Coeliac disease and infertility

Coeliac disease (CD) is should be considered during the evaluation of infertility:

• many females show a mean diagnosis of CD between ages of 40- 50 years (1)
  • CD may be diagnosed with a delay up to 10 years, the entire cycle of reproductive life is lost in women with undiagnosed CD (1)
  • prevalence of CD in unexplained infertility may be as high as 4-8% (2,3,4) - compares to a prevalence of approximately 1% in the general population (4)
  • infertility in untreated CD may be related to malabsorption e.g.iron and/or folate, and various deficiencies of vitamins and minerals
  • a meta-analysis has revealed (5):
    • a significant association was found between women with a diagnosis of infertility and undiagnosed celiac disease [OR 3.09 (95% CI 1.74-5.49)]
    • when considering those studies assessing the occurrence of infertility in subjects with already-diagnosed celiac disease, no difference was found between celiac disease patients and control subjects [OR 0.99 (0.86-1.13)]
      
      
  • the diagnosis of CD is often done in women without classic malabsorption symptoms (6)
    • the "silent" presentation causes a diagnostic delay with a prolonged dietary gluten exposure that may lead to a reduction of the fertile life period
    • though GFD in these patients might resolve the obstetric/gynecological problems related to CD - this does not happen in all patients
      • the potential of a GFD to have a positive effect on fertility is rationalized by the improvement of nutritional imbalance that includes malabsorption and blood deficiency of zinc, selenium, iron, folate; these elements may be important to develop coeliac disease-mediated reproductive disorders
• note that CD may also cause a decrease in fertility in men by affecting sperm motility and androgen levels (7)

Reference:

• Shah S, Leffler D. celiac disease: an underappreciated issue in women's health. NIH-PA Womens Health (Lond Engl) 2010; 6: 753-66.
• Collin P, Vilska S, Heinonen PK, Hallstrom O, Pikkarainen P. Infertility and celiac disease. Gut 1996; 39: 382-84
• Meloni GF, Dessole S, Vargiu N, Tomasi PA, Musumeci S. The prevalence of celiac disease in infertility. Hum Reprod 1999; 14: 2759-61
• Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multi-center study. Arch Intern Med 2003; 163: 286-9
• Lasa JS et al. Risk of infertility in patients with celiac disease: a meta-analysis of observational studies.Arq Gastroenterol. 2014 Apr-Jun;51(2):144-50.
• Choi JM, Lebwohl B, Wang J, Lee SK, Murraj JA, Sauer MV, et al. Increased prevalence of celiac disease in patients with unexplained infertility in the United States. J Reprod Med 2011; 56: 199-203
• Karaca N et al. Is there any relationship between unrecognized Celiac disease and unexplained infertile couples? Turk J Gastroenterol. 2015 Nov;26(6):484-6