Celiac disease is a chronic inflammatory disorder of the intestine with varying degrees of gluten intolerance and may be associated with recurrent miscarriage and infertility. Gluten insensitivity or allergy may not cause significant intestinal inflammation as in the case of celiac disease and its impact on fertility is most likely not significant. Common complaints with celiac disease include abdominal discomfort, diarrhea, malabsorption, fatigue, weight loss and pelvic pain.
Pelvic pain is a relatively common complaint in reproductive age women and can be associated with endometriosis, fibroids or pelvic inflammation, which are common causes of infertility and recurrent miscarriages. Women who present with pelvic pain may have a “negative gynecological work up” which may suggest gastrointestinal disease in some of these patients. In such cases, women need to be screened for celiac disease which may explain chronic pelvic pain in addition to other intestinal problems. Once celiac disease is diagnosed with serum markers and endoscopic evaluation, eliminating gluten from the diet has been proven to improve gastrointestinal symptoms, “gynecological pelvic pain” and overall outcome.
The association of celiac disease with infertility and recurrent miscarriage has been controversial because some studies suggested higher incidence of celiac disease in the infertility population whereas others reported similar rates. It’s possible that celiac disease may increase the risk of recurrent miscarriage and infertility because of its inflammatory nature. Malabsorption of essential nutrients, circulating autoimmune antibodies, activated natural killer cells or inflammatory cytokines may impact implantation or continuation of a healthy pregnancy. Celiac disease can be associated with diabetes, thyroid disorders, anemia and bone loss. In women with the disorder who are planning on becoming pregnant, it would be recommended to screen for these co-existing problems to minimize risks during and after the pregnancy.