Is there a link between coeliac disease and infertility?
A growing number of scientific studies indicates that the link between coeliac disease and reproductive health is indeed very strong. While in 27% of cases infertility is the result of ovulation disorders and in 25% of cases it is linked to identified male disorders, 17% of couples have unexplained fertility problems. It has been found that the rate of coeliac disease is 2.5 to 3.5 times greater in women with unexplained infertility. Many researchers agree that men and women with unexplained infertility problems, as well as women with the history of miscarriages, intrauterine growth retardation and low birth weight babies, should be screened for coeliac disease. Unfortunately, no routine screening is currently being done in those cases.
Until 2004, it was believed that coeliac disease was a rare disease of childhood. However, we now know that coeliac disease affects people of all ages. In the UK and Europe coeliac disease affects at least 1 in 100 people with only 24% of sufferers being officially diagnosed. Coeliac disease used to be perceived as a disease with gastrointestinal symptoms linked to malabsorption, now known as “classic” or “typical” form of coeliac disease.
But this is only one side of the coin. People with coeliac disease often have “silent” or “atypical” form of this disease: they have no gastrointestinal symptoms but their other organs and systems are still being affected, including the reproductive system. In fact, the majority of people with coeliac disease have the “silent” version of the disease with no obvious gastrointestinal symptoms. What we also know is that those with coeliac disease are more likely to suffer from other auto-immune disorders, compared to the general population. The two most common auto-immune disorders in coeliacs being type 1 diabetes and thyroid disease.
So what does that have to do with compromised fertility?
During the first trimester, pregnant women with an increase in thyroid autoimmunity have a significantly increased risk for a miscarriage compared to women who do not have an auto-immune disorder. It has been also reported that 14% of women with untreated coeliac disease will have an elevation of antiphospholipid antibodies. Amongst other things, increased antiphospholipid antibodies are linked to foetal wastage, which means higher risk of pregnancy loss. But is it not all doom and gloom. Studies have also shown positive pregnancy outcomes in coeliacs who adhered to a strict gluten-free diet, despite previous fertility problems. There are many reasons why you do not want to “cheat” when you are a coeliac and this is one example how exposure to even small amounts of gluten when you have a coeliac disease can compromise yours and your baby’s health.
Additionally, malnutrition and associated symptoms are most commonly present in undiagnosed females with coeliac disease. This can directly compromise the potential and ability to conceive. Those with undiagnosed coeliac disease or those who do not follow a strict gluten-free diet may intensify unfavorable conditions for conception within the body. Furthermore, studies have shown an increase in miscarriages and stillbirths in women with coeliac disease who are not on a strict gluten-free diet. One study compared 94 untreated and 31 treated coeliac women and showed that the relative risk of spontaneous abortion was 8.9 times higher, the relative risk of low birth weight baby was 5.8 times higher and duration of breast feeding was 2.5 times shorter in untreated mothers. Once again, all of these were effectively corrected with a gluten-free diet.
In men infertility can also stem from undiagnosed celiac disease. Again, the positive news is that eliminating gluten out of the diet resulted in improved semen quality and in previously infertile men and subsequent successful pregnancy.
So what is the conclusion?
All this illustrates the need for routine coeliac disease screening in couples with unexplained infertility as well as the importance of adhering to a strict gluten-free diet once you have been diagnosed or generally if you want to conceive.
Dr Eva Detko is a nutritional therapist and clinical hypnotherapist with almost 15 years of experience in the field of natural health. Over the years, she has successfully supported people with compromised immune function, weight problems, depression, anxiety, chronic pain, as well as digestive, skin and cardiovascular conditions. She is an author of two gluten and dairy-free cook books and a presenter on a weekly radio show called the Natural Path to Health (available on I Tunes too).
Ciacci C et al. (1996) Celiac disease and pregnancy outcome. Am J Gastroenterol; 91(4):718-722.
Farthing M et al. (1983) Male gonadal function in coeliac disease: 2. Sex hormones. Gut; 24, 127-135.
Fasano A (2003) Celiac Disease – How to Handle a Clinical Chameleon. NEJM; 348: 2568-2570.
Fasano A, Catassi C (2001) Current Approaches to Diagnosis and Treatment of Celiac Disease: An Evolving Spectrum. Gastroenterology; 120:636-651.
La Villa G et al. (2003) Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol; 9(6): 1377-1380.
Pellicano R et al. (2007) Women and celiac disease: association with unexplained infertility. Minerva Med; 98:217-219.
Poppe K et al. (2006) Thyroid autoimmunity and female infertility. Verh K Acad Geneeskd Belg; 68:357-377.