Is There A Link Between Celiac Disease and Infertility?

Infertility is a difficult diagnosis to receive for any couple. There are many causes of infertility, with one in five couples being diagnosed with unexplained infertility. ^{(1, 2, 3, 4)} In recent years, there has been a growing body of scientific evidence that shows that undiagnosed or untreated celiac disease is also an underlying cause in many cases of unexplained infertility.

Several years ago, when in vitro fertilization (IVF) was still a relatively new technology, infertility specialists would rarely take into consideration celiac disease to be a potential cause of miscarriage or infertility.^{(5, 6)} Even today, there is no consensus amongst experts about celiac disease and its impact on both female and male reproduction. However, doctors are becoming more open to talking about whether this condition has an effect on conception and pregnancy. This is especially good news for those who have undiagnosed celiac disease, as diagnosing and treating celiac disease has been found to help many people become pregnant.⁽⁷⁾

Celiac disease is an autoimmune disease that is hereditary. The symptoms of this disease are triggered by the ingestion of gluten, which is a protein found in wheat, barley, and rye. In people with celiac disease, eating gluten causes an immune response. This can lead to damage to the small intestines, a lack of nutrient absorption, and inflammation.

These symptoms may have a potential impact on the reproductive ability. Even though the exact mechanism between infertility and celiac disease is not yet clear, research has shown that there are reproductive changes that are believed to be caused by untreated celiac disease in men, women, and even pregnant women.⁽⁸⁾ However, at the same time, other studies have suggested that this evidence might not be very strong.

Reproductive changes in the female reproductive system due to untreated celiac disease may include:

• Early menopause⁽⁹⁾
• Delayed onset of menstruation
• No menstruation or amenorrhea⁽¹⁰⁾
• Inability to conceive

During pregnancy, you may experience:

• Premature birth
• Recurrent miscarriage⁽¹¹⁾
• Low birth weight
• Intrauterine growth restriction⁽¹²⁾

Meanwhile, reproductive changes in the male reproductive system may include:

• Reduced sexual activity or drive
• Abnormal sperm motility or ability to swim
• Abnormal sperm morphology, or sperm shape and size

Many studies have shown a correlation between unexplained infertility and celiac disease and pregnancy loss as well.⁽⁶⁾ The reasons for this remain unclear. However, there are many theories as to how they may be connected.

Some experts believe that a system-wide inflammation or problems with nutrient absorption might be to blame. People with celiac disease who do not avoid the consumption of gluten may end up having decreased fertility.⁽¹³⁾ There might even be a relation to nutrient deficiency, inflammation, or the effects of being underweight. Due to these factors, it is essential to rule out celiac disease when doctors investigate the causes of infertility.

One reason that sensitivity, allergy, or celiac disease may lead to infertility is that it causes systemic inflammation. Systemic inflammation means that there are signaling molecules along with other inflammatory markers that are circulating through the body. These inflammatory markers signal the entire body that it is under attack. When this happens, less of the body’s energy starts getting used in non-essential processes, for example, reproduction.⁽¹⁴⁾

Researchers from the Università Cattolica Del Sacro Cuore in Italy have suggested two mechanisms by which celiac disease might affect reproduction. These include autoimmune mechanisms and nutrient deficiencies. In one study, women who followed a gluten-free diet had improved reproduction performance even with celiac disease. On the other hand, though, other studies have not found similar results. Current research does not point to nutrient deficiency being the primary cause of reproductive issues in women with celiac disease.⁽¹⁵⁾

When it comes to autoimmune mechanisms, studies have found that people with celiac disease manufacture anti-transglutaminase (tTG) antibodies that attack the tissue transglutaminase, which is an enzyme that is released from cells during inflammation. In vitro studies have found that these antibodies can bind to the placental cells and reduce invasiveness.^{(16, 17)}

The only treatment available for celiac disease is following a gluten-free diet. By eliminating gluten from your diet, you will be able to decrease the inflammation produced by your immune system in response to gluten. Cutting out gluten will also reduce the potential for the ongoing damage in the small intestine, which is what causes the malabsorption of nutrients.

Following a gluten-free diet once you are diagnosed with celiac disease will help boost your fertility but as part of a larger treatment strategy to treat your infertility and also reduce the chances of miscarriage.

However, it is important to keep in mind that there are many causes of infertility, and sometimes it is possible to have more than one. Even after getting diagnosed with celiac disease, you may still have trouble conceiving or carrying a pregnancy to full term if there are additional underlying issues. These can include:

• Polycystic ovary syndrome (PCOS)^{(18, 19)}
• Advanced maternal or paternal age
• Endometriosis ^{(20, 21)}
• Primary ovarian insufficiency ⁽²²⁾
• Thyroid disease ^{(23, 24)}

In a study carried out in 2000, 845 pregnant women were tested for celiac disease. Out of this, 12 were diagnosed as having the disease. Six of these 12 women went on to have healthy babies after the women followed a strict gluten-free diet for one year. However, there was no external control group used in this study that could have helped with a comparison.⁽²⁵⁾

For this reason, there is no research to show whether eating gluten will impact your pregnancy, but it is best not to eat gluten at all during pregnancy. Or even while you are trying to get pregnant and you know that you have celiac disease. This also includes not doing the gluten challenge. The gluten challenge is a type of diagnostic test that allows the antibodies to build up in the bloodstream. It is designed to diagnose celiac disease in people who are already following a gluten-free diet. The gluten challenge needs you to consume gluten-containing foods every day for at least six to eight weeks. According to the Celiac Disease Foundation, this test should never be carried out during pregnancy.⁽²⁶⁾

Can gluten tolerance or gluten sensitivity cause fertility issues? People who have gluten intolerance or sensitivity also experience similar symptoms to celiac disease. However, since gluten intolerance is not an autoimmune condition, it is unlikely to affect fertility in the same way as celiac disease does. At the same time, there is no evidence that gluten sensitivity or intolerance impacts fertility. However, if you are sensitive to gluten, it is a good idea to avoid gluten for your overall health and comfort.

If you have trouble conceiving or you have experienced more than one miscarriage, seeing a doctor is a good idea. Typically, the rule of thumb is to wait for a year if you are under the age of 35 or six months if you are over 35 years. However, infertility is bound to take an emotional toll when you are going through it. For this reason, it is better to consult a doctor sooner than later, no matter what your age is.

This situation may get further aggravated in people with celiac disease. If you have the symptoms of celiac disease or a family history of the condition, you should first consider seeing a doctor to get tested for celiac disease.

It is essential to keep in mind that even now, more research is required to understand whether celiac disease causes infertility. Different doctors also have different opinions. So if you are concerned that celiac disease could be the cause of your infertility, you should first confirm your diagnosis before attempting to get pregnant.

Celiac disease is an autoimmune condition that may affect your fertility and even the outcome of your pregnancy. There is no cure for celiac disease, and the only treatment is to follow a gluten-free diet. Not eating gluten has been found to help restore fertility. It can also reduce the rate of miscarriage.

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