmedani & Lisa R. Miller-Matero

  3. MetroHealth Medical Center, Division of Reproductive Endocrinology, 2500 Metrohealth Dr, Cleveland, OH, 44109, USA

    Bryan R. Hecht

Authors
  1. Leah M. Hecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashley Hadwiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shivali Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bryan R. Hecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amy Loree
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brian K. Ahmedani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lisa R. Miller-Matero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leah M. Hecht.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix 1

Appendix 1

Ovid MEDLINE Results: 47.

(exp fertility/ or exp Infertility/) and (treatment or therapy or IVF).ti,ab. OR ((fertil* or infertil* or Fecundability or Fecundity or Sterility or Subfertility) adj4 (treatment or therapy or IVF)).mp.

AND

((Eating adj2 pathology) or (eating adj2 problem*) or (eating adj2 concern*) or disordered eat* or eating disorder* or eating behav* or Feeding Disorder* or (eating adj2 attitude*) or (food adj2 behavior) or (avoid* adj2 food) or overeating or (restrict* adj2 food*)).mp. OR exp "Feeding and Eating Disorders"/

Limit to English language.

Exclude (animals not (humans and animals)).sh.

Embase Results: 95.

'eating disorder'/exp/mj OR 'feeding behavior'/exp/mj OR ((eating NEAR/2 pathology):ti,ab) OR ((eating NEAR/2 problem*):ti,ab) OR ((eating NEAR/2 concern*):ti,ab) OR 'disordered eat*':ti,ab OR 'eating disorder*':ti,ab OR 'eating behav*':ti,ab OR 'eating attitude*':ti,ab.

AND

((fertil* OR infertil* OR fecundability OR fecundity OR sterility OR subfertility OR 'assisted reproduction') NEAR/4 (treatment OR therapy OR ivf)):ti,ab OR 'infertility therapy'/exp OR (('infertility'/exp/mj OR 'fertility'/exp/mj) AND (treatment:ti,ab OR therapy:ti,ab OR ivf:ti,ab)).

Limit to English language, exclude animals.

Web of Science: 32.

TS = ((fertil* or infertil* or Fecundability or Fecundity or Sterility or Subfertility) NEAR (treatment or therapy or IVF)) AND TS = ((Eating NEAR pathology) or (eating NEAR problem*) or (eating NEAR concern*) or disordered eat* or eating disorder* or eating behav*) Indexes = SCI-EXPANDED Timespan = 2002-present.

APA PsycInfo: 20.

(exp fertility/ or exp infertility/ or exp Reproductive Technology/ or exp Fertility Enhancement/) and (treatment or therapy or IVF).ti,ab. OR ((fertil* or infertil* or Fecundability or Fecundity or Sterility or Subfertility or ovulation or conception or reproduction) adj4 (treatment or therapy or IVF)).mp.

AND

exp eating attitudes/ or exp eating behavior/ or exp eating disorders/ OR ((Eating adj2 pathology) or (eating adj2 problem*) or (eating adj2 concern*) or disordered eat* or eating disorder* or eating behav* or weight control).mp.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hecht, L.M., Hadwiger, A., Patel, S. et al. Disordered eating and eating disorders among women seeking fertility treatment: A systematic review. Arch Womens Ment Health 25, 21–32 (2022). https://doi.org/10.1007/s00737-021-01156-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-021-01156-x

Keywords

Search

Navigation