Should subfertile women be screened for eating disorders?

Eating disorders and infertility are both common among women in industrialized countries, and eating disorders (most notably anorexia nervosa) have long been considered to significantly reduce fertility. Especially since eating disorders are often undiagnosed, routine screening has been widely suggested when infertile women present for investigation or treatment. This paper reviews fertility of women with current, or a history of, eating disorders. There is evidence that anorexia nervosa directly impairs fertility, but the situation is less clear for milder eating disorders. Fertility and the treatment of infertility are impaired by excessive weight, so any eating disorder that is associated with obesity will contribute to infertility. While previous screening studies of infertile women have suggested that eating disorders are common, there have been very few such studies and a total of less than 250 women have been screened. The paper summarizes logical criteria for routine screening and concludes that insufficient numbers of women have been scrutinised at present to know if this would be appropriate. If prevalence were found to be high then it may be deemed necessary to demonstrate that such women could be engaged in treatment for their eating disorders and perhaps also that this had a tangible effect in improving fertility rates before a strong case for routine screening could be argued.