A Link Between Celiac Disease and Infertility

A confusing connection – celiac disease and infertility

Here are some stories about moms who experienced infertility linked to celiac disease.

Lindsey Reimer became pregnant in 2013, however, in 2010 she was diagnosed with celiac disease. Seventeen weeks after becoming pregnant, she lost her baby girl. After that, she had to go through an ectopic pregnancy. You won’t believe it when I tell you that again in 2014, at 17 weeks, she lost another daughter. When asked about her condition with celiac, she admits that she didn’t follow a gluten-free diet.

About celiac disease

For those who may not know, celiac disease is a condition that some people suffer from in regards to foods that contain gluten. Gluten is a protein found in grains like wheat, rye, and barley. For those who have this disease and eat foods that have gluten, the gluten triggers an unnatural immune response. This leads to damage of the small intestine, which could lead to less absorption of nutrients from food.

Some of the celiac symptoms and signs of the disease:

• Unnatural iron deficiency
• Fatigue/bone and joint pain/arthritis
• Osteoporosis or osteopenia
• Increased migraines and seizures
• Anxiety or depression
• Liver problems and issues of the biliary tract
• Irregular menstrual cycles for women
• Peripheral neuropathy
• Canker sores in the mouth
• Diarrhea, gas
• Infertility or miscarriages
• Dermatitis herpetiformis 

With all these problems that the disease brings along, it doesn’t seem to be the best way to enjoy a healthy lifestyle.

Time for a change?

"I had high blood pressure, I was anemic. I wasn't actually gaining weight; I was losing weight,” said Stephanie.

Another example of women who have had major complications during pregnancy would be Mrs. Stephanie Derendinger. We include these different examples to look at this issue from multiple angles.

After noticing all these symptoms, Stephanie decided to go on bed rest (just taking it easy in hopes for lower risks during pregnancy) and eventually gave birth to her son, Logan. The interesting thing was that Logan’s birth weight was low. To Stephanie’s surprise, she was diagnosed with celiac disease just a few months later.

Both Lindsey and Stephanie suspected that there must be something causing this. Two women both diagnosed with celiac disease, both with major complications during their pregnancies.

Lindsey wondered if celiac disease was causing her problems, too, and wanted to try out something new. She decided to follow a gluten-free diet, after doing so she had a successful pregnancy.

Three years later, Stephanie gave birth to both a healthier and heavier baby girl named Brooklyn. It turned out that Stephanie decided to change her diet too. She also asked her doctor if her recent diagnosis of celiac disease was the reason for these complications.

What does the doctor say?

Dr. Olive is someone who regularly tests for celiac disease in women who have unexplained infertility in his clinic. Examining his opinion will bring both clarity and a different angle for looking at this issue.

"As it stands right now, the best available evidence suggests there is a relationship between Celiac disease and unexplained infertility as well as a relationship between Celiac disease and recurrent miscarriage,” said Olive.

Dr. David Olive is a part of the Wisconsin Fertility Institute in Middleton, he explained how a blood protein, in response to and counteracting a specific antigen, or an “antibody” plays a role in this relationship. One particular antibody, called the IgA or Immunoglobulin A, binds to an early developing placenta, which decreases the supply of blood and also doesn’t allow the placenta to correctly position itself in the uterus. When a person with celiac disease goes on a gluten-free diet, this antibody lessens in their system. 

Have any studies been done?

There is always still a reason to question whether this disease really does cause infertility. Dr. Thomas Molinaro also examines celiac in his patients. He is a member of the American Society for Reproductive Medicine. His team at ASRM is currently studying whether or not women who seek help from them have celiac disease.

"That's what sort of prompted the study in the first place, because there was an internal debate in our own group, you know, how many patients have you actually had that tested positive?" said Dr. Molinaro.

IVF is an assisted reproductive technology (ART) and is a procedure to help a woman become fertilized. The process includes combining a sperm sample with an extracted egg in a lab dish. Dr. Molinaro focused his study on seven hundred women who were in the process of IVF treatment. Early results discovered that the presence of celiac in patients was low, only about 1.8%. It also didn’t discover a difference in fertility results between females with celiac and those without it who were undergoing IVF.

"The studies that show a positive link, they're looking at women who have confirmed, biopsy confirmed inflammatory markers in the blood. In that situation, it's very likely Celiac is contributing to infertility in some way."

One final example

The link between celiac and infertility is a tough one to confirm, so it helps to look at the issue from multiple angles. Mrs. Jessica McllHeny is probably both one of the most unique and extreme examples we have, a great model of the complexity of the issue. Coming in as our third mom example has multiple diagnoses, some that link closely with celiac disease including lymphocytic colitis. The interesting thing about Jessica is that she has been on a gluten-free diet for seven years prior to attempting to become pregnant. Even with the proper dieting she still had four miscarriages.

Call to action – what to make of all this?

Dr. Molinaro said he would say the same thing to both a woman with celiac disease and a woman with ulcerative colitis - that is, to become gluten-free before pregnancy treatments. Once a woman has her disease managed as best as possible, then would be a good time to try to get pregnant.

But will treating celiac by dieting actually improve fertility outcomes? Dr. Molinaro and Dr. Olive both agree.

So what’s the bottom line? Well, doctors say if a woman has celiac disease it should definitely be treated before attempting pregnancy. If women are having a hard time becoming pregnant, they might want to get checked for celiac disease. Sometimes, celiac shows signs and symptoms, but sometimes it doesn't. If a woman is showing some signals, then there is no reason not to be checked for the disease. Seek help from your doctor, and remember, that while celiac disease could be a factor, there are many other causes of infertility as well.