Celiac disease is a genetic autoimmune disease affecting people of all ages that results in small intestine enteropathy and is caused by the permanent intolerance to gliadin and glutenin, two proteins found in gluten containing grains 1. It is a female dominant disease, meaning the prevalence is higher in women than men. I’ve written on its evasiveness to obtaining a prompt and proper diagnosis prior in my article Celiac Disease: The Clinical Chameleon but I feel it is important for me to reiterate the fact that autoimmunity and inflammation in the gastrointestinal tract can be present PRIOR to the onset of clinical symptoms, and that in many instances, uncommon symptoms are the primary symptom. Infertility may be that one single symptom.
If undiagnosed, this disease has the capability to ruin lives and dreams, which brings me to the topic of this article. According to clinical research, celiac disease can negatively impact the fertility of women and men. Trust me, it is not on the forefront of the mind of those treating your infertility. As a scientist, father, and a member of the healthcare system, I say this with confidence to both men and women. If you are a listener of my podcast, or just started reading my blogs, or heard me on an interview, you probably know I focus on the scientific facts for everything I discuss. Of course, being a PhD, science is how I form my opinions.
So, when I first started seeing patients in practice that were experiencing fertility challenges and I helped identify celiac disease cases within that pool of patients, it was coming on the heels of some fledgling research on the topic. I can assure you at that time there were no recommendations to screen individuals experiencing infertility for celiac disease. Sadly, that is still the case, and thus the catalyst for this article.
The pattern was there, appearing in the literature over the years, albeit with some conflicting data, but now the association is extremely clear. Singh and colleagues published the findings of their meta-analysis on celiac disease and women with infertility in the Journal of Clinical Gastroenterology back in 2016.2 The key take home was that celiac disease is more prevalent in women with all cause infertility and unexplained infertility than in those without the disease.2 The math turns out to be women with unexplained infertility have six times higher odds of having celiac disease than a control group that is negative for celiac disease.2
Allow me to dispense some good news. Please note that according to more modern research in Denmark by Grode and colleagues, infertility in women diagnosed with celiac disease compared with those without the disease is the same!3 Obtaining a prompt diagnosis enhances fertility. Meaning, the real problem is getting a prompt diagnosis. If you haven’t, please read my article What do you do if you think you may have celiac disease?, which covers that topic.
Let’s take a look at what Grode et al identified. Undiagnosed women with celiac disease unfortunately experienced 11 more spontaneous abortions, 1.62 more stillbirths, and 25 fewer pregnancies per 1000 pregnancies when compared to their non-celiac disease counterparts.3
The reasons why celiac disease can induce infertility and poor pregnancy outcomes are multifactorial and include alterations of hormones, amenorrhea, early menopause, abnormal placental function, nutritional deficiencies, autoimmune reactions, and others.4
Men are not exempt. In the World Journal of Gastroenterology, Freeman reviewed data on men with celiac disease, and summarized literature that included sperm morphology and motility abnormalities in men with celiac disease, which would disrupt fertility.4 Sperm normalized after celiac diagnosis and a gluten free diet was implemented.4
Please allow me to be redundant and understand that infertility could be your only symptom of celiac disease. This is an extremely complex disease. If you are experiencing infertility, alert your physician to the connection with celiac disease and be sure that you are tested properly to see if you are at risk for the disease. My platform, my voice, my mission is to end or at least greatly truncate the duration to diagnosis and the percentage of undiagnosed.
1. Pastore RL, Murray JA, Coffman FD, Mitrofanova A, Srinivasan S. Physician Review of a Celiac Disease Risk Estimation and Decision-Making Expert System. J Am Coll Nutr. 2019 May 7:1-7. doi: 10.1080/07315724.2019.1608477. [Epub ahead of print] PubMed PMID: 31063433.↩
2. Singh P, Arora S, Lal S, Strand TA, Makharia GK. Celiac Disease in Women With Infertility: A Meta-Analysis. J Clin Gastroenterol. 2016 Jan;50(1):33-9. doi:10.1097/MCG.0000000000000285. PubMed PMID: 25564410.↩
3. Grode L, Bech BH, Plana-Ripoll O, Bliddal M, Agerholm IE, Humaidan P, Ramlau-Hansen CH. Reproductive life in women with celiac disease; a nationwide, population-based matched cohort study. Hum Reprod. 2018 Jun 15. doi:10.1093/humrep/dey214. [Epub ahead of print] PubMed PMID: 29912336.↩
4. Freeman HJ. Reproductive changes associated with celiac disease. World J Gastroenterol. 2010;16(46):5810–5814. doi:10.3748/wjg.v16.i46.5810.↩