Celiac disease (CD) is an autoimmune disorder where ingesting gluten, a protein found in wheat, barley, and rye, triggers an immune response that damages the small intestine. This damage causes various symptoms, often extending beyond the digestive tract. Research indicates a relationship between undiagnosed or untreated celiac disease and difficulties with conception. Addressing this underlying autoimmune condition can resolve long-standing reproductive struggles.
The Connection Between Celiac Disease and Fertility Difficulties
The question of whether celiac disease makes it harder to get pregnant is answered primarily by looking at cases where the condition has not been diagnosed or treated. Women with undiagnosed celiac disease experience significantly higher rates of reproductive issues compared to the general population, including infertility, delayed conception, and recurrent miscarriage. Studies focusing on women with unexplained infertility show a notably increased prevalence of undiagnosed celiac disease.
Research suggests that the rate of undiagnosed celiac disease in women with unexplained infertility may be as high as 5.9% to 8%, which is several times higher than the estimated prevalence in the general population. Infertility is defined as the inability to achieve a pregnancy after a year of trying. Untreated celiac disease is associated with adverse pregnancy outcomes, including recurrent fetal loss. Active celiac disease is a modifiable risk factor for reproductive challenges.
How Untreated Celiac Disease Impacts Reproductive Health
The mechanism linking untreated celiac disease to reproductive difficulties involves two primary biological processes: systemic inflammation and nutrient malabsorption. The ongoing immune reaction to gluten causes chronic inflammation throughout the body, disrupting the hormonal balance necessary for reproduction. This inflammatory state interferes with the hypothalamic-pituitary-ovarian axis, the communication system governing the menstrual cycle. Such disruption can lead to irregular menstrual cycles, a lack of ovulation (anovulation), or the cessation of menstruation (amenorrhea).
Damage to the intestinal lining, known as villous atrophy, severely impairs the body’s ability to absorb essential micronutrients from food. Reproductive function is dependent on adequate stores of specific nutrients, including iron, folate, zinc, and Vitamin D. Iron deficiency contributes to anemia, which negatively affects the overall health needed for pregnancy. Folate and zinc are important for healthy egg development and early fetal development. Deficiencies impair egg quality, create an inhospitable environment for implantation, and increase the risk of early pregnancy loss. Untreated celiac disease has also been linked to delayed onset of menstruation (menarche) and earlier onset of menopause, shortening the fertile lifespan.
Restoring Fertility Through Dietary Management
The primary treatment for celiac disease is strict, lifelong adherence to a gluten-free diet (GFD), which resolves associated fertility problems. Eliminating gluten allows the damaged small intestine to heal, restoring the integrity of the intestinal villi. This healing enables the body to properly absorb nutrients, correcting the deficiencies that undermine reproductive health. Normalized nutrient levels provide the necessary building blocks for healthy hormone production and egg maturation.
The resolution of chronic systemic inflammation is another benefit of the gluten-free diet. Reducing this inflammatory burden helps stabilize the hormonal axis, often leading to the return of regular menstrual cycles and spontaneous ovulation. Many women with celiac-related infertility who adopt a strict GFD find their ability to conceive improves significantly. Fertility often returns to normal levels within six to twelve months of consistent GFD adherence. Maintaining a strict GFD is also important throughout pregnancy, as it reduces the risk of adverse outcomes such as preterm birth and low birth weight.
Screening for Celiac Disease When Conceiving Is Difficult
Given the strong association between undiagnosed celiac disease and unexplained reproductive issues, medical guidelines recommend screening for the condition in specific patient populations. Women experiencing unexplained infertility, recurrent miscarriage, or adverse obstetric outcomes should discuss celiac disease testing with their healthcare provider. This recommendation is relevant even without typical gastrointestinal symptoms, as many cases are silent or present with non-digestive complaints.
The initial screening step involves a simple blood test for specific antibodies, such as the IgA anti-tissue transglutaminase (IgA-tTG) antibody. The individual must continue consuming gluten regularly before and during this testing process. Starting a gluten-free diet beforehand can cause antibody levels to drop, potentially leading to a false-negative result and a missed diagnosis. If the screening blood tests are positive, an endoscopy and biopsy of the small intestine are performed to confirm the diagnosis of celiac disease.