Celiac disease is a hereditary, chronic immune-mediated, inflammatory disorder of the small intestine. It is caused by an intolerance to gluten and glutenin proteins in the grains wheat, barley and rye. The only treatment is to adhere to a strict gluten-free diet. Research has found a link between many cases of infertility and celiac disease. Celiac disease afflicts 1% of the human population and it is estimated that 3 million Americans have celiac, but that 95% of them remain undiagnosed. Celiac is considered one of the most underdiagnosed autoimmune diseases. Research has also shown that women with unexplained infertility have a 2.5 to 3.5 times greater incidence of celiac disease than women with normal fertility.

How Celiac Disease Impacts Reproductive Health

Because celiac is an autoimmune disease that impacts the small intestine, there are a wide range of health issues stemmed from the disease that may negatively impact reproductive health. Women and men with celiac disease carry a greater risk for thyroid disease, malnutrition, hormone imbalances, poor egg health, poor sperm health, low sperm count and atrophy of the reproductive organs. Women with celiac also are at higher risk for late onset of menarche, early menopause, endometriosis and pregnancy complications including recurrent miscarriage, stillbirth and poor fetal development known as intrauterine growth retardation (IUGR) .

Nutritional Deficiency

As discussed before, celiac disease is caused by an intolerance to gluten and glutenin proteins in the grains wheat, barley and rye. These grains are used in a variety of common foods eaten around the world daily. More than any other grain, wheat is used as an additive in many food products and medications.

When a person with celiac consumes anything that contains gluten, a cascade of inflammatory response in the body occurs, but primarily in the the mucosa of the small intestine. The elevated immune response increases T lymphocytes, natural killer (NK) cells, neutrophils, eosinophils, macrophages and mast cells. The only treatment is to adhere to a strict, permanent gluten-free diet (GFD). Some studies have shown that even when celiac has been in complete remission for years, recruitment of activated neutrophils (most common type of white blood cell) may be present. Basically this means that inflammatory response is still elevated, which may continue to cause health problems within the body.

Damage to the small intestine from celiac may be widespread or mild depending on the person afflicted. Regardless of the extent of damage, celiac is damaging to the digestive system. Ingestion of gluten triggers an inflammatory cascade within hours. Chronic damage to the mucosal lining compromises the barrier of the wall of the small intestine, including the villi. Nutrients from food are absorbed by the villi. Over time the villi become so damaged, they no longer work properly. This creates a situation where the body is not able to receive nutrients from food, resulting in malnutrition. Poor function of the pituitary gland and atrophy of the reproductive organs are associated with malnutrition.

Proper absorption and assimilation of nutrients play a very important role not only in overall health, but the health of the developing baby during pregnancy.

Nutrient Deficiencies Caused By Celiac Disease Negatively Impacts Fertility

The following nutrients have been shown to be deficient in celiac patients:

Protein is almost completely absorbed by the small intestine. The human body requires protein for energy and are required for building and repair of the body’s tissues. This includes a growing baby in its mother’s womb. The amino acids that make up protein are the building blocks of the body’s cells, including those of a growing fetus.

Vitamin A is required for development of the retina and vision, gene transcription, immune system function, reproductive health, embryonic development, skin and cell health, and antioxidant activity. For men the key roles for vitamin A and reproductive health are testosterone secretion and spermatogenesis.

Vitamin D plays a vital role in proper bone formation, proliferation and differentiation of cells, neuromuscular function and inflammation response. Low levels of vitamin D have been linked to ovulatory dysfunction, PCOS and infertility. Low levels of vitamin D may also be linked to altered immune system response giving rise to autoimmune disease and recurrent miscarriage to to immunological response.

Vitamin E is essential for reproductive health. Without it the body cannot reproduce. Vitamin E supports fertility for both men and women in a variety of way, so many I cannot include them all. Click here to learn how vitamin E benefits fertility…

Vitamin K is vital to the health of a developing fetus. Without adequate levels of vitamin K a fetus may be born with deformities, including that of spinal column, upper jaw and nose and nasal cavity.

Hypoprothrombinemia is a well-known complication of celiac disease. Hypoprothrombinemia is a blood disorder resulting in delayed blood clotting. Prolonged prothrombin (blood clotting) time has been reported in 18.5% of adults and 25.6% in children diagnosed with celiac. This is of great concern for pregnant mothers with undiagnosed celiac because this increases the risk of miscarriage and postpartum hemorrhage. Vitamin K is also essential for proper blood clotting in a newborn baby, this is why it is typically given directly after birth.

Other nutrients celiac patients have been shown to be deficient in that impact fertility include selenium, folate, iron and zinc. Each of these play an important role in reproductive function in both men and women. Without these key nutrients, fertility is lowered. Low levels of folate are firmly tied to the development of neural tube defect in a developing fetus.

Increased Risk for Autoimmune Thyroid Disease

30% – 43% of celiac patients present with thyroid disorders. The prevalence of thyroid antibody positivity was four times higher in celiac disease patients than controls. During the first trimester of pregnancy, women with an increase in thyroid autoimmunity are significantly more likely to miscarry.

Late Menarche, Amenorrhea & Early Menopause

Studies show a potential link between celiac disease and it’s impact on the menstrual cycle. Women with celiac disease who did not eat a gluten-free diet were found to have their first menstrual period 1.5 years later than women who ate gluten-free diets. The delay was increased with increased malnutrition.

Women with untreated celiac disease were shown to go through menopause five years before those women who ate a gluten-free diet.

Secondary amenorrhea (lack of a menstrual period for more than 3 consecutive months) was found in 39% of those women with untreated celiac disease, compared to only 9% in those on gluten-free diets.

Delayed menstruation, early onset menopause and secondary amenorrhea may be an indication for celiac disease testing.

Recurrent Miscarriage, Stillbirth and Intrauterine Growth Retardation

An Italian study in 2000 showed that pregnancies of women with celiac disease commonly had unfavorable outcomes. The Italian study included 845 pregnant women. Each of these women were screened for celiac disease, 12 of them tested positive. Of the 12 pregnancies, 7 had unfavorable outcomes. There were 3 deaths, 5 premature births and 3 low birth weight babies. The good news that comes out of this study is that half of these twelve women went on to have six successful pregnancies after six months of following a gluten-free diet.

Two other studies showed a higher incidence in miscarriage, stillbirths, low birth weight and shorter breastfeeding time in mothers with celiac who did not follow a GFD. Again, rates of healthy pregnancies and babies increased for those same mothers once they adhered to a strict GFD.

Several other studies show that women with untreated celiac disease have a much higher incidence of babies with Intrauterine Growth Retardation (IUGR). IUGR is defined as a poorly growing fetus. Babies with IUGR weigh less than one tenth percentile for their gestational age. IUGR may adversely affect the health of the baby including decreased oxygen levels, poor suckling, difficulties handling labor and delivery, trouble maintaining body temperature and abnormally high red blood count. This may lead to long-term developmental problems for the child. Other causes of IUGR include smoking cigarettes, drinking alcohol in pregnancy, high blood pressure, heart disease, some infections and sickle cell anemia. Mothers that have no other history of those issues, yet have a history of IUGR and recurrent miscarriage, should consider testing for celiac disease.

There is a strong correlation between malnutrition, lower body fat, increased immune response, recurrent miscarriage, IUGR and stillbirth among untreated women with celiac disease.

The risk for a low birth weight baby with a father with untreated celiac is 5 times higher than the general population. This leads us to our next section on how celiac disease impacts sperm health in men.

Low Sperm Count and Health

Celiac disease is more prevalent in women than men, but for those men with celiac disease negative reproductive health risks are a concern. Studies have shown a higher incidence of tissue resistance to androgens, mainly testosterone. This increases follicle stimulating hormone (FSH) and prolactin levels in men, which may lead to hypogonadism. Hypogonadism is a condition in which the body doesn’t produce enough testosterone. Androgens and the correct levels of FSH are required for spermatogenesis (the creation of sperm). Low levels of androgens combined with higher levels of FSH and prolactin in men may lead to a great reduction in sperm production. Combine the poor nutritional status of those with untreated celiac disease with lowered endocrine function leading to hormone imbalance and sperm health greatly declines.

One study showed that approximately 19% of males with celiac disease were infertile. The good news here is that in most cases once a GFD is established, testosterone levels increased, hormone levels across the board normalized and semen quality improved. Men with untreated celiac disease, whose female partners had been diagnosed with unexplained infertility, were shown to go on to have successful pregnancies after the male partner removed gluten from their diet.

Elevated Levels of Prolactin

Both men and women with celiac disease have been shown to have higher levels of prolactin. As shown above, this impacts male fertility by contributing to lower sperm count and health. In women, elevated prolactin levels are known as hyperprolactinemia. Higher levels of prolactin may disrupt ovulation and cause breast milk production in the absence of pregnancy.

Endometriosis

Some studies have shown that sensitivity to dietary wheat and gluten is linked to making endometriosis pain worse. Doctors aren’t sure why, but in a 2009 study of 120 women with endometriosis tested positive for markers that signal the possibility of celiac disease. Of those 9 women, 4 agreed to intestinal biopsy to confirm celiac disease, all 4 tested positive. Researchers concluded that celiac disease appears to be common in women with endometriosis.

Closing Thoughts

If you have been struggling to get pregnant and the information in this article sounds familiar, or you have been diagnosed with unexplained infertility, consider getting testing for celiac disease. Testing for markers that indicate celiac disease is only a few hundred dollars. If these tests come back conclusive, then an intestinal biopsy or endoscopy may be suggested to confirm celiac disease and determine the extent of damage to the small intestine.

I don’t suggest following a gluten-free diet unless you absolutely need to. You may be wondering why. This is because not only is wheat, barley and rye very nutrient dense, but those grains are in most foods at your local supermarket. In fact wheat is in most processed foods. If you don’t believe me, take a look at the labels of your favorite food items. What’s more troubling with label reading is that if a food is prepared or fermented in wheat, wheat isn’t going to be listed on the label. For example white vinegar is processed with wheat, so it is not gluten free. Almost all condiments contain white vinegar; ketchup, mustard, salad dressings, etc. Look for labels that say gluten free.

Couples who are trying to conceive and suspect, or have been diagnosed with celiac disease should follow a strict gluten-free diet. As a person who has been gluten-free for almost 3 years now, I am very familiar with just how tough the transition to gluten-free can be. I find that many options for processed gluten-free foods may be just as unhealthy as other processed foods and this is why I highly recommend eating a modified Fertility Diet. Those couples embracing a gluten-free lifestyle can still eat a Fertility Diet, they just need to also avoid gluten. The easiest way to do this is to eat whole foods, avoid processed foods and make foods from scratch. Many other nutrient dense grains are gluten free such as millet, brown rice, buckwheat and quinoa.

Celiac disease testing is NOT part of the typical fertility testing that fertility specialists perform, it must be requested. The numerous studies linking celiac disease to lowered fertility should give doctors a clear signal the celiac disease testing should be preformed for couples with unexplained infertility. Sadly it is not a routine screening, but more and more information on celiac disease is coming out, forcing it into the health spotlight. Gluten-free living is not a trend, it is a necessity for a major health concern. Gluten-free foods are now widely available at most food markets.

References:
1. Bast, Alice; O’Bryan, Tom; Bast, Elizabeth. Celiac Disease and Reproductive Health. Practical Gastroenterology, October 2009. BastArticle.pdf
2. http://www.celiac.com/articles/22602/1/Untangling-the-Relationship-Between-Celiac-Disease-and-Infertility/Page1.html
3. http://natural-fertility-info.com/fertility-vitamin-d.html
4. Aguiar F.M., et. al. (2009). “Serological testing for celiac disease in women with endometriosis. A pilot study”. Clin. Exp. Obstet. Gynecol. 36 (1), 23-25. Retrieved online from: http://europepmc.org/abstract/med/19400413
5. http://www.webmd.com/baby/iugr-intrauterine-growth-restriction