Celiac disease is a chronic autoimmune condition of the small intestine triggered by ingesting gluten, a protein found in wheat, barley, and rye. Consuming gluten initiates an immune reaction that damages the intestinal lining, leading to malabsorption and systemic health issues. While often associated with digestive symptoms, untreated celiac disease has an overlooked link to difficulties in conception and adverse pregnancy outcomes.
The Established Connection Between Celiac Disease and Reproductive Health
Clinical data shows that untreated celiac disease contributes to significant challenges in both female and male reproductive health. For women, undiagnosed celiac disease is associated with a higher risk of unexplained infertility; some analyses suggest affected women are three to six times more likely to have the condition than the general population. Untreated disease also affects reproductive milestones, including delayed onset of menstruation (menarche) and a risk of earlier menopause, which shortens the fertile lifespan.
Adverse pregnancy outcomes are a concern. Women with undiagnosed celiac disease face an increased risk of recurrent miscarriage and spontaneous abortion. Active celiac disease during pregnancy is associated with a greater likelihood of complications like low birth weight and preterm delivery.
The reproductive health of men is also implicated. Men with untreated celiac disease can experience issues with semen quality, including decreased sperm motility and abnormal sperm morphology. Undiagnosed disease may also be associated with gonadal dysfunction, which further complicates fertility. These difficulties underscore the systemic nature of celiac disease beyond the digestive tract.
Biological Mechanisms Driving Fertility Impairment
The interference of untreated celiac disease with reproductive function stems from two main consequences: chronic systemic inflammation and the malabsorption of specific micronutrients. The ongoing immune response against gluten causes damage that extends beyond the gut, leading to chronic systemic inflammation. This inflammation is characterized by the release of pro-inflammatory cytokines, such as IL-6 and TNF-α, which directly interfere with reproduction.
In women, this inflammatory environment can impair ovarian function, disrupting ovulation and altering the endometrial environment. High levels of inflammatory markers and celiac autoantibodies may compromise endometrial receptivity, making successful implantation difficult. This interference with the uterine lining is a factor in unexplained infertility and recurrent miscarriages.
The damage to the small intestine’s villi limits the absorption of nutrients vital for gamete production and hormonal balance. Malabsorption leads to deficiencies in trace elements like zinc and selenium, which are foundational for healthy sperm development and motility in men. Zinc deficiency negatively impacts sperm function during spermatogenesis.
For women, deficiencies in iron and folate are relevant to reproductive outcomes. Iron deficiency causes anemia, reducing oxygen delivery to reproductive organs, while folate deficiency increases the risk of early pregnancy complications. These micronutrient depletions disrupt the endocrine system, leading to hormonal imbalances that negatively affect the menstrual cycle and egg quality, impairing conception.
Improving Outcomes Through Dietary Management
The most effective intervention for mitigating reproductive risks associated with celiac disease is strict, lifelong adherence to a gluten-free diet (GFD). Eliminating gluten stops the immune response, allowing the damaged intestinal lining to heal and restoring nutrient absorption. This reversal of the underlying pathology often normalizes reproductive function.
For women with unexplained infertility or recurrent loss, adopting the GFD leads to significant improvement in fertility outcomes, with successful pregnancies often reported within months. The diet helps extend the fertile lifespan by preventing the early onset of menopause. Men with celiac disease also see improvements in sperm count and quality parameters after beginning the GFD.
Given this strong association, screening for celiac disease is recommended for individuals experiencing unexplained infertility or recurrent pregnancy loss. Nutritional supplementation (iron, folate, zinc, and selenium) may be necessary alongside the GFD to quickly correct deficiencies. The goal is to address nutritional deficits and systemic inflammation, allowing the reproductive system to function optimally.