Anorexia nervosa, fertility and medically assisted reproduction

Abstract

Anorexia nervosa is a psychiatric disorder that mainly affects women (sex ratio 1/10) and for which the prognosis remains poor (10% of deaths and high risk of chronicity). This disorder is associated with a risk of infertility explained by different physiopathological pathways. Thus, the clinical and subclinical forms of this disease may be over-represented in populations of women using medically assisted reproduction technologies. This raises the question of a narcissistic investment of the pregnancy, with a desire for pregnancy for what it brings to the woman. However, this recourse to mechanized care to access motherhood leads to questions for these women for whom access to femininity and sexuality may have been hindered. Furthermore, suffering from eating disorders might have a significant impact upon pregnancy, birth, and the offspring's well-being with psychiatric, obstetric, pediatric, child psychiatric and developmental morbidities. Thus, several specific aspects must be considered by medical professionals when women with anorexia nervosa either intend to undergo fertility treatment or become pregnant. It is important to promote the training of nursing and medical staff to the specific clinic of anorexia nervosa and the development and implementation of multidisciplinary teams to ensure follow-up of these women from the beginning of their treatment until the sixth month postpartum.