Celiac Disease and Infertility

Introduction

Celiac Disease (CD) has been reported to be more common in women who have fertility problems that cannot otherwise be explained (4% to 8%), women who have had three or more miscarriages in a row (6.7%), and women who have had a low-birth weight baby or a baby that was stillborn (5.7-9.33%) than in women in the general population (1.3%).

What is Celiac Disease?

Celiac Disease is a type of condition where the body has an overactive immune response against its own tissues. In other words, the body actually attacks its own cells. This is called an autoimmune disease. CD is passed down (inherited) through the family. The disease leads to parts of the bowel (small intestine) becoming damaged when the person eats anything that contains gluten, wheat, barley, oat, and rye proteins. Normally the intestines are able to break these items down and absorb them. However, in people who have CD that is not treated, the lining of the intestines becomes flatten due to the disease and as a result absorbing the nutrients from these kinds of foods does not happen in the way that it should. You can have this disease at any stage of life.

Celiac disease is a chronic intestinal disease involving inflammatory injury to the inside lining (mucosa) of the small bowel, associated with poor digestion and absorption of food (malabsorption).

Symptoms of Celiac Disease

People who have CD can present in many different ways ranging from no symptoms (asymptomatic) to symptoms like generalized weakness, recurrent abdominal symptoms and diarrhoea, anaemia, growth failure in children, bone pain, muscle cramps, and night blindness.

Women who have CD tend to have gynaecological problems, including a shortened reproductive lifespan - delayed onset of menstruation and premature menopause - and more irregular periods. They may also have a variety of gastrointestinal symptoms, including, bloating, abdominal pain, constipation, heartburn, increased flatus, loose stools, nausea/vomiting, and belching. However, many women have ''silent'' CD.

Previously undiagnosed patients often have mild gastrointestinal symptoms, but they may have no symptoms or have non-gastrointestinal symptoms such as iron-deficiency anaemia, osteoporosis, and/or fatigue.

Failure to recognize unusual symptoms and presentations of CD can lead to a delay in the diagnosis of this disease.

Celiac Disease and Infertility

Even though the main mechanism responsible for reduced fertility in CD is currently unknown several possible explanations have been suggested to explain the association between CD and infertility. Deficiency of essential nutrients can have an adverse effect on fertility. Also, women who have CD and who eat a normal diet are more likely to have a shortened reproductive lifespan with a delayed start of periods (menarche) and an early menopause. Fertility problems cannot be completely explained by poor absorption of nutrients, although nutrients such as zinc and folic acid play an important part in maintaining pregnancy. Potential additional explanations include other genetic and immune features of CD. Nonetheless, irrespective of reasons behind the relationship between CD and infertility, commencing a gluten-free diet leads to a greater possibility of a favourable pregnancy outcome.

Investigations

Some researchers recommend that screening for CD should be routine in all women with unexplained infertility. Blood screening involves testing for IgA, transglutaminase IgA antibodies (TTG) and IgG modified gliadin. The diagnosis of CD is confirmed with a small bowel biopsy.

Treatment

For women who have infertility and/or pregnancy problems associated with CD the treatment involves diet modification, specifically eliminating gluten. They must remember that the change in diet is to keep both them and the baby healthy. Left untreated CD can not only lead to infertility but, in pregnant can increase the risk of miscarriage, a smaller baby, and foetal growth problems.

A copy of our celiac disease and infertility fact sheet can be downloaded from the bottom of this page.

Celiac Disease and Infertility Fact Sheet - 123 KB