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Our approach to fertility healthcare needs to change

By Alisha Vaswani

Being told to lose weight is common advice for gynaecological and fertility-related issues, but what about the stress and anxiety that comes with intense attempts at weight loss?

Content Warning: Mention of eating disorders

When I was 17, I was handed a comprehensive list of what I could no longer eat.

It was a few months from when I was diagnosed with Polycystic Ovary Syndrome (PCOS) a common condition that affects the female reproductive system, and can lead to issues like Type II Diabetes, weight gain, heart disease and infertility. Sitting in my gynaecologist’s office, a copy of my latest ultrasound image on the desk, I watched, half-amused, half-horrified, as she mapped out my diet plan for the indefinite future. In red ink, there were the foods I absolutely couldn’t eat anymore, except for rare occasions: bread, flour, pasta, most dairy products, sugar, so on. In green ink was a (worryingly short) list of fruit I could eat (mostly berries) – fruit being high in sugar content, I was told I’d have to cut out most of them as well. Seeing it laid out on paper so matter-of-factly was a strange experience, and one I still remember vividly. It wasn’t presented as food I should eat less frequently and food I should eat more often. It was presented as food I could eat, and food I couldn’t.

After that day, I had my options for food neatly categorised into green and red, good and bad. For about a year, that list was hung up on my refrigerator. I’d resolved myself to adopting that inane dichotomy as my own, changing my lifestyle in whatever way I could. That isn’t to say I didn’t carve out my own surreptitious middle-ground: there were some aspects I found a bit too ridiculous to take seriously. But all in all, even though these guidelines didn’t come from a dietician, they still came from a healthcare professional. This was someone who dealt with several people with this condition every day, and I wanted to do my best to follow her advice.

It was only after doing my own research about PCOS that I realised I should never have been given that advice in the first place. Carbohydrates help regulate inflammation, which means cutting them out completely could worsen symptoms in people with PCOS that have low-grade inflammation. They’re essential to helping maintain healthy blood sugar levels and reducing the risk of stroke and heart disease. And of course, something I can attest to: they’re vital for energy, and cutting them out leaves you drained. Julie Dillon, a dietician told Refinery29: “Telling people to limit the one nutrient that their body is screaming for is only going to lead to a failure.” So, while, yes, a low-carb diet is important for women with PCOS, it’s not a solution to cut them out completely.

The main aspect I have an issue with now that I’ve done my own research is being told that there’s something wrong with your lifestyle, and that’s what has led to these issues. Another doctor I went to previously encouraged me to lose 10 kilos and revert to the weight I was when I was 14. It’s true that weight regulation is one of the most crucial methods of treating PCOS symptoms, particularly as there is currently no cure. But for me, being neither overweight at the time, nor having a particularly unhealthy lifestyle, I found it stressful to have the onus placed solely on me. Now knowing that there’s a strong genetic basis for PCOS, I wish that I didn’t take all the responsibility for it, initially.

This experience made me consider what gynaecological and fertility healthcare systems could do better. The over-emphasis on weight loss without much other guidance is what concerns me most. Recently, I read a report by BBC News in which they spoke to a woman suffering from endometriosis who had been seeking out fertility treatment. The woman, Rachel Rowlands, was advised to lose weight and was not given any further professional advice about improving her fertility. Since then, she has been diagnosed with an eating disorder, and says she wants “doctors and nurses to really think about how they address weight management issues with people who are struggling with fertility, and just approach it in a kinder way.” Issues with fertility are difficult enough as it is. Having a painful, often debilitating condition like endometriosis is difficult enough as it is. While being told to lose weight can be helpful advice, it can’t operate as a perpetual stand-in for other forms of treatment. It’s an absolute necessity that medical professionals account for the immense emotional and physical toll that disordered eating can take on a person. Being told that the only solution to your problem is to lose weight, no matter the cost, is disheartening at best, life-threatening at worst.

When it comes to PCOS specifically, a study found that the prevalence of disordered eating was over four times higher in individuals with PCOS compared to those who didn’t have it. Having read that statistic, I can’t help but wonder how many of the people in this study, like me, sat in the office of a gynaecologist and were handed a list of foods in red and green ink. How many of them, like Rachel, were told that there was one solution, a singular way forward, and it was entirely their responsibility to follow through with it?


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