“It makes sense to screen for celiac disease in women with infertility.” That's the conclusion of a new 2010 study evaluating the impact of celiac disease upon women who are trying to conceive (1). Bravo, finally the link between gluten sensitivity and fertility is beginning to get the recognition it deserves. As studies accumulate on the gluten / infertility connection it will be easier to get tested and more women may have a speedier journey to conception with far fewer miscarriages.
Other studies have come to the same end point, and some have estimated that as many as 8% of women with infertility may also have celiac disease. A similar 2007 study also concluded that “each woman with unexplained infertility should be screened for CD (celiac disease).”(2)
These important studies - and their compelling conclusions - are for many women the key to getting their physicians to test them for celiac disease. Currently, there is no requirement that physicians test for gluten intolerance in women trying to conceive - just as there is no requirement that they test for thyroid antibodies, vitamin D deficiency and other common fertility and IVF saboteurs.
Other studies show that when women have thyroid autoimmune disease the incidence of celiac disease rises sharply to 27%. (3) This study linking celiac and thyroid autoimmunity concluded that;
"...all subjects with TPO should be routinely screened for CD (celiac disease), through EMA, IgA and IgG..."
Other studies on this link between these two diseases have concluded that:
"CD (celiac disease) is significantly increased in patients with thyroid autoimmune disease for this reason it is important to screen for CD in patients with AITDs (auto-immune thyroid disease)." (4)
Similar research has shown that women with endometriosis have more than double the average risk for celiac disease, and that women with other autoimmune diseases also show elevated risk. Women with PCOS and ovarian failure may also want to get tested.
What ever the cause of your infertility, you may want to ask your physician for a celiac disease test. Bear in mind that if you have been carefully avoiding wheat and gluten in your diet for sometime, the test results will not be as accurate as they would be if you were regularly eating gluten. When gluten is withdrawn from your diet, antibody levels drop and the inflamed gut surface can repair itself. It’s best to consistently eat wheat and other gluten containing grains daily (wheat, barley, rye, barley) for some weeks before your test to get a true reading.
Oats also contain gluten but it's a different kind of gluten which seems well-tolerated by some celiacs, so don't rely on oats to trigger your gluten response in the weeks before testing.
Celiac disease is diagnosed through blood work - and confirmed with an endometrial biopsy - although the treatment is the same if one - or both -tests are positive, you have to rigorously cut out gluten in all it’s ubiquitous forms.
In a celiac woman, gluten ingestion triggers an immune response from the intestinal mucosa. This stimulates the production of antibodies to gluten which circulate in the blood and focus and autoimmune attack on the intestine lining which subsequently becomes inflamed and damages the tiny villi that absorb nutrients and fats. This damage renders the gut unable to effectively absorb nutrients and can cause significant shortages in folic acid, iron, vitamin D and other nutrients critical to a fertility and a healthy pregnancy.
Despite having a nutritious diet a celiac woman may absorb inadequate levels of nutrients to support embryonic growth may find it difficult to stay pregnant. Although many studies clearly state the association between recurrent miscarriage and celiac disease, this screening test is rarely offered to women with recurrent loss. One such study concludes that:
"Women having recurrent miscarriage or intrauterine growth retardation could have subclinical coeliac disease, which can be detected by serological screening tests." (5)
The malabsorption problems which occur with celiac disease are known to be a significant cause of anemia which can be a tip off to a hidden celiac problem. Other common signs and symptoms of hidden celiac disease are lack of menstruation and ovulation, weight loss, menstrual irregularities, early menopause, recurrent miscarriage, hair loss, skin and nail problems and infertility. Erratic TSH levels can also be an indicator of celiac disease in women who are taking levothyroxine; TSH irregularities can be triggered by poor absorption of thyroid hormones.
Having a relative with celiac disease or type 1 diabetes is another tip off that celiac disease may be an issue for you.
In pregnancy, the malabsorption of nutrients caused by celiac disease is tightly linked to recurrent miscarriage, fetal growth impairment, low birth weight and premature birth. Also, studies show that a mother's gluten antibodies can attach to the placenta where they may disrupt nutrient transfer to the fetus. (7)
Ironically many celiacs do not have digestive symptoms such as diarrhea and bloating usually associated with celiac disease making it imperative to diagnose with blood work whether or not GI distress is present.
Population studies show that the average incidence of celiac disease in adults in the USA and Europe is at least one in one hundred, but most people with the disease don't know that they have the disorder. The ratio of diagnosed to undiagnosed celiacs is estimated to be 1:8. Some studies, especially those evaluating children and young adults have found an alarmingly higher incidence of one in thirty three persons being affected with celiac disease. (6)
If you are experiencing infertility and/or recurrent loss you may be one of the many undiagnosed celiacs who could benefit from a gluten free fertility diet, ask your physician about getting tested.
Many women have reactions to gluten and feel phenomenally better when they avoid gluten containing grains, despite not being celiacs. There is suspicion that these milder forms of gluten-sensitivity may interfere with infertility too, even when celiac disease is not the issue.
The best way to test for celiac disease is with the following tests.
IgAtTG: Immunoglobulin A (IgA) and tissue transglutaminase (tTG) antibody
IgAEMA: Immunoglobulin A (IgA) and antiendomysial antibody (EMA)
Ask for a test today and find out if your fertility journey could be significantly shortened by a gluten free diet.
This article is purely for educational and informational purposes only and is NOT a substitute for medical diagnosis and nutritional advice for which you should consult a physician or dietitian.
Would you like articles like this delivered to your email weekly? Sign up for the BellaOnline infertility newsletter, it's free, super informative and you can unsubscribe anytime you like. The link is below.
1.Should infertility patients be screened for celiac disease? Gynecol Endocrinol. 2010 Jun 23.
Women and celiac disease: an association with unexplained infertility. Pellicano et al. Minerva med 2007. Jun;98(3):217-9
3.Prevalence of cleiac disease in patients with autoimmune thyroiditis. R Luorio et al. Minerva Endocrinol 2007.Dec;32(4):239-43
Celiac disease in North Italian patients with autoimmune thyroid disease. Spadaccino AC et al. Autoimmunity. 2008 Feb;41(1):116-21
Recurrent spontaneous abortion and intrauterine fetal growth retardation as symptom of coeliac disease. Gasbarrini MD et al. Lancet 365 Issue 9227 29 Jul 2000 p 399-400
Journal of pediatrics Jan 2000 136:86-90
Maternal celiac disease autoantibodies bind directlu to syncytiotrophoblast and inhibit placental tissue transglutaminase activity, Repro Biol Endo 2009. Anjum N et al.