In Depth with Dr Sarah Trobe: Fertility, your body, and your eating concerns

Dr Sarah Trobe: [00:00:00] Fertility difficulties and going through fertility treatment can increase the risk of experiencing an eating disorder, but also eating disorders can impact on fertility. The prevalence of a current eating disorder or a past eating disorder, as well as body image concerns and disordered eating, are significantly higher amongst people seeking fertility treatment.

Really at the heart of it, fertility treatment is an absolute focus on your body. and the function of your body. And so really when you’re going through that, you’re what you lean on is to be able to change that, how we can actually enhance our body’s response to the treatments that we can for pregnant.

Sam Ikin: Going through fertility treatment can be nerve wracking and demoralizing at the best of times. But when it’s coupled with the current or experienced eating disorder, the whole process can just get a whole lot more complicated. The [00:01:00] National Eating Disorders Collaboration, or the NEDC, has recently launched a fertility care for professionals program.
It can help anyone who’s working in fertility care to identify and respond when someone is experiencing an eating disorder. To tell us a little bit more about it, we’ve brought in the National Manager from the NEDC, Sarah Trobe. who used her own lived experience of fertility treatment to help contribute to this program.

Dr Sarah Trobe: So I’m a clinical psychologist by background and currently the national manager at the National Eating Disorders Collaboration. So I have the privilege of working at the system level and supporting lots of clinicians and services across Australia in enhancing their response to eating disorders. I’m originally from Tasmania and now reside in Melbourne, which is lovely, but I do, do miss the fresh air that the state provides. Personal level, I’m a mum, four year old, he has ARFID, so have that living experience of supporting someone with [00:02:00] an eating disorder through this phase of their life and curveballs that come with that, but also being able to be a mum to a kid. Beautiful little boy.

Sam Ikin: ARFID, or Avoidant Restrictive Food Intake Disorder, is when someone, often a child, avoids certain foods or eats very selectively because of things like sensory sensitivities or the fear of choking.
This can make it really tough for them to eat all the nutrients that they need, and it can lead to health issues. What does that look like for a four year old?
Dr Sarah Trobe: Yeah, my son experienced difficulties from birth, so he was born at very low weight and so was tube fed from day five and has now got a peg tube, has continued to have a lot of difficulties with choking and vomiting, which has led to an overall aversion to eating because it’s a really scary experience for him.

So we’re fortunate to have a wonderful care team so that, and we have a PEG tube so that that can really support his intake when things are really tough for him. [00:03:00]

Sam Ikin: I’m going to jump in quickly and explain what a PEG tube is. PEG stands for percutaneous endoscopic gastrostomy. It’s a surgical procedure where a feeding tube is inserted directly into the stomach and it allows the patient to receive nutrition directly through the tube into their stomach.

Dr Sarah Trobe: But I guess day to day, it’s just going with wherever the eating disorder might be at that time. Sometimes we can have, Charlie can experience a really easy experience as a meal and sometimes it can be quite overwhelming and lead to vomiting. So. It’s just riding the waves that come and ensuring that he can have a normal upbringing and go to school and have play dates and all those things that we want our children to be able to have.

Sam Ikin: Is this something that brought you into this field or were you already in eating disorders?

Dr Sarah Trobe: I was actually already in eating disorders, Sam, and I feel actually really privileged to have the expertise that I do to be able to navigate a system that probably isn’t as equipped. Um, to respond to ARFID as some of the other eating [00:04:00] disorders because it is a new diagnosis.

I became pregnant when I was probably five years into my eating disorders work and started to notice things in Charlie as he started to grow and get older, but I was able to advocate for him because a lot of the health professionals we were working with weren’t familiar with ARFID. And of course, we’re still navigating what is the best treatment for young people and adults with ARFID.

So, Being able to actually explore that from both a professional perspective, but also from the wants of being a mom and knowing your child so well.

Sam Ikin: That sounds, wow. That sounds like a tough kind of a situation. And I guess we’re talking about being parents and that’s why we’re talking. And I think we were just, before we started recording, we were both talking about our experiences going through IVF and fertility care and all of the different Things that we’ve got to put our bodies through, women, sorry, the women have to put their bodies through, men have to be supportive, but of course we’re not the ones who [00:05:00] it’s happening to.
But so can you tell us about the interaction between eating disorders and fertility care? This is a group that I understand at much higher risk than everyone else.

Dr Sarah Trobe: Yeah, absolutely. And again, feel very lucky to be able to drive some work that I’m particularly passionate about after my own experience of going through IVF.

Okay. But yeah, when we started to dig around and look at some of the research that does exist that we know that the prevalence of a current eating disorder or a past eating disorder as well as body image concerns and disordered eating are significantly higher amongst people seeking fertility treatment.

So we’re talking up to 16 percent experiencing a current eating disorder, which is much higher than the general population data, of course. Um, and around about 25 percent have a past experience of an eating disorder. So really alarming statistics, but we know that only less than a third of people will actually tell their fertility specialist that has been their experience in the past or [00:06:00] current, which, which can obviously lead to some real complications.

Sam Ikin: Is that reluctance to talk about it? Does that have anything to do with stigma or some of the other negative connotations that, uh, put on. Disordered eating and these kinds of areas even by medical staff that we’ve spoken about a lot in this podcast. But is that the same kind of pressures or is it different?

Dr Sarah Trobe: Yeah. I think that’s a really good question. And I’ve reflected on this a lot as we’ve been. Um, doing this work and I guess that there is stigma around eating disorders that continues to exist, um, and be perpetuated and sometimes by health professionals. Possibly people are not feeling confident or comfortable to talk to an obstetrician or gynecologist that may not have expertise in eating disorders.

But there may be another layer of anxiety in raising something that might cause complications to the treatment process and possibly put the brakes on [00:07:00] the ongoing fertility treatment. And we know that people can feel a real sense of urgency when they start. Any type of fertility treatment. So not wanting to bring up something that might have to put any of that on hold while we address the concern, which might be an eating disorder.

Sam Ikin: Yeah. Of course, time’s a factor because everything costs so much money. So there’s so much pressure for everything to work. And then when you’re told that fertility is affected by. You, the, the shape of your body a lot of the time as well. These are all things that I remember experiencing, but I’m, I’m sure there are far more.

And again, I keep saying that I experienced, I didn’t experience, I was just there, right? But again, I keep, are there more than just these things that I’ve mentioned?

Dr Sarah Trobe: Yeah, absolutely. We know that there’s a really complex interaction between eating disorders and fertility and its bi directional sandwich. Fertility difficulties and going through fertility [00:08:00] treatment can increase the risk of experiencing an eating disorder, but also eating disorders can impact on fertility. So if we think about, and I do lean on my own lived experience of fertility treatment and hearing from the stories of others, but if we think about the experience of going through fertility treatment and how this might increase body image concerns or disordered eating or an eating disorder.

You think about wanting to fall pregnant is one of the most important things to you in that time. And it can feel really out of your control and out of your hands. There’s not much that you can really do to control it. And so then you can lean on Google and there’s just so much information out there that’s possibly no evidence behind it, but can tell you to cut this, restrict that, no dairy, no meat, no carbs, take this supplement.

Exercise more, exercise less, don’t stress, relax more, and you do all of these things and read all of this information in the hope that it will actually increase your chances of [00:09:00] falling pregnant. And of course, all the other stress that can come around it too, around your relationships and financial pressures, but really at the heart of it, that fertility treatment is an absolute focus on your body.

And the function of your body. And so really when you’re going through that, you’re, what you lean on is to be able to change that, how we can actually enhance our body’s response to the treatments that we can for pregnant. So you can see how that. Well, that whole experience can increase your risk of changing the way you’re eating so that you can change your body, which we know can absolutely predict or increase the risk of an eating disorder.
Yeah. If we flip to the other side, the really complex interaction around how an eating disorder or disordered eating habits can actually impact on your physical health and your endocrine system and reproductive health. So this is complicated and we don’t have to go into it in detail today, but just understanding the impact that eating disorder behaviours, such as restriction, [00:10:00] laxative diuretic use, binging and purging, et cetera, can have on your endocrine system and your hormones and of course linked to male and female fertility.

So coming both sides, how you can see how complicated the picture can be and the importance Helping people to be equipped with information and resources and equipping our workforce so that they can respond in a compassionate and informed way.

Sam Ikin: And so it’s one of these vicious cycles, really, where you are, you’re having fertility issues or low facility.
And so you go and seek help and then seeking help causes you to behave in a certain way that reduces your fertility, right? So like you’re damned if you do, damned if you don’t.

Dr Sarah Trobe: Yes, absolutely. And I think about my own experience. I went into this with knowledge about eating disorders, knowledge about nutrition and risk factors and all those sort of things.

And so I could still read all of this information and absolutely be impacted by it. But [00:11:00] my professional mind could criticize and really interrogate the information I was reading. But how many people come to fertility treatment? as an eating disorder clinician. And so this is why we’re having these conversations today, is that how can we actually raise awareness so that people are not impacted by some really harmful messaging that they can receive through the process?

Sam Ikin: It’s just a tough kind of a situation as well in general, because we, I think we’ve spoken a lot about how closely linked all areas of mental health are. People very seldom just have an eating disorder. This eating disorder co occurs with. Depression, or anxiety, or OCD, or one of a myriad of other things.

And so, in going into something that’s quite stressful, and that can lead to an increase in some of these other areas, it makes sense that this is. And so, how are you, what are you trying to do about it?

Dr Sarah Trobe: I feel that some of the things we’ve been talking about might paint a bit of a [00:12:00] stark picture about the, this whole experience and maybe there’s nothing we can do about it, but there, there is a lot we can do about it and I think prevention really lies at the heart of it.
So we can think about it as two prongs that we’re equipping the workforce and we’re equipping people who are going through fertility treatment. When I talk about the workforce, we’re not talking about necessarily fertility specialists that only work in fertility, but of course we are talking about those, including gynecologists and obstetricians.

We’re talking about the broader workforce as well, nurses, mental health professionals, dieticians, naturopaths, acupuncturists, all those people that, and professionals that people going through fertility treatment might actually seek out through that journey, that we actually need to equip all of them with the understanding of this high risk.

Okay. But also with the skills to be able to have a conversation with their patients or clients about bodies, food and eating, and being able to explore that in a really compassionate and informed way. Because if we’re not [00:13:00] identifying the problem, it’s really hard to be able to respond to it, either prevent it from happening or prevent it from worsening.

We are very excited to have free training available on our website for people working in the fertility care space. And that training is designed to do exactly that. So to equip all of those professional groups with the knowledge and skill to be able to identify and respond to eating disorders, but absolutely to prevent it from happening in the first place.

That relates to your earlier point too around weight stigma, Sam, that there’s some really great information in there about how we might be able to challenge some of the stigma that can come around weight and bodies so that that stigma isn’t causing further harm.

Sam Ikin: You, you’ve mentioned a few challenges that you’re up against here. Are there any further challenges? So I guess we’re talking in general about Eating disorder care in the broader healthcare community. We talk about that a lot. Is it markedly different in this area of healthcare in particular? [00:14:00]

Dr Sarah Trobe: Some of the challenges we do face is thinking about the multidisciplinary care team in fertility treatment.

We’re often seeing multiple different professionals and they might not all be under the same roof. And that’s the same with eating disorder care, and what we really need is a whole, a care team wrapping their support around the person and working in a holistic way. So we’re not having to put aside the eating disorder treatment or the fertility treatment, but the professionals from the different practices and services are actually able to communicate in a way that’s supporting the person with all of their needs.

And all working from an eating disorder informed lens. So that means that the gynecologist and obstetrician is aware of what the dietician and psychologist are working on, and that the person is feeling informed about all the treatment decisions that are happening. Now, we know that care team planning can be really challenging, but we also know how important it is in this space because if we’re neglecting either side, we’re not going to see much success with either the eating disorder treatment or the fertility care [00:15:00] treatment.

Sam Ikin: Are we still feeling around in the dark or is there a way that we can reduce all of these different factors and the risks that they pose?

Dr Sarah Trobe: Yeah, absolutely. So what we know, um, from the professionals that have engaged in, in learning and upskilling is that when they do have access to the right information, it does lead to changes in practice.

That we can see people feeling more confident and willing to ask questions when they’re working with a person about experiences of body image concerns and eating behaviors, and being able to feel confident to link them in with eating disorder specialists, so a mental health professional and dietitian in the community and work collaboratively with them. The other space that is really important though, of course, is to be equipping people who are going through fertility treatment with this information as well. So that we’re working from the other, I guess, the other lens so that people can go in an informed way, understanding the process of fertility treatment and how it might impact [00:16:00] on their body and feeling confident to ask questions about their treatment and to interrogate information that’s provided to them about diets and weight loss and those sorts of things, which is so prevalent amongst healthcare settings and social media and general website searches.

Sam Ikin: Is there a way that we can support the professionals who are going through all of this? Of course, only want the best outcomes for your patients. How can we better support people who are the professionals who are supporting people in fertility care?

Dr Sarah Trobe: I think that last point is really important, Sam, is that Our fertility care, um, specialists do want people to be able to fall pregnant. That’s, that’s why they’re absolutely working in this, right? But and so if, again, if they’re aware the, of the impact of eating disorders and the prevalence of, they will want to do something about it.

So our first step is to raise awareness of this high risk group and we, uh, NEDC is doing our absolute best at being [00:17:00] able to connect with fertility specialists across Australia to let them know of that. And then we need to equip them, and that’s why we developed this free e learning that is accredited by the professional bodies so that the fertility care professionals can go in and say, what do I need to do? What is my role in this? Feel contained in the role that I’m responding to it, and then I’m going to connect with a treatment provider outside my service. That they don’t feel that they need to be out, have to do everything. That they need to be able to fulfill a specific role in identifying and responding and preventing the occurrence.
So really encourage any health professional listening to this podcast today, that even if you’re seeing one person in your clinical practice that’s experiencing fertility difficulties, to jump in and have a go at the e learning, that we know that by equipping yourself and letting others know about this training, we can definitely see a more enhanced response across all of the fertility clinics that exist in the country.

Sam Ikin: What’s involved [00:18:00] in that? Is it just an internet connection and. A few minutes of your time.

Dr Sarah Trobe: Absolutely. So the training runs for about 90 minutes. It’s a really interactive training. So there are case studies and it provides you resources and it’s available via our website and that’s access for free. So you can just jump onto the particular webpage and connect to the training.

Sam Ikin: Great. We’ll put a link in the show description for that as well. That’d be wonderful. Now, so that’s professionals. This is the people who are working in the area, but what about, and I guess we’ve spoken about our experience as consumers. What are some of the things you’d recommend to people who are going through fertility treatment?

Dr Sarah Trobe: Yeah, I think this is the same message, Sam, around knowledge is absolutely power and we need to equip people with information and resources so that they can better manage those risks that we’ve spoken about earlier. When we have knowledge and we’ve got resources and skills that promote body image and protect our emotional well being, we can navigate the fertility journey with [00:19:00] greater resilience.

Thank you, Sam. That’s not to say the journey is going to be easy, because we know that it is a really challenging journey. But by having this in our bit of a toolbox, we can make the journey a little bit easier. When we think about prevention strategies, we’re trying to tackle the underlying causes that might contribute to the disordered eating or eating disorder, but we’re also thinking about the protective factors around that person, their support networks and the way they’re actually looking after their well being.

Some of the really key things that we recommend, and so that people don’t feel that they need to write down everything I’m saying now, Sam, we do have a really excellent resource that, um, we can talk about in a second, but some of the really key things are actually letting your health professional know that you have an experience of an eating disorder in the past or current, so that the health professional can really think holistically about your treatment plan, interrogate the information and recommendations that are being made, particularly if they are around your weight, Or diet, or body shape.
[00:20:00] Ask information about what’s the evidence behind that recommendation. Can you have some further information about it? Or, ask to be referred to an eating disorder informed clinician that can help explain that information and navigate it in a safe way. Practicing self care, we get this all the time, but it is really important.

And engaging in activities that promote self compassion and body positivity, whether that’s yoga and meditation and those sorts of activities. Because we have to look after our well being to get through this with the most strength we possibly can.

Sam Ikin: Yeah, so that’s all while you’re in treatment, I guess, you need to be going through all that.

But if you’re thinking about it and it’s something that you’ve either deciding upon or you have decided but haven’t started yet, what can you do ahead of time before you start the treatment to set yourself up a bit better?

Dr Sarah Trobe: If someone has an experience of an eating disorder in the past and they are about to go into fertility treatment, [00:21:00] it is really important again to understand the risks, but you don’t have to feel despondent by the information that you’ve heard today that people can absolutely fall pregnant after they’ve had an eating disorder in the past.

But as I’ve mentioned, it’s important to let your treatment team know that and really seek care from professionals that are able to provide care in an eating disorder informed setting. safe and accessible way. And so that means that your fertility provider can think about your treatment plan in that holistic way, considering your health and all of the other various factors that contribute to fertility and your wellbeing.

Seeking extra support from eating informed clinicians in the community, such as a psychologist or dietitian. And also importantly, knowing your rights in that treatment process. So if weighing is triggering for you, talk to your health professional about it and see if it’s actually really required, or you can do that in a safe way, [00:22:00] or refusing particular types of treatment because that is triggering for you. So it’s like you’re equipping yourself with a really hefty toolbox before you’re going into treatment. And that’s just starting by understanding risks and a few strategies to start the process.

Sam Ikin: Pretty good advice too. And I don’t think many people realize how difficult it can be going through this process. Some people might be very lucky and sail through, but a lot of people, by the time you get there, there’s already a lot of emotion and a lot of feelings involved. So I think this is extremely, it’s really important that we get this kind of information out there. So it’s a wonderful resource that you’ve created there. I’ve run out of questions though. Is there anything else you wanted to add?

Dr Sarah Trobe: Yeah, there’s just one thing, because I think that we rely on the internet for so much information, Sam, and there’s, you can Google anything in relation to health and [00:23:00] nutrition and fertility care and. They claim to have strategies to promote hormone regulation and egg quality and sperm quality and fertility. But these messages can be just so harmful on people attempting to conceive and may encourage people to engage in potentially harmful weight loss or eating behaviours which can actually reduce their health and well being at this really crucial time in their life. So I would suggest shutting down Google for a moment and seeking information from qualified professionals that can give you evidence based information about how to navigate this journey and providing and seeking anything you need to look after your own well being, emotional health, and mental health during a really challenging time.

Sam Ikin: And Butterfly’s got a great database of professionals on the website as well, which might be a better place to go to find that kind of information, I think. So, yeah. Wonderful advice. Yeah. [00:24:00] Alright, Sarah, thank you so much for your time. Really appreciate chatting and yeah, we’ll make sure that all of those links go out in the show notes.

Dr Sarah Trobe: Thank you for the opportunity.

Sam Ikin: The program is called Eating Disorder Core Skills e-learning for Fertility Care Professionals, and you can find it on nedc.com.au on the website nedc.com.Au. There’s also a link for that in the show description or the notes or whatever that’s called in the app that you’re listening to this on. There’s also some links to some helpful resources from the NEDC in the show notes as well, including a fact sheet about the connection between fertility care, disordered eating, and eating disorders.

If you need support right now, the best place to start is Butterfly’s National Helpline on 1 800 334 673. That’s 1 800 ED HOPE. Butterfly: Let’s Talk is produced for Butterfly Foundation by Ikin [00:25:00] Media with the support of the wonderful Warratah Education Foundation. Our executive producer is Camilla Becket, who does an amazing amount of work for this program, and we truly appreciate the time that she puts in.

Until next time, I’m Sam Ikin.