diagnosis guide
If you’ve just received a medical diagnosis, or you’re concerned that something in your present or past health history might be jeopardizing your fertility, check here for quick info on common medical conditions and how they can affect conception and pregnancy.
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Bulimia
(Also see entry for Anorexia and Eating Disorders)
What It Is
Just like anorexia, bulimia is a type of eating disorder in which the person is preoccupied with her/his weight and body shape, often judging herself severely and harshly for perceived flaws. Bulimia is usually categorized in two types: Purging bulimia, which includes regular self-induced vomiting or the misuse of laxatives, diuretics or enemas to compensate for binges, and non-purging bulimia in which other methods are used to rid oneself of calories and prevent weight gain, such as fasting or over exercising (also called exercise bulimia). The line between the two types of bulimia often blurs or overlaps. The frequent purging—and lack of nutrition—can cause gum disease, osteoporosis, kidney disease, heart disease, and sometimes even death.
Who Gets It
Bulimia affects mostly women and teenage girls, especially those who participate in activities that put a premium on appearance (such as modeling or acting).
Symptoms
Physical symptoms include abnormal bowel functioning, damaged teeth and gums, swollen glands in the cheeks, sores in throat and mouth, bloating, dehydration, dry skin, fatigue, irregular heartbeat, sores or calluses on the knuckles or hands, loss of menstruation (amenorrhea) or irregular menses. Behavioral and emotional symptoms include feeling out of control when it comes to eating and portion control, eating much larger quantities at one meal than normal, exercising for hours on end, a preoccupation with body shape and weight, misuse of laxatives, having a distorted negative body image, depression, anxiety.
How It's Diagnosed/Detected
Family members, friends, dentists or the family doctor may recognize signs of an eating disorder, although many women suffering from bulimia maintain normal weights (unlike the extremely underweight bodies of those with anorexia).
How It Affects Fertility and Pregnancy
If a woman is somewhat underweight, she may be secreting some hormones but not in the precise amounts or with the correct timing needed to ensure conception and a healthy pregnancy. Even with IVF treatments, there’s a high rate of failure and miscarriage in women whose body mass index (BMI) is low (below 18.5). Research from the Harvard Nurses’ Study 2 is anything but reassuring: Data on over 2,500 women suggested that those who were significantly under- or overweight at age 18 were more likely to experience trouble becoming pregnant at age 22 or older. Women who begin a pregnancy underweight may be encouraged to gain more weight than the usual guidelines suggest, to compensate for the lack of body fat.
Treatment
Women who are bulimic should seek professional help. A team of doctors, nutritionists, and therapists can teach healthy eating patterns and coping strategies. To stop a person from binging and purging, a doctor may recommend a combination of nutritional advice, psychotherapy (especially cognitive behavioral therapy or CBT) and medication.
Pregnancy Prognosis
A pregnant woman with active bulimia is at an increased risk for miscarriage, high blood pressure, diabetes (mother), still birth, cesarean section, premature delivery, low birth weight, birth defects (such as blindness or mental retardation), and problems breastfeeding. While achieving a healthy weight at as young an age as possible is ideal, women who’ve recovered from bulimia and maintained a normal weight should have no lasting effects or problems with pregnancy.
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