I sat in the fertility doctor’s office—white walls, bare wooden desk, opaque window—alone. For a time, I imagined this moment would go exactly like this. I always knew I wanted to be a mom, with or without a partner. That is, until I met Paul two and a half years ago.
I had expressed concern to my primary care physician about turning 35—the benchmark age for “geriatric” pregnancy, according to the American College of Obstetricians and Gynecologists—and asked for a referral to a reproductive facility in our area. Despite having a partner, my original vision—sitting in a fertility clinic by myself—came true. Paul was called away on an extended work trip. So there I was, merely wanting to assess that everything was in working order, given my age. The fertility doctor asked about my hobbies. I didn’t contain my excitement when I told her how I spend my free time. Like a kid expecting a reward for getting straight As, I rambled about how I started running in high school and that I run marathons every year.
I expected a “good for you” for engaging in a healthy activity or a request for a shoe recommendation. Instead, she asked if I had a history of eating disorders.
All About 75 Hard eating disorder in college, but that I had been seeing a therapist since 2020, coming to terms with my past and getting treated for briefly falling back on these habits during the pandemic.
As if to test my progress, she said I’d have to limit my running to 30 minutes per workout, five days a week; stop running marathons because of my history of having irregular periods; and gain five pounds before starting fertility treatments or having a baby on my own.
This is the moment I regret—of all the things I could have contested, I just had The Best Songs to Add to Your Playlist this Month.
“Five pounds?” I exclaimed. (For women trying to conceive, it’s recommended that their BMI fall within the normal range between 18.5 and 24.9; my BMI was 19.5. Incidentally, the average adult’s weight can fluctuate five to six pounds per day.)
Her expression became grave. On a sheet of green paper with an illustration of the uterus and ovaries, she wrote on top “hypothalamic amenorrhea” (HA), a disorder when the hypothalamus ceases production of hormones that control menstruation due to excessive exercise and undereating. Using rhetorical questions, she framed an alternate version of my pregnancy should I try to have children with my “current mindset.”
What if you have trouble conceiving because you won’t gain five pounds? What if you conceive and you don’t gain the pregnancy weight and the baby’s organs don’t develop and it’s born premature? What if you have a healthy pregnancy but you’re not eating all the nutrients you need for your milk? What if you see your baby as pudgy and restrict food? What if your child…becomes like you?
“Normally I’d say you and your partner should try on your own, if things are fine after we examine you today. But you’re most likely not ready,” she said. “I think you should wait two years. For now, we can preserve your fertility, create embryos.”
I walked out of the office into the next room in a haze. A vaginal ultrasound probe scanned my follicles as I lay on the examination table dazed.
“Twenty-two on the right ovary, 20 on the left,” said the doctor, looking at her screen. “Very fertile. Good for you!”
That day, back in September 2023, I left the clinic knowing I was biologically able to have children and yet, feeling like I was unfit to be a mother. The story the doctor told wasn’t my story, but its possibility filled me with shame.
It took me over 10 years to see a therapist about my disordered eating. I had kept my struggles to myself. Disbelief from a friend and a physician who dismissed my worries about binge eating when I was in college had drawn me away from revealing my eating disorder (ED) to anyone. I was also embarrassed that I had become a statistic, admitting I was just another stereotypical runner obsessed with body image and food. I thought I had managed my obsession with focusing on my weight until the pandemic sent me spiraling down a path where I was weighing myself several times a day, counting calories, eating less, and running more. There was also an insidious internal dialogue, where I told myself how ugly and disgusting I was, that I didn’t even realize I was repeating every day until I spoke with my therapist.
Growing up, my mom was insecure about her weight, indirectly influencing how I viewed my body (not to lay all the blame on my mom; I was a media-fed child of the 2000s). Through therapy, I realized my obsession with my weight didn’t just stem from my A-type personality and desire to look a certain way. It was a silent desperation to prove my self-worth. Transference of these issues onto my future children is something my therapist and I discussed, and I’d have to guard against with extreme care, knowing from personal experience what effect weight obsession has on a child.
I feared keeping my ED secret would catch up with me. But I thought I had tamed—if not beaten—the beast, maintaining a regular menstrual cycle and healthy weight. When I sat in the fertility clinic facing my biological clock, I didn’t expect that my suitability as a parent would be scrutinized because of it.
Months have passed since I sat in that office where I felt implicated for child abuse before having a child. I understood the doctor’s intentions: Not every woman who walks through her door is mom material. Not every woman who sits in that chair can handle pregnancy.
But her words continued to haunt me as I ran marathons, missing a period for a month or so after each race. One day, I listened to a guest on the podcast How to Improve Your Running Recovery Plan talk about HA. The speaker, known as the Period Nutritionist, was Cynthia Donovan, MS, RDN, CDN, who specializes in helping women with HA regain their period so they can become pregnant.
In Donovan, a runner who had experienced HA herself while trying to conceive, I recognized someone I could speak with openly and vulnerably. I knew she would understand how running was a part of my identity. On a video call, I told Donovan what the fertility doctor said to me and asked if her running and weight advice was medically sound.
“To my knowledge, while there’s limited research on HA, there are no research studies out there saying, if you are a BMI of X, you need to gain X pounds and only exercise X minutes,” she said. “There’s just too many variables genetically. So for that doctor to say specifics like that, she’s got nothing backing it.”
However, there is research where a BMI of 22 or greater is good for fertility.
“But here’s the thing: There are women out there who have a BMI of 18, 19, and they have no problems conceiving,” she said. “But to err on the side of caution, we would want these women to gain weight if necessary. One thing your doctor is sort of right about is that if we get to a healthier body weight or closer to that fertile BMI of 22 or 23, you’re going to have a higher chance of not being malnourished afterward.”
I asked Donovan what’s the deal with missing a period after running a marathon and whether eating more would keep it in stasis.
“When we run marathons, we know that there’s likely low energy availability, meaning that there’s not enough food, combined with the stress of the physical activity,” she said. “You may eat all the extra food, but your body might think you’re still in a state of stress with high levels of cortisol and adrenaline.”
Essentially, I’d have to find what works for me through trial and error.
Finally, I admitted my darkest truth to Donovan: that I still had hangups about gaining weight, and blurting out “five pounds?” in the fertility clinic came from a place of fear. I was convinced I would feel differently as my body expanded to make room for a child.
“These two things can be true: ‘I want to be a mom, but I also maybe don’t want to gain weight, but I’m also okay with gaining weight if it’s for the greater good of a baby,’” she said. “I just want to let you know that it’s a thought across the board, every woman I talk to who wants to get pregnant has it.
“Unfortunately, we live in a world that is very ‘make sure you’re exercising during pregnancy,’ ‘fit back into whatever pair of leggings or jeans postpartum,’ and ‘belly-only pregnancy.’ There’s so much societal pressure, which is very normalized on women who are trying to conceive.”
After I spoke with Donovan, I knew what she said was basically the same thing the fertility doctor was trying to tell me. But instead of saying I wasn’t ready and making me feel ashamed, Donovan listened to my story with compassion, giving me grace.
It’s weird to reveal one of my biggest secrets publicly. Up until now, only three people, including Paul, knew about my ED. I danced back and forth on sharing my experience and voiced my worries out loud. “What will my family think? My friends? God, I hope no one reads this.”
“Why would you not want anyone to read your story when it could help people?” Paul said.
When I started dating Paul, I was encouraged by my therapist to tell him about my ED. He listened without judgment, his reaction going against what I always feared if I told someone about my past.
He was right about wanting people to read my story. According to Donovan, 50 percent of women have menstrual irregularities. Maybe one of them has a story like mine.
I know I have my work cut out for me: After running Boston in April, I’ve scaled back on my weekly mileage but still run six days a week to keep my sanity. I try to not skip a meal or recovery snack. I monitor my menstrual cycles to make sure they’re regular. Ultimately, we decided we want to take our time, trying to get pregnant on our own semi-seriously, while also freezing embryos as a safeguard. Obviously, we’re seeking treatment at a different clinic. I still struggle with body image, but I try to keep it in check. I remind myself that I’m strong, brave, and capable of great things—the same credo we’ll instill in our kid.
If you or someone you know is struggling with an eating disorder, getting professional help can help you understand and manage your feelings and behaviors. You can contact the National Eating Disorders Helpline at (800) 931-2237 or text “NEDA” to 741741 for immediate support.
Amanda is a test editor at Runner’s World who has run the Boston Marathon every year since 2013; she's a former professional baker with a master’s in gastronomy and she carb-loads on snickerdoodles.