Undiagnosed Celiac Disease Can Lead to Infertility

Fertility often returns after you start the gluten-free diet

Is gluten why you can't get pregnant?. Credit: Getty Images/Fuse

Undiagnosed or untreated celiac disease can lead to a host of seemingly unrelated problems, including osteoporosis, depression, and anemia. Now, medical researchers — along with some observant obstetrician-gynecologists — are realizing that undiagnosed celiac disease also may be a cause of otherwise unexplained ​infertility in both women and men

Infertility in Celiac Disease: Why?

Many doctors define infertility as the inability to get pregnant after one year of unprotected sex.

In women, fertility difficulties often result from a problem with ovulation, while in men, infertility usually occurs because the man doesn't produce enough sperm, or produces abnormal sperm.​

It's not clear why more people with undiagnosed or untreated celiac disease suffer from infertility. It's possible that malnutrition, which occurs because you can't absorb the nutrients in your food, may be to blame. There also may be some yet-undiscovered reason.

High Rates of Infertility in Women with Celiac Disease

Medical studies have found celiac disease rates of about 4% in women with otherwise unexplained infertility. In one study, which found four cases of celiac disease in a group of 98 women with unexplained infertility, none of the celiac women had very much damage to their small intestines. However, two of the women suffered from iron deficiency anemia, which is a symptom of celiac disease.

Another study looked at the rate of children born to patients with celiac disease compared to children born to control subjects. It found that women with celiac disease had significantly fewer children prior to their celiac diagnosis — 1.9 children, on average, compared to 2.5 children in controls.

After the women were diagnosed with celiac disease, the difference began to even out.

The researchers concluded that celiac disease caused the difference in fertility prior to diagnosis, while the gluten-free diet corrected it following diagnosis.

Fewer medical studies have been conducted looking for male reproductive issues in celiac disease. However, Italian researchers have noted that male celiac disease patients have a greater risk of infertility and other reproductive issues, as well as a greater incidence of androgen (male hormone) deficiency.

Period Problems in Celiac Women

In women with celiac disease, problematic periods are commonplace, suggesting some possible reasons for infertility.

For example, in another Italian study, nearly 20% of the celiac women had amenorrhea, or missed menstrual periods. Only 2.2% of those who didn't have celiac suffered from amenorrhea.

Meanwhile, pregnancy complications such as threatened miscarriage, pregnancy-related hypertension, severe anemia and intrauterine growth retardation occurred four times more often in women with celiac disease.

Unexplained Infertility? Consider Celiac Screening

Many researchers and clinicians now recommend that you be screened for celiac disease if you have unexplained infertility — especially if you have any of the classic celiac disease symptoms or risk factors.

However, many of the women diagnosed in these infertility studies had subtle symptoms of celiac disease or even so-called "silent" celiac disease, in which they had no apparent symptoms (you can have celiac disease without digestive symptoms, or in fact without any symptoms at all). So you shouldn't rely on your symptoms to determine your risk for the condition.

If you're infertile and you have celiac disease, there's hope: Many previously infertile women were able to conceive successfully after being diagnosed with celiac disease and adopting the gluten-free diet.


Collin P et al. Infertility and coeliac disease. Gut. 1996;39:382-384. http://gut.bmj.com/content/39/3/382.abstract

Lasa JS et al. Risk of infertility in patients with celiac disease: a meta-analysis of observational studies. Arquivos de gastroenteroligia. 2014 Apr-Jun;51(2):144-50.

National Foundation for Celiac Awareness. Infertility and Celiac Disease. National Foundation for Celiac Awareness. 

Sher KS et al. Female fertility, obstetric and gynaecological history in celiac disease. A case control study. Digestion. 1994;55(4):243-6. http://www.ncbi.nlm.nih.gov/pubmed/8063029

Stazi AV et al. [Celiac Disease and its endocrine and nutritional implications on male reproduction]. Minerva Med. 2004. Jun;95(3):243-54. http://www.ncbi.nlm.nih.gov/pubmed/15289752

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