The major causes of subfertility
Subfertility is defined as a failure to conceive after one year of unprotected regular sexual intercourse. One in six couples have an unwanted delay in conception, with many factors being described as possible causes.
The relationship between subfertiltiy and coeliac disease has been well described and may be the only presenting feature of coeliac disease
The relationship between untreated coeliac disease and subfertilily?
Studies have shown that the prevalence of unrecognised coeliac disease (as a cause of subfertility) in women presenting to subfertility clinics is in the range of 2.7-3%, a significantly higher prevalence than that found in the general population (1.06%). Molteni et al found that menarche was significantly delayed among untreated patients with coeliac disease. Sher and Mayberry confirmed this and also reported significantly earlier age of menopause. Undiagnosed coeliac disease is also associated with a poorer outcome for the foetus.
A cohort Danish study found that babies of patients with untreated coeliac disease had significantly lower birth weights than controls. This was not observed in newborns of treated patients, therefore suggesting treatment with a gluten-free diet is of importance in reducing the incidence of foetal growth restriction. The prevalence of low birth weight before and after a gluten-free diet prescribed to coeliac mothers fell from 29% to 0%.
An increased incidence of miscarriage among patients with untreated coeliac disease has also been reported. Following a gluten free diet, the miscarriage rate among patients with untreated coeliac disease was similar to that of controls. Conversely Kolho et al found no difference in the incidence of coeliac disease among patients with recurrent miscarriage screened for coeliac disease and among healthy controls.
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- Sher KS and Mayberry JF. Female fertility, obstetric and gynaecological history in coeliac disease. Digestion 1994;55:243-246.