By Rachel Neifeld, RD, CDN
Many factors play a role in affecting fertility, but one disease is gaining more attention as it becomes increasingly prevalent in the population. Celiac disease is a condition that millions of people have, but most don’t know they have it, in part because symptoms can be so varied. The disease is caused by an allergy to gluten, a protein found in wheat, barley, rye, and possibly oats. In people with this allergy, gluten damages the lining of the small intestine preventing it from absorbing important nutrients. These include vitamin D, iron, vitamin K, vitamin B12, and folate. These nutrient deficiencies could in turn decrease fertility. It’s becoming more common to test for celiac disease if either partner trying to conceive is having symptoms.

Symptoms of celiac

The symptoms of celiac disease can be different from person to person and depend in part on a person’s age and the degree of damage to the small intestine. Many adults have the disease for a decade or more before they are diagnosed. Symptoms may also vary according to the length of time a person was breastfed, the age a person started eating gluten-containing foods, and the amount of gluten-containing foods one eats.

Symptoms may include abdominal pain, bloating, gas, constipation, diarrhea, lactose intolerance, and stools that float and are foul-smelling (caused by the intestines' decreased ability to absorb fat). As the disease progresses, the effects of long term nutrient deficiencies may start to manifest in symptoms such as depression, fatigue, hair loss, missed menstrual periods, and nose bleeds, to name a few.

How celiac affects fertility

Along with malnourishment, one reason why celiac disease can affect fertility is that women with the disease are reported to start having periods later and stop menstruating earlier than average. They also suffer from amenorrhea (when menses start and stop) leading to fewer ovulations and fewer chances of getting pregnant. Not only does the disease affect women’s fertility, but men’s as well. Men with the disease can have abnormal sperm- such as lower sperm numbers, altered shape, and reduced function. 

Another factor that affects a couple's chances of conceiving is the frequency of intercourse, which could be reduced if ether partner is feeling fatigued or unwell. In fact, a recent study showed that sexual relations occurred less often when one partner had active celiac disease compared with couples in which the partner’s celiac disease was being treated.

To test for celiac disease, a blood test or intestinal biopsy can be performed. The blood test looks for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA) to diagnose celiac. Since the disease is hereditary, people with family members who have the disease should be tested. 

The treatment for celiac is a gluten-free diet that avoids wheat, barley, and rye. Fortunately, there are some gluten-free grains like amaranth, buckwheat, and quinoa that are very nutritious and provide a great source of fiber, protein, calcium, and iron. When planning a gluten-free diet, it’s recommended that one meet with a registered dietitian to create a well-balanced meal plan which will ensure you receive all the nutrients you need.

For couples who may be experiencing symptoms of celiac, diagnosing and treating this manageable disease could not only improve fertility, but also overall well being and quality of life.  

Sources:
NY Times: Can Foods Contribute to Infertility?
NIH, National Institute of Diabetes and Digestive and Kidney Diseases: Celiac Disease