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Energy Balance and Fertility – A Holistic View

Beth Heller M.S.

A   recent study examined the prevalence of eating disorders in women preparing for their first IUI at a private fertility clinic and found that an astounding 21% met the criteria for a past or present eating disorder.    The researchers who conducted this study recommend that the infertility screening process include an eating disorder assessment as part of the overall intake.

When I read this study I was thrilled that the medical community is moving toward an active assessment of not only what a woman is eating, but also the psychological factors that play in to many women’s relationship with food, exercise and body image.   At the Moon we see a lot of women who do not have a full-fledged eating disorder but who work quite hard to maintain a fashionably thin figure.  It’s not uncommon for a normal weight/svelte woman to struggle to remain five pounds below her ideal body weight.  It’s so common that we even have a name for it:  the “final five syndrome” (or FFS) and I’ve long wondered about the role FFS may play in a woman’s ability to conceive.

From a nutrition standpoint, the concept of  Energy Balance is critical for fertility.  When Energy In (the food we eat) is greater than Energy Out (our metabolism + activity) we gain weight, which can be a problem for fertility.  Excess fat tissue can disrupt estrogen metabolism and too many calories-in can impair blood sugar regulation, with the result that overweight and obese women have a harder time getting/staying pregnant than women at a healthy body weight. On the flip side, when Energy In is less than Energy Out , women also struggle to conceive.  The body has a very precise, evolutionarily defined priority for the way it uses its calories (energy).  First “served” are the functions that are absolutely essential for life – nerve transmission, cellular metabolism, respiration/circulation.  Once these processes are secured, energy is diverted to less-critical but still essential body functions including locomotion, immune function and growth.  Last served are non-essential functions like reproduction, which can essentially be “turned off” during lean times without harming the individual.   Reproductive function doesn’t necessarily shut off all at once, either.  Cycles can lengthen,  the luteal phase can shorten and menstruation can become scant prior to complete loss of periods.  Clearly, none of these conditions is optimal for conception.

When Energy In = Energy Out there is balance, healthy body weight and healthy appetite.  Yet for many women energy balance can be a difficult, and at times scary, place to find.  Our society promotes a version of athletic thin-ness that is nearly impossible to emulate.  This unattainable image means that women who are naturally svelte are still spending hours at the gym, counting calories and worrying that they will become fat if they release this state of constant vigilance.  While not a full-fledged eating disorder, it wouldn’t be surprising, at least from the holistic perspective of Pulling Down the Moon, if reproductive function suffered in women struggling for the perfect figure.

So how do we address the FFS at the Moon?  Well, one of the amazing things we’ve found over the years is that techniques that work with the body, mind and spirit – like yoga, acupuncture and psychotherapy – can be very effective in healing the FFS.  As women begin to “fill up” their body with life energy, it becomes harder to deplete and deny themselves.  The fear of “letting themselves go” transmutes into a desire to simply “let themselves be.”  Exercise doesn’t go away – it simply becomes less grueling and more fun.  Including more nourishing foods and fats in the diet leaves women feeling more satisfied and stronger.  Interestingly, for most women these changes take place without any change in actual physical weight.

If you are interested in learning more about the ways the good nutrition, stress reduction and other holistic techniques can support fertility, visit