There was a point during my anorexia, after the stunted growth but before the fractured bones, when I came to understand that my actions then would make it difficult for me to get pregnant later. The thought would come to me in bed at night and I’d break into a cold sweat, vowing to turn things around the next morning. But then I’d wake up, and it would still feel impossible to eat more or exercise less, and the cycle would continue. Through it all, though, through the punitive days and panicked nights, a glimmering silver lining buoyed my hopes: when it came time to try to get pregnant, I would be forced to gain weight.

To those readers who haven’t suffered from an eating disorder, the fact that this gave me comfort might be confusing. Anorexics, after all, are terrified of gaining weight, they fear food and avoid eating at all costs, right? That’s true, but it’s only part of the story. Anorexics don’t dislike food, or fear food, or even hate eating—I love food, and eating is quite possibly my favorite activity. No, what we fear, the thing that impels our disordered behaviors and drives us near death, is the wrath of the punishing voice within. I loved that basket of curly fries I’d eat late at night alone in my dorm room, windows shut and doors locked; but I feared the overwhelming shame that would descend and take hold after the last bite, and the grueling gym sessions and half rations I imposed the next day as penitence.

How does anorexia affect pregnancy?

Pregnancy would be different, though. A doctor would tell me I had to gain weight, and this edict would silence the tyrannical thoughts. For years, I looked forward to the day when the disease would have no choice but to loosen its reins; I fantasized about eating a snack, taking a second helping, skipping the gym without guilt. I couldn’t wait to eat.

My visits with doctors seemed to suggest that these fantasies would become reality. I wasn’t ready to get pregnant yet, but I visited several OB-GYNs and asked them all the same thing: how does anorexia affect pregnancy, and what would I need to do when I was ready? Each one told me that I’d need to get my period back—I’ve been amenorrheic for many years—which would mean gaining weight. That was the indisputable first step, and then we’d go from there.

But once my husband and I were ready, on our very first visit with the fertility doctor, my hopes were dashed. During that first appointment, he told us of a breakthrough study from 2012 that inadvertently discovered that women did not need to menstruate in order to ovulate and get pregnant. In fact, the amenorrheic women in the study had higher instances of pregnancy. We could induce ovulation through pills and injections, circumventing the need to get my period back naturally. Circumventing the need to gain weight.

A week later, I saw a psychiatrist who told me the same thing. She also told me about a patient of hers had who had gotten pregnant at 60 pounds, sans period. There was no question: my silver lining had been a mirage.

Dealing with a new reality

Part of me was happy—happy that we could begin trying immediately, that I could keep my body—but another part, a much larger part, was crestfallen. The oppressive remnants of my anorexia had been given a free pass to remain.

We’ve now been trying for over six months, and I’m the same weight I was when we started—just a few pounds shy of a normal BMI—and the doctor still says that’s fine. Every once in a while I’ll ask him, leadingly, whether it might make a difference for my chances of conception if I gained some weight. Every time, he says no.

Since I was 11 years old, I’ve been waiting for someone to give me permission to eat. Now, it seems that permission might never come; neither the doctors nor scientific evidence have given me justification for eating more, and nothing short of that will silence the voice.

But I wonder if I might be able to at least quiet it, and if, despite my doctor’s words, that might help.

Discovering permission—and peanut butter

After six failed cycles, I’m trying to think about my body as a potential home for a new life, and what I might be doing to make that home inhospitable. I’m not a doctor, but I know what it’s like to live in my body; I know the restricted food and obsessive exercise, and I certainly wouldn’t want to make a home there, if I had the choice.

So I’m trying to give my body what it needs, to nourish it rather than control it. I’ve never done this before, and it’s always seemed distasteful to me: “soft,” “weak,” “stupid.” Now, though, I need to make my body welcoming to a little human, to cultivate a place of warmth and love rather than sharpness and rigidity. My doctor may not have given me the permission I needed to eat freely, but he did give me a reason to treat my body better. It doesn’t beat my anorexia into submission the way I’d hoped, but it certainly makes it weaker.

Yesterday, I was starving, and it was at least two hours before dinner. On any other day during the previous two decades, I would have done the same thing: ignore the hunger and wait for it to pass. But this time, I stood up, walked to the kitchen, and ate a huge spoonful of peanut butter. It was delicious, because of course it was, but what was far more delicious was the fact that I’d allowed myself the radical act of eating such a dangerous food so spontaneously, and had my hunger replaced with satiety rather than shame.

I know the peanut butter won’t change my odds of conception. And I have no idea if the few pounds I might gain through this shifted outlook will make any difference. But I like to think that I’m filling my body with love—crowding out the fear, the hunger, the tyranny, the shame—and I hope my baby will notice, and want to make its way home.