Celiac disease is an autoimmune disorder caused by an intolerance to the gluten in wheat and other cereals such as barley, rye and oats.
People with celiac disease have inflammatory reactions in the mucosa of the small intestine in the presence of gluten, which hinders digestion and absorption of nutrients.
As a consequence, gluten intolerance can lead to other diseases such as infertility. Both men and women who are unaware that they have celiac disease may have problems conceiving and, in the case of women, may have repeated miscarriages
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What is celiac disease?
Celiac disease is the most severe form of gluten intolerance and one of the most common intestinal disorders, although many sufferers are unaware of it.
Gluten intolerance is characterized by provoking an immune response in the small intestine after consuming foods containing this protein and triggering an inflammatory process that damages the intestinal villi.
The short and long term consequences are poor absorption of nutrients and, therefore, the appearance of pathologies such as osteoporosis due to lack of calcium, anemia due to lack of iron, etc., as well as diarrhea and abdominal pain.
Types
Thanks to the latest research on celiac disease, it has been discovered that the following types of celiac disease may exist according to the appearance of symptoms:
- Symptomatic celiac disease
- is the most common type with well-defined symptoms.
- Subclinical celiac disease
- those affected have no symptoms, but diagnostic tests give a positive result.
- Latent celiac disease
- gluten intolerance appears only on certain occasions.
The causes of celiac disease are currently unknown, but it is known that there is a genetic predisposition that can be inherited. This means that children of celiac parents will be more likely to manifest gluten intolerance.
What symptoms does celiac disease cause?
The most common symptoms of people who are gluten intolerant and that may make them suspect a possible celiac disease are the following:
- Diarrhea
- Swelling of the abdomen
- Abdominal pain.
- Skin rashes.
- Weight loss.
- Nausea.
- Fatigue
However, the lack of nutrient absorption can lead to other less frequent manifestations, including fertility alterations and obstetric problems. In addition, many adults with celiac disease also have joint pain, decreased spleen function and osteoporosis, among other clinical manifestations.
In children, celiac disease often results in pale, foul-smelling stools, as well as damage to tooth enamel, irritability and short stature.
How is celiac disease diagnosed?
Celiac disease can occur at any time of life, i.e. from infancy to adulthood. While a few years ago celiac disease was hardly talked about, nowadays more and more cases of people with gluten intolerance and the implications this has on health are becoming known. Even so, the vast majority of people with celiac disease have not yet been diagnosed.
In a first study of celiac disease, it is simply necessary to do a blood test to detect anti-gliadin, anti-endomysial and anti-transglutaminase antibodies.
In relation to patients who come to an assisted reproduction center because they present fertility problems, tests for celiac disease are not included in the basic study of sterility. This results in about 6% of patients who actually have celiac disease being diagnosed with sterility of unknown origin.
Infertility due to celiac disease
Uncontrolled celiac disease causes alterations in fertility and problems in achieving a full-term pregnancy.
For this reason, all women or couples diagnosed with infertility without apparent cause should be tested for celiac disease, as simply eliminating gluten from the diet can solve many of these problems.
Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.
Below, we will describe the reproductive and fertility-related alterations in women and men that could indicate a possible gluten intolerance.
Gynecological alterations
Depending on the age at which celiac disease begins to manifest itself, a woman may have the following fertility-related symptoms:
- Late menarche (first menstruation).
- Irregular menstrual cycles
- Amenorrhea (absence of menstruation).
- Chronic pelvic pain.
- Early menopause.
- Endometriosis
- Polycystic ovary syndrome (PCOS)
- Difficulty getting pregnant.
The nutrients that the woman cannot absorb due to celiac disease (iron, zinc, vitamin B12, etc.) are important for the implantation of the embryo, hence the problems in conceiving.
In addition, oral nutritional supplements are also of no use to these women, as they cannot be absorbed due to damage to the intestinal wall.
Pregnancy with celiac disease
Women with uncontrolled celiac disease who manage to become pregnant also have an increased risk of obstetric problems.
The antibodies released in response to gluten damage the trophoblastic tissue of the placenta, which prevents the fetus from receiving all the nutrients it needs and the woman suffers recurrent gestational losses.
This placental insufficiency can also result in intrauterine growth retardation (IUGR ) and the birth of a low birth weight baby.
As we have said, all this could be avoided if celiac disease is diagnosed before pregnancy and the woman follows a special gluten-free diet.
Celiac disease in men
Although there is less information on male infertility due to celiac disease, hormonal alterations caused by nutrient deficiencies may also affect their reproductive function. Some symptoms are lack of libido and impotence due to an increase in the hormone prolactin, a condition known as hyperprolactinemia.
On the other hand, semen quality may also be diminished, as spermatogenesis will be affected by the lack of the hormone testosterone.
FAQs from users
Does celiac disease cause infertility in women?
Celiac women on a gluten-free diet have the same pregnancy rates as the general population.
However, it has been observed that untreated celiac patients may have late menarche, early menopause, secondary amenorrhea.
These patients are more at risk of developing spontaneous miscarriages, recurrent miscarriages and, if they do achieve gestation, of having preterm deliveries and newborns with lower birth weight.
Infertility in untreated celiac women is related to malabsorption of minerals such as iron and deficiency of vitamins such as folic acid, vitamin D and B12.
A deficit of zinc and/or selenium implies an alteration in the synthesis and secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and folic acid is essential for the metabolism of nucleic acids and for the neuronal development of the embryo. Its deficiency can cause alterations at both levels.
Is it possible that I have celiac disease during pregnancy?
Yes, celiac disease is not really caused by pregnancy, but the woman may not have had any symptoms before pregnancy and now, due to hormonal changes, it starts to trigger the typical gastrointestinal manifestations.
In this case, it is recommended to undergo diagnostic tests for celiac disease and, if positive, to start the appropriate treatment in order to avoid complications during pregnancy.
Is there a relationship between celiac disease and anembryonic pregnancy?
A direct relationship has been demonstrated between spontaneous abortions and celiac disease, but not with anembryonic pregnancy, also known as hollow egg or pregnancy without embryo.
It is estimated that 80% of anembryonic pregnancies are due to chromosomal alterations or incorrect division of the embryo.
On the other hand, it has been shown that untreated celiac disease can cause problems in pregnancy. It increases the risk of miscarriage, low birth weight, intrauterine growth restriction and premature delivery.
Therefore, it is extremely important to follow a strict gluten-free diet once the diagnosis is made.
Can eating a gluten-free diet affect pregnancy or the baby's health?
No. Following a gluten-free diet during pregnancy has no impact on fetal development. Nor will it affect breastfeeding after delivery.
Controlled celiac women can have a completely normal pregnancy
Can the baby become celiac during breastfeeding?
No. Normally, celiac babies present symptoms once breastfeeding has ended and they have been weaned, when the first gluten-containing cereals are introduced into the diet (porridges, cookies, soups).
One of the first signs is that the baby stops eating and, therefore, its growth is affected. Diarrhea and vomiting may also occur.
Does celiac disease affect assisted reproduction treatments?
No. Pregnancy rates through fertility treatments are similar between patients with celiac disease and those without.
However, it is important that women with celiac disease follow a proper diet to avoid problems in the absorption of nutrients, which would have a negative effect on the success rate of assisted reproduction treatments.
Suggested for you
We have mentioned that one of the problems in women with uncontrolled celiac disease is recurrent miscarriages. If you want to know more about this, you can continue reading here: What are repeat miscarriages?
On the other hand, since celiac disease is an autoimmune disorder, it is also related to infertility of immunological origin. You can get all the information on this topic in the following article: What is immunological sterility?
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References
Eliakim R, Sherer DM. Celiac disease: fertility and pregnancy. Gynecol Obstet Invest. 2001;51(1):3-7 (See)
Guerreiro AM, Villaescusa R, Morera LM, Alonso M, Martínez L, Junco Y. Detección de anticuerpos antigliadina y antitransglutaminasa en pacientes con clínica sugestiva de enfermedad celíaca. Rev Cubana Hematol Inmunol Hemoter, 2010; 26(2):28-32.
Lasa JS, Zubiaurre I, Soifer LO. Risk of infertility in patients with celiac disease: a meta-analysis of observational studies. Arq Gastroenterol. 2014 Apr-Jun;51(2):144-50 (See)
Moleski SM, Lindenmeyer CC, Veloski JJ, Miller RS, Miller CL, Kastenberg D, DiMarino AJ. Increased rates of pregnancy complications in women with celiac disease. Ann Gastroenterol. 2015 Apr-Jun;28(2):236-240 (See)
Saccone G, Berghella V, Sarno L, Maruotti GM, Cetin I, Greco L, Khashan AS, McCarthy F, Martinelli D, Fortunato F, Martinelli P. Celiac disease and obstetric complications: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016 Feb;214(2):225-234 (See)
Sarikaya E, Tokmak A, Aksoy RT, Pekcan MK, Alisik M, Alkan A. The Association Between Serological Markers of Celiac Disease and Idiopathic Recurrent Pregnancy Loss. Fetal Pediatr Pathol. 2017 Oct;36(5):373-379 (See)
FAQs from users: 'Does celiac disease cause infertility in women?', 'Is it possible that I have celiac disease during pregnancy?', 'Is there a relationship between celiac disease and anembryonic pregnancy?', 'Can eating a gluten-free diet affect pregnancy or the baby's health?', 'Can the baby become celiac during breastfeeding?' and 'Does celiac disease affect assisted reproduction treatments?'.
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