Infertility and coeliac disease
Most women with treated coeliac disease do not seem to have a greater risk of fertility problems than women without coeliac disease.
However, undiagnosed coeliac disease may be an underlying cause of unexplained fertility problems so in these cases testing for coeliac disease should be considered.
The NICE guideline on the recognition, assessment and management of coeliac disease recommends that a blood test for coeliac disease should be considered in people with unexplained subfertility (below normal levels of fertility) or recurrent miscarriage.
Recent research carried out by Dr Joe West and his team at Nottingham University has looked at the relationship between coeliac disease and fertility.
The researchers found that women with coeliac disease, either before or after diagnosis, were no more likely to report fertility problems than women in the general population. The only exception were women diagnosed with coeliac disease aged between 25 and 29 years old. In this group recorded fertility problems were 41% higher than those of women, in the same group, who did not have coeliac disease.
This means that for women between the ages 25 and 29 years, over a period of a year, one in every 100 women without coeliac disease would report a fertility problem compared with 1.5 in every 100 women with coeliac disease.
The study provides reassurance to women with coeliac disease as it shows that most women with coeliac disease who are following a gluten free diet do not appear to have a greater risk of fertility problems than women without coeliac disease.
However, undiagnosed or untreated coeliac disease may be an underlying cause of some fertility problems so testing for coeliac disease should be considered in individuals with unexplained infertility.
We don’t really know why untreated or undiagnosed coeliac disease affects fertility, but there are a number of theories about why this may occur:
- If you have coeliac disease and are not following a gluten free diet, you are more likely to be deficient in folic acid, iron, zinc and selenium. This is because you are not absorbing these nutrients from food because of the damage to the lining of your gut. These nutrients are all essential for a healthy reproductive life. However, some studies have shown that people with untreated coeliac disease and unexplained infertility did not show any signs of nutrient deficiency. This suggests that infertility cannot be explained simply by being deficient in certain nutrients and other factors must be involved.
- Coeliac antibodies that are produced in untreated coeliac disease can have a negative influence during the early stages of pregnancy.
- Women with coeliac disease may be fertile for a shorter period of time because they may start their periods later and have an earlier menopause. This may be related to altered hormonal levels or because women with undiagnosed coeliac disease can have a lower body mass index.
More research is required to confirm any of these theories.
Pregnancy complications and birth outcomes
Women diagnosed with coeliac disease on a gluten free diet did not have an increased risk of pregnancy complications (haemorrhage, pre-eclampsia and mode of delivery) or adverse birth outcomes (preterm birth, still birth and low birth weight) compared to women without coeliac disease.
In women with undiagnosed or untreated coeliac disease there was a very small risk of having a preterm birth and low birth weight baby.
Congenital anomalies, also known as birth defects, can occur during the development of the baby in the uterus. The research showed that there was no significant increased risk of congenital anomalies in children born from women diagnosed with coeliac disease compared with women without coeliac disease.
However, women with undiagnosed or untreated coeliac disease were at a very small increased risk of congenital anomalies in their infants.
Getting tested for coeliac disease
It is recommended that anyone with unexplained subfertility (below normal levels of fertility) or recurrent miscarriage is offered a blood test for coeliac disease, even if there are no other symptoms present.
If you think you have undiagnosed coeliac disease, you must continue to eat gluten and speak to your GP for advice.
If you are diagnosed with coeliac disease, the treatment is a lifelong gluten free diet.
Following a healthy, gluten free diet seems to lengthen the fertile life span in women and has been shown to improve fertility and reduce the risk of reproductive problems in men and women.
If you have any concerns about your fertility speak to your GP for further advice. More information about coeliac disease diagnosis.