Infertility and ovarian failure in celiac disease

Abstract

Unexplained infertility in females may be a devastating event for the reproductive-aged female. However, infertility may be due to ovarian failure associated with celiac disease, an immune-mediated disorder that may have few or no symptoms and can be successfully treated. In some prospective serologically-based studies, over 4% of infertile females may prove to have celiac disease. Serological screening for celiac disease is relatively inexpensive and involves testing for antibodies to tissue transglutaminase. If positive, a small intestinal biopsy should be done to confirm the diagnosis. The initial treatment for this disorder is a gluten-free diet. To date, a number of reports have indicated that this treatment for celiac disease may result in successful pregnancy, in spite of prolonged periods of infertility. Celiac disease, when untreated, may also lead to several adverse events following pregnancy including increased risk of recurrent abortions, low birthweight and impaired fetal growth. Recent molecular and pathological studies from different laboratories suggest that altered placental function may be due to binding to cells in the trophoblast by tissue transglutaminase antibodies impairing embryo implantation and leading to failure of early pregnancy or retarded intrauterine growth.

Keywords: Celiac disease; Infertility; Ovarian failure; Autoimmune disease; Polyglandular syndrome

Core tip: Females with unexplained infertility should be screened for celiac disease. This involves use of a simple and inexpensive serological quantitative method for detection of tissue transglutaminase antibodies, a marker for celiac disease. If positive, biopsy evaluation should be done to determine if pathological features of untreated celiac disease are present in the small intestinal mucosa. A gluten-free diet may lead to effective management of celiac disease and may promote a favorable pregnancy outcome.