The University of Nottingham

December 3 2014

Women with coeliac disease present with fertility problems no more often than women in the general population, a study by researchers at The University of Nottingham has found.

Coeliac disease is a digestive condition caused by an adverse reaction to gluten in food which can cause severe symptoms in some cases. The research has been published in Gastroenterology, the official journal of the American Gastroenterological Association.

“Despite inconsistent findings from small studies, concern has been raised that coeliac disease may cause infertility. Most evidence is from specialist infertility treatment clinics which is unlikely to represent most women with coeliac disease,” said lead study author Dr Nafeesa Dhalwani from the University’s Division of Epidemiology and Public Health. “Coeliac patients should rest assured; our findings indicate that women with coeliac disease do not report fertility problems more often than women without coeliac disease”

Researchers conducted a large population-based cohort study, analysing more than two million women of childbearing age in the United Kingdom, to compare the rates of new clinically recorded fertility problems in groups of women with and without coeliac disease. The findings show women with coeliac disease do not have a greater likelihood of reporting fertility problems, either before or after diagnosis of coeliac disease. However, rates of clinically recorded fertility problems were 41 per cent higher among women diagnosed with coeliac disease when they were 25-29 years old, compared to women in the same age group without the disease.

Dr Dhalwani said: “It is important to recognise that this represented only a very small increase in the number of women consulting with fertility problems — if we followed women between ages 25-29 years over a one year period, presentations with fertility problems would occur in one of every 100 women without coeliac disease, but in 1.5 of every 100 women with coeliac disease. The fact that this increase was not seen in women of the same age with undiagnosed coeliac disease indicates that it is unlikely to represent a biological impact of the condition on fertility. It may instead be related to heightened concern that may prompt earlier consultation if women experience delays in conception. This does, however, warrant further assessment.”

While undiagnosed coeliac disease is likely to be an underlying cause of unexplained infertility for some women, these findings indicate that most women with coeliac disease, either undiagnosed or diagnosed, do not have a substantially greater likelihood of clinically recorded fertility problems than women without coeliac. Therefore, screening when women initially present with fertility problems may not identify a significant number of women with coeliac disease, beyond the general population prevalence.

Previous studies associating infertility with coeliac disease included small numbers of women attending infertility specialist services and subsequently screened for coeliac disease, so they may not be representative of the general population. This is the largest study to assess the association between coeliac disease and fertility problems to date with data on more than two million women over a 20-year period.

Coeliac disease affects about one per cent of the population in North America and Western Europe, with women constituting about 60 to 70 per cent of the clinically diagnosed population. Coeliac disease is an autoimmune condition which can result in intestinal malabsorption and prevents the body from collecting nutrients as food passes through the small intestine. The primary treatment for coeliac disease is the strict following of a gluten-free diet. Learn more about coeliac disease in the AGA patient brochure.

Women with Coeliac Disease present with Fertility Problems no more often than women in the general population by Nafeesa Dhalwani, Joe West, Alyshah Abdul Sultan, Lu Ban and Laila Tata is available here: http://www.gastrojournal.org/article/S0016-5085(14)01036-1/abstract