Celiac Disease: An Underlooked Cause of ‘Unexplained Infertility’
Getting a diagnosis of ‘unexplained infertility’ is an extremely frustrating and unfortunately common experience. It’s estimated that between 15-30% of those experiencing infertility have been told it is unexplained. Technically, ‘unexplained infertility’ should only be diagnosed once all causes have been ruled out and thorough testing and imaging has been done. Unfortunately, in my practice, I have many patients who are given the diagnosis of ‘unexplained infertility’ after only basic hormonal testing.
There are many potential causes of ‘unexplained infertility’ that need to be ruled out before patients are given this diagnosis. One of the causes that are very rarely discussed or investigated is celiac disease.
What Is Celiac Disease?
Celiac disease is a chronic autoimmune disorder that is triggered by gluten, the protein that is found in wheat, barley, and rye. The ingestion of gluten in those with celiac disease leads to destruction and damage to the small intestine.
Classic celiac disease symptoms include diarrhea, gas and bloating, fatigue, vomiting and nausea. Interestingly, a growing body of research indicates that some individuals have ‘silent celiac disease’ with no obvious symptoms so these individuals can go years or even a lifetime without being diagnosed.
Undiagnosed celiac disease can impact reproductive health in multiple ways. Research has found that undiagnosed celiac disease can cause a late onset of the first period, loss of menstrual cycles (amenorrhea), early menopause and infertility. Undiagnosed celiac disease has also been found to impact healthy pregnancy and birth outcomes and can lead to low-birth-weight babies, preterm labour, and even impact breast feeding.
Celiac Disease & Unexplained Fertility
Multiple studies have found that the incidence of celiac disease is higher in individuals and couples who have been given a diagnosis of ‘unexplained infertility’. The rate of celiac disease in the general population is about 1%, while the rate of celiac disease in those with ‘unexplained infertility’ is estimated to be between 2-6%.
Because of the higher prevalence of celiac disease in patients with ‘unexplained infertility’ many scientists suggest that patients who have both the diagnosis of ‘unexplained infertility’ and any digestive complaints or relevant history, should be screened for celiac disease. Some researchers even suggest screening all patients with ‘unexplained infertility’ whether they have digestive symptoms or not based on the research and the presence of silent celiac disease.
Why celiac disease can impact fertility is still being investigated but the malabsorption of important nutrients like folic acid, zinc, selenium, and iron is likely playing a role. Other studies suggest that untreated celiac disease could impact healthy implantation in the uterus, and may even cause damage to the forming placenta.
Testing for Celiac Disease
The first step in screening for celiac disease is a blood test to look for the presence of celiac antibodies known as anti-tissue translutaminase (tTG) and anti-endomysial antibodies (EMA). These blood tests are highly sensitive and specific for the disease. If elevated antibodies are found, patients are then typically referred to a gastroenterologist for further evaluation with endoscopy and official diagnosis.
Looking For More Fertility Support?
Understanding how to optimize your fertility, reduce miscarriage risk and support yourself for the healthiest pregnancy and postpartum period is incredibly important! Naturopathic medicine has many tools that can support you along your fertility journey. You can read more about our fertility approach here, and reach out to the clinic if you have any questions!
References:
Tersigni, C., Castellani, R., de Waure, C., Fattorossi, A., De Spirito, M., & Gasbarrini, A. et al. (2014). Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Human Reproduction Update, 20(4), 582-593. doi: 10.1093/humupd/dmu007
Singh, P., Arora, S., Lal, S., Strand, T., & Makharia, G. (2016). Celiac Disease in Women With Infertility. Journal Of Clinical Gastroenterology, 50(1), 33-39. doi: 10.1097/mcg.0000000000000285
Pellicano R, Astegiano M, Bruno M, Fagoonee S, Rizzetto M. Women and celiac disease: association with unexplained infertility. Minerva Med. 2007 Jun;98(3):217-9. PMID: 17592443.
Choi JM, Lebwohl B, Wang J, Lee SK, Murray JA, Sauer MV, Green PH. Increased prevalence of celiac disease in patients with unexplained infertility in the United States. J Reprod Med. 2011 May-Jun;56(5-6):199-203. PMID: 21682114; PMCID: PMC3122153.
Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, Scambia G, Di Simone N. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Hum Reprod Update. 2014 Jul-Aug;20(4):582-93. doi: 10.1093/humupd/dmu007. Epub 2014 Mar 11. PMID: 24619876.