Overview

Coeliac disease is a chronic immune disorder that affects the body’s ability to digest gluten, causing damage to the small intestine.¹ Coeliac disease is triggered by eating foods that contain gluten. Gluten is found in foods that contain wheat, barley, or rye, which are the main ingredients in bread, biscuits, pasta, and cake. It can also be found in household products like toothpaste, lipstick and balms. 

There can be complications associated with untreated coeliac disease. One of these complications can be infertility. In most cases, symptoms and complications can be averted through the adoption of a gluten-free diet. In this article, we will examine the mechanism of coeliac disease, its symptoms, treatment and association with infertility. 

What are the symptoms of coeliac disease?

You should get tested for celiac disease if you experience any of these symptoms regularly:

• Recurring digestive issues such as diarrhoea, constipation, stomach pain, and bloating
• Vitamin B12 deficiency
• Iron deficiency
• Prolonged tiredness
• Autoimmune thyroid disease
• Type 1 Diabetes
• Irritable bowel syndrome
• Close family history of coeliac disease

Diagnosis of coeliac disease

Diagnosis of coeliac disease is typically done by a blood test and it is recommended that you DO eat gluten as you undergo diagnosis to make sure that coeliac disease antibodies will be present in your blood during testing. If your blood test comes back positive, your GP or health provider may refer you to a specialist doctor for further blood tests or a biopsy of your small intestine to take samples that are then examined for coeliac disease.

The diagnosis of celiac disease is very important in maintaining your health and well-being, as you may risk damage to your small intestine by continued consumption of gluten-rich foods.

When diagnosed, your healthcare provider will talk through what you can and cannot eat, and what possible lifestyle changes you may need to make. They may recommend further tests to check the levels of vitamins and minerals in your blood, such as iron as a deficiency may have occurred due to the malabsorption caused by eating gluten.

What is infertility? 

Infertility is the inability to get pregnant after 12 months or longer after having regular, unprotected sex. Infertility can affect both genders. In order to achieve pregnancy there are multiple steps that must happen and including:

• An egg must be released from one of the ovaries
• The egg must be fertilised by sperm
• The fertilised egg must then move through the fallopian tubes and into the womb
• The fertilised egg must attach (implant) inside the womb

Any problems achieving these steps can be a cause of infertility.

Prevalence of infertility

Around 9 to 15% of couples will experience infertility whilst trying to get pregnant.² In a study by the World Health Organisation, it was found that in 37% of infertile couples, female infertility was the leading cause, whilst, in 35% of couples, infertility was caused by both the male and females and infertility in 8% of couples was found to be caused by the male.³

What causes infertility?

Infertility can be caused by a variety of disorders, deficiencies, and structural anomalies in the reproductive organs of both men and women. The most common cause of female infertility is ovulatory disorders, affecting 25% of couples. Ovulatory disorders⁴ can be categorised into three main groups:

• Group 1 is caused by hypothalamic-pituitary failure (the inability to make hormones) and can be found in 10% of infertile people assigned female at birth (PABA). Group 1 ovulatory disorders include hypothalamic amenorrhea, a condition that causes lost periods and is brought on by low body weight and excessive exercise, and hypogonadotropic hypogonadism where the body does not produce sex hormones⁵ 
• Group 2 affects 85% of infertile paba and is most commonly represented as polycystic ovary syndrome (PCOS)
• Group 3 is due to ovarian failure and is only found in 4-5% of infertile paba

It is thought that certain chronic diseases can be a cause of ovulatory disorders.⁶

What is the connection between coeliac disease and infertility?

One study discovered that 6.25% of paba diagnosed with coeliac disease were struggling with infertility for seemingly unknown reasons.⁷ It has been found that there are connections between coeliac disease and amenorrhea, related to infertility, due to coeliac disease being associated with poor absorption of nutrients and a low caloric intake.⁸

Can coeliac disease-related infertility be managed?

Adopting a gluten-free diet can reverse the fertility problems caused by coeliac disease.⁹ However it is important to visit your GP or healthcare provider to rule out other causes 

Summary

Coeliac disease is an autoimmune disease where your immune system will attack the small intestine if you eat gluten-rich foods, like bread and pasta, causing your body to be unable to properly digest and absorb nutrients. Infertility can be a symptom of coeliac disease but can be almost completely cured by eating a gluten-free diet as long as it is the sole reason for your infertility. It is important to visit your GP or healthcare provider for testing and diagnosis if you think you may have coeliac disease, as you risk damage to your small intestine if left untreated.