Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy

IVF-induced pregnancy and early motherhood among women with a history of severe eating disorders

Background

There is a higher prevalence of eating disorders among women seeking in vitro fertilization (IVF). Women with a history of eating disorders may be particularly vulnerable to eating disorder relapse during IVF, pregnancy, and early motherhood. The experience of these women during this process has hardly been studied scientifically, despite its high clinical relevance. The overall aim of this study is to describe how women with a history of eating disorders experience the process of becoming a mother through IVF, pregnancy, and the postpartum period.

Methods

We recruited women with a history of severe anorexia nervosa who had undergone IVF (n = 7) at public family health centers in Norway. Semi-openly, the participants were interviewed extensively first during pregnancy, and then 6 months after birth. The 14 narratives were analyzed using interpretative phenomenological analyses (IPA). All participants were required to complete the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE), during both pregnancy and postpartum.

Results

All participants experienced a relapse of an eating disorder during IVF. They perceived IVF, pregnancy, and early motherhood to be overwhelming, confusing, a source of severe loss of control, and a source of body alienation. There were four core phenomena that were reported that were strikingly similar across all participants: "anxiousness and fear," "shame and guilt," "sexual maladjustment," and "non-disclosure of eating problems." These phenomena persisted continuously throughout IVF, pregnancy, and motherhood.

Conclusion

Women with a history of severe eating disorders are highly susceptible to relapse when undergoing IVF, pregnancy, and early motherhood. The process of IVF is experienced as extremely demanding and provoking. There is evidence that eating problems, purging, over-exercising, anxiousness and fear, shame and guilt, sexual maladjustment, and non-disclosure of eating problems continue throughout IVF, pregnancy, and the early years of motherhood. Therefore, it is necessary for healthcare workers providing services to women undergoing IVF to be attentive and intervene when they suspect a history of eating disorders.

Use of pulsatile gonadotropin-releasing hormone (GnRH) in patients with functional hypothalamic amenorrhea (FHA) results in monofollicular ovulation and high cumulative live birth rates: a 25-year cohort

PURPOSE

To analyze outcomes of pulsatile administration of gonadotropin-releasing hormone (GnRH) in infertile women diagnosed with functional hypothalamic amenorrhea (FHA).

METHODS

A single-center retrospective cohort study was conducted from 1996 to 2020. Sixty-six patients with the diagnosis FHA that underwent therapy using the pulsatile GnRH pump for conception were included and analyzed. The primary outcome was the live birth rate (LBR). Secondary outcomes were the number of dominant follicles, ovulation rate, biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), miscarriage rate, and multiple pregnancy rate. A matched control group was selected to compare the birth weight of newborn children.

RESULTS

During the study period, 66 patients with FHA underwent 82 treatments (14 of 66 patients had more than one treatment) and a total of 212 cycles (ovulation induction attempts) using pulsatile GnRH. The LBR per treatment was 65.9%. The ovulation rate per cycle was 96%, and monofollicular ovulation was observed in 75% of cycles. The BPR per treatment was 80.5%, and the cumulative CPR per treatment was 74.4%. The miscarriage rate was 11.5%. One dizygotic twin pregnancy was observed (1.6%). Average newborn birth weight (NBW) from patients with FHA was comparable to the control group.

CONCLUSION(S)

In patients with FHA, excellent pregnancy rates were achieved using the subcutaneous GnRH pump. The high cumulative LBR with normal NBW as well as low rates of multiple gestation indicate that the pulsatile GnRH pump represents a safer and more physiologic alternative to ovulation induction with injectable gonadotropins.

TRIAL REGISTRATION

Ethics Committee Northwest and Central Switzerland (Ethikkommission Nordwest- und Zentralschweiz - EKNZ) - Project-ID 2020-01612.

Prevalence and phenotype of eating disorders in assisted reproduction: a systematic review

Background

Eating disorders (EDs) are common conditions that mainly affect women of reproductive age and have a major impact on fertility. Our systematic review focuses on the prevalence of EDs in patients in the process of assisted reproductive technique (ART) and describes the phenotypes of EDs identified.

Methods

Our systematic review is based on the PRISMA criteria. Articles were collected using the Medline/Pubmed, Web Of Science and Cochrane databases. The articles chosen had to mention the prevalence of ED in infertile patients undergoing ART and be cohort or case–control studies assessing the prevalence of ED during fertility treatment.

Main findings

Fifteen articles were included in this review. The prevalence of active ED varied between 0.13 and 44% depending on the types considered in each study. The main phenotypes described were EDNOS (eating disorder not otherwise specified) and binge eating disorders (BED) occurring in women with a normal body mass index (BMI) and a history of ED. Mainly subthreshold forms with cognitive distortions were described.

Conclusion

This review highlights a 6 times higher prevalence of EDs in infertile patients undergoing fertility treatment compared to regular pregnant women. However, diagnosing these conditions is complex. As a result, it is essential that professionals in contact with this population are alert to symptoms consistent with these conditions in order to refer them to specialized psychiatric care.

Eating disorders are frequent pathologies that primarily affect women of childbearing age. Numerous articles reveal an increased risk for the mother and the child in case of an active disorder during pregnancy.

We conducted a systematic review to determine the prevalence and phenotypes of eating disorders in infertile subjects undergoing fertility treatment.

The results of the fifteen articles included show a prevalence six times higher than in pregnant women in the general population. Subjects with eating disorders have normal body mass indexes. The active forms are mainly characterized by episodes of binge eating disorders or other unspecified forms. Studies also describe incomplete forms characterized by the presence of dysfunctional thoughts around shape and weight without associated compensatory behavior.

Professionals working in the field of reproductive medicine and providing fertility treatment have a major role to play in identifying and referring these subjects at risk to specialized care.

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

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.

Eating disorders, pregnancy and the postnatal period: a review of the recent literature

PURPOSE OF REVIEW

Eating disorders (ED) are severe psychiatric disorders that affect women in reproductive age. The purpose of this review is to provide an up-to-date overview of the impact of maternal ED on pregnancy and the postnatal period. The clinical implications for identification and management of maternal ED are also discussed.

RECENT FINDINGS

In the last 2 years, 15 articles focused on the impact of maternal ED in pregnancy and postpartum. Findings from this review indicate that around 15% of pregnant women are likely to have had an ED at some point in their lifetime, and about 5% have an ED in pregnancy. Although ED symptoms tend to decrease during pregnancy, remission is often only temporary with symptoms typically resurfacing in the postnatal period. Women with ED are prone to psychiatric comorbidities such as depression and anxiety during the perinatal period, with up to a third of women with ED reporting postnatal depression in clinical studies and prevalence ranging between 40% and 66% in general population samples. Furthermore, recent findings continue to highlight that current and prior history of maternal ED are associated with a heightened risk of adverse pregnancy and birth outcomes, most notably preterm birth and adverse birth weight outcomes.

SUMMARY

These findings continue to emphasise the clinical importance of early identification and response to maternal ED to mitigate potentially adverse maternal and infant outcomes.