Undiagnosed or untreated celiac disease can lead to a host of seemingly unrelated problems, including osteoporosis, depression and anemia. Now medical researchers - along with some observant obstetrician-gynecologists - are realizing that undiagnosed celiac disease also may be a major cause of otherwise unexplained infertility in both men and women.
Infertility in Celiac Disease May Be Linked to Malnutrition, Malabsorption
Many doctors define infertility as the inability to get pregnant after one year of unprotected sex. In women, fertility difficulties often result from a problem with ovulation, while in men, infertility usually occurs because the man doesn't produce enough sperm, or produces abnormal sperm.
It's not clear why more people with undiagnosed or untreated celiac disease suffer from infertility. It's possible that malnutrition resulting from malabsorption of nutrients in your food may be to blame, or there may be some yet-undiscovered reason.
Several Studies Find High Rates of Infertility in Women with Celiac Disease
Medical studies have found celiac disease rates of about 4% in women with unexplained infertility. In one study, which found four cases of celiac disease in a group of 98 women with unexplained infertility, none of the celiac women had extensive malabsorption, but two suffered from iron deficiency anemia.
Another study looked at the rate of children born to patients with celiac disease compared to children born to control subjects. It found that women with celiac disease had significantly fewer children prior to diagnosis - 1.9 children, on average, compared to 2.5 children in controls. After the women were diagnosed with celiac disease, the difference began to even out. The researchers concluded that celiac disease caused the difference in fertility prior to diagnosis, while the gluten-free diet corrected it following diagnosis.
Fewer medical studies have been conducted looking for male reproductive issues in celiac disease. However, Italian researchers have noted that male celiac disease patients have a greater risk of infertility and other reproductive issues, as well as a greater incidence of androgen (male hormone) deficiency.
Women with Celiac Disease Frequently Suffer from Menstrual Abnormalities
In women with celiac disease, menstrual disorders are commonplace, suggesting some potential reasons for infertility.
For example, in another Italian study, nearly 20% of the celiac women had amenorrhea, or missed menstrual periods. Only 2.2% of the control subjects suffered from amenorrhea.
Meanwhile, pregnancy complications such as threatened miscarriage, pregnancy-related hypertension, severe anemia and intrauterine growth retardation occurred four times more often in women with celiac disease.
Consider Celiac Disease Screening if You Have Unexplained Infertility
Many researchers and clinicians now recommend that you be screened for celiac disease if you have unexplained infertility - especially if you have any of the classic celiac disease symptoms or risk factors.
However, many of the women diagnosed in these infertility studies had subtle symptoms of celiac disease or even so-called "clinically silent" celiac disease, in which they had no apparent symptoms. So you shouldn't rely on your symptoms to determine your risk for the condition.
If you're infertile and you have celiac disease, there's hope: many previously infertile women were able to conceive successfully after being diagnosed with celiac disease and adopting the gluten-free diet.
P. Collin et al. Infertility and coeliac disease. Gut. 1996;39:382-384. http://gut.bmj.com/content/39/3/382.abstract
Infertility and Celiac Disease. National Foundation for Celiac Awareness. Accessed Oct. 6, 2010.
K.S. Sher et al. Female fertility, obstetric and gynaecological history in celiac disease. A case control study. Digestion. 1994;55(4):243-6. http://www.ncbi.nlm.nih.gov/pubmed/8063029
A.V. Stazi et al. [Celiac Disease and its endocrine and nutritional implications on male reproduction]. Minerva Med. 2004. Jun;95(3):243-54. http://www.ncbi.nlm.nih.gov/pubmed/15289752