Women with celiac disease present with fertility problems no more often than women in the general population, according to a new study in Gastroenterology1, the official journal of the American Gastroenterological Association.
"Despite inconsistent findings from small studies, concern has been raised that celiac disease may cause infertility," said lead study author Nafeesa N. Dhalwani, PhD, from the University of Nottingham, United Kingdom. "Celiac patients should rest assured; our findings indicate that women with celiac disease do not report fertility problems more often than women without celiac disease."
Researchers conducted a large population-based cohort study, analyzing more than 2 million women of childbearing age in the United Kingdom, to compare the rates of new clinically recorded fertility problems in groups of women with and without celiac disease. The findings show women with celiac disease do not have a greater likelihood of fertility problems, either before or after diagnosis of celiac disease.
However, rates of infertility were 41 percent higher among women diagnosed with celiac disease when they were 25-29 years old, compared to women in the same age group without the disease. Dr. Dhalwani provides guidance on these findings: "It is important to recognize that this represented only a very small increase in the number of women consulting with fertility problems -- if we followed women between ages 25-29 years over a one-year period, presentation with fertility problems would occur in one of every 100 women without celiac disease, but in 1.5 of every 100 women with celiac disease. The fact that this increase was not seen in women of the same age with undiagnosed celiac disease indicates that it is unlikely to represent a biological impact of the condition on fertility. It may instead be related to heightened concern that may prompt earlier consultation if women experience delays in conception. This does, however, warrant further assessment."
While undiagnosed celiac disease is likely to be an underlying cause of unexplained infertility for some women, these findings indicate that most women with celiac disease, either undiagnosed or diagnosed, do not have a substantially greater likelihood of clinically recorded fertility problems than women without celiac. Therefore, screening when women initially present with fertility problems may not identify a significant number of women with celiac disease, beyond the general population prevalence.
Previous studies associating infertility with celiac disease included small numbers of women attending infertility specialist services and subsequently screened for celiac disease, so they may not be representative of the general population. This is the largest study to assess the association between celiac disease and fertility problems to date with data on more than 2 million women over a period of 20 years.
Celiac disease affects about 1 percent of the population in North America and Western Europe, with women constituting about 60 to 70 percent of the clinically diagnosed population. Celiac disease is an autoimmune condition which can result in intestinal malabsorption and prevents the body from collecting nutrients as food passes through the small intestine. The primary treatment for celiac disease is the strict following of a gluten-free diet.