June 5, 2013

Is There a Link Between Celiac Disease and Reproduction?

Gluten Free Pregnancy

Celiac disease is not new. However, in recent years, it has gained more awareness in the public eye. It is a chronic disease whose cause is intolerance to ingested gluten. This intolerance causes an immune-initiated inflammatory response in the small intestine. In turn, this constant inflammation causes damage to the delicate lining of the intestines. The classic presentation of the disease is malabsorptive syndrome; it manifests in gastrointestinal distress and diarrhea. Is there a link between celiac disease and reproduction? Well, this immune-related response also may have a negative effect on reproductive potential and pregnancy.

It often affects women during their most fertile years. The latent disease has been associated with infertility, premature ovarian insufficiency, miscarriage and fetal growth restrictions. However, a causal effect of celiac disease on reproductive function remains elusive; and thus, controversial.

Unexplained infertility, which may account for up to 30% of infertility cases, is an enigma. Unexplained is defined as infertility in the absence of any identifiable cause. With the prevalence of celiac disease up to 1-2% of the population, it is plausible that latent celiac disease may account for a percentage of these unexplained infertility cases. Thus, a molecular mechanism would be culprit.

Supporting an association is a cross-sectional study that looked at the prevalence of markers of celiac disease in women with infertility. In these women, the presence of overt celiac disease (celiac disease blood-markers and abnormal intestinal biopsies) was 1%. Those women with latent celiac disease (blood markers only) had a prevalence of 3%. Interestingly, the subgroup of women deemed previously to have unexplained infertility demonstrated a 10% prevalence of latent celiac disease.

This example is one of many suggesting an association between infertility and celiac disease. Further studies are required and ongoing to define the need for routine blood-marker testing for celiac disease in those women diagnosed with unexplained infertility. Additionally, if the association is validated, the underlying link between infertility and inactive celiac disease remains to be defined.

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Danielle Vitiello, Ph.D., M.D.

Danielle Vitiello, Ph.D., M.D. Board-Certified in Obstetrics and Gynecology, Reproductive Endocrinology and Infertility