Celiac Disease and Infertility

One in eight couples faces infertility, according to RESOLVE, the National Infertility Association. Infertility can be caused by a number of hormonal or anatomical problems in either partner, but in 20 percent of infertility cases, there’s no identifiable cause. Recent studies indicate that women with unexplained infertility may actually have celiac disease, which could be hampering their attempts to conceive. In some of these cases, when the women switched to strict gluten-free diets, they conceived and had healthy, successful pregnancies. Almost 6 percent of women with unexplained infertility had celiac disease—a rate nearly six times higher than expected, per a recent study from the Celiac Disease Center at Columbia University.

Alicia Woodward, editor of LivingWithout magazine, shared her expertise on celiac disease and infertility with The Healthy Moms Magazine recently.

What are the common symptoms of celiac disease?

Celiac disease is a genetic autoimmune disorder that occurs when the body reacts abnormally to gluten, a protein found in wheat, rye and barley. It affects about 1 in 133 people, an estimated 3 million Americans. Approximately 85 percent of these are thought to be undiagnosed.

When someone with celiac disease eat foods that contain gluten, an immune-mediated reaction causes damage to the small intestine, as well as to other systems in the body. Celiac disease is a lifelong condition that cannot be outgrown. Often present without obvious symptoms, it continues to “silently” cause intestinal damage if left untreated by the gluten-free diet.

Symptoms of celiac disease vary widely from person to person. They may occur in the digestive system or in other parts of the body. It’s possible that symptoms may only be recognized in hindsight or, again, that there may be no symptoms at all.

Symptoms may include classic gastrointestinal distress, such as diarrhea, cramping and bloating, as well as non-gastrointestinal signs such as short stature, anemia and liver problems. Over a lifespan, symptoms tend to shift from primarily gastrointestinal in children (diarrhea and/or constipation, bloating, pain, weight loss, vomiting) to fatigue, anemia, arthritis, depression, anxiety and numbness/tingling in the fingers and toes in adults.

Left untreated, those with celiac disease are more likely to be afflicted with problems relating to inflammation, mal-absorption and malnutrition, including osteoporosis, tooth enamel defects, central and peripheral nervous system disease, pancreatic disease, seizures, organ disorders (gall bladder, liver and spleen) and gynecological disorders, including infertility.

When researchers at the Celiac Disease Center at Columbia University screened 188 women with infertility for celiac, there was no higher risk of the disease until they narrowed it to just those with unexplained infertility. Of that group, almost 6 percent had celiac disease—a rate nearly six times higher than expected.

Some studies suggest that the following reproductive disorders may be linked to untreated celiac disease:

Late puberty
Absence of menstruation
Early menopause
Endometriosis
Miscarriage
Stillbirth
Intrauterine growth restriction
Low birth-weight babies
Cesarean section

What should you do if you suspect that you may have celiac disease?

Consult with your doctor and request a celiac blood panel to screen for the disease. The current “gold standard” for confirming a celiac diagnosis is via a biopsy of the small intestine, obtained through an endoscopy.

How can celiac disease impact a woman's fertility?

Mal-absorption (resulting in malnourishment) probably isn’t the only mechanism behind celiac-induced infertility. One recent study suggests there’s something about the celiac process itself that may directly affect one’s ability to carry through a pregnancy. The study showed antibodies to tissue transglutaminase—one of the key markers of celiac--can have a negative effect on the placenta’s development.

A higher rate of miscarriage, stillbirth and fetal growth problems like intrauterine growth restriction has been well documented in women with undiagnosed celiac disease. Treatment with the gluten-free diet seems to reduce these risks.

If you have celiac disease and you are trying to have a baby, what steps should you take in order to have a healthy pregnancy?

Strictly adhere to the gluten-free diet!

Then work closely with your doctor and follow all medical guidelines for a healthy pregnancy. If you’re newly diagnosed with celiac disease, it’s best to wait six months to a year--eating strictly gluten free and getting all celiac symptoms well under control--before attempting to conceive. But, again, check with your doctor about what is best for you individually.

Do you have any other tips for women with celiac disease and Infertility problems?

Again, the best advice is to maintain a strict gluten-free diet—

absolutely no cheating--and to work closely with your doctor. After that, everything else is routine. For great gluten-free recipes, tips and advice, check out Living Without.

One final (and important) thought:

Before starting a gluten-free diet, celiac experts strongly recommend testing for celiac disease. Going gluten free before getting tested will affect the accuracy of test results.

Alicia Woodward is editor of

Living Without, the nation’s leading magazine for people with food allergies and sensitivities. She is also a licensed psychotherapist, specializing in the psychological and social aspects of celiac disease and food allergies and sensitivities. For more about traveling and dining out with special dietary needs, go to LivingWithout.com.

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