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    Latest Study Says Celiac Disease Reduces Ovarian Reserves


    Jefferson Adams
    • Compared to healthy controls, female celiac patients of reproductive age showed decreased AMH levels and ovarian reserves that reflected the length of celiac duration; the longer the celiac disease, the greater the decrease.

    Latest Study Says Celiac Disease Reduces Ovarian Reserves
    Image Caption: Image: CC--Thomas van de Weerd

    08/21/2018 - Does celiac disease have any kind of adverse effect on ovarian reserve levels in women of reproductive age? To get an answer, a team of researchers recently conducted a study of ovarian reserve in patients of reproductive age with celiac disease using anti-Müllerian hormone (AMH) levels, antral follicle counts (AFCs), and ovarian volume.

    The research team included Erol Cakmak, Savas Karakus, Ozlem Demirpence, and Banu Demet Coskun. They are variously affiliated with the Department of Gastroenterology, the Department of Obstetrics and Gynecology, the Department of Biochemistry, Cumhuriyet University Faculty of Medicine, Sivas, Turkey, and with the Department of Gastroenterology, Kayseri Training and Research Hospital in Kayseri, Turkey.

    For this study, their team included 46 female celiac patients and 40 healthy female subjects of reproductive age, 18–45 years of age. 

    The team drew blood samples from both groups on days 2–4 of the menstrual cycle, and measured follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), and AMH levels. On the same day, the team measured AFCs and ovarian volume for each patient. They also recorded patient body mass index (BMI), gravidity/parity/abortions/alive counts, disease duration, and Marsh histological classification.

    The results showed no statistically significant differences between celiac disease patients and control groups in terms of mean age, BMI, or median gravidity/parity/abortions/alive counts.  Also, there were no statistically significant differences between the groups in terms of average FSH, LH, E2, PRL levels, right and left ovarian volumes, and median right and left ovarian AFCs. 

    The team found AMH levels to be markedly lower in the celiac group. The Spearman correlation test showed no significant connection between AMH levels and age, BMI, FSH, LH, E2, PRL levels, right and left ovarian volumes, right and left ovarian AFCs, or Marsh histological classification.

    However, the team did find that, compared to healthy controls, female celiac patients of reproductive age showed decreased AMH levels and ovarian reserves that reflected the length of celiac duration; the longer the celiac disease, the greater the decrease.

    It appears that, especially over time, celiac disease can reduce ovarian reserves, which could have an adverse affect on fertility. 

    Read more at:  Med Sci Monit. 2018; 24: 1152–1157.

     

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    Guest CMcCulley

    Posted

    What would be interesting is to know if the celiac disease patients follow a strict gluten free diet and if that makes a difference or not in their ovarian reserve. For instance a control group, gluten free celiac disease patients and non-gluten free celiac disease patients. Also, they say the median age of the celiac disease patients is 35.2 +/- 7.9 and the control group is 31.5 +/- 9.5 and this is not statistically significant. However, since fertility changes with age, it seems that there might be a difference between celiac disease and control patients with medians that differ by 3.7 years. I got pregnant naturally at age 43, was diagnosed with celiac disease about 35 and had symptoms of celiac disease for years before being diagnosed.

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    It’s a bit discouraging as a woman, being 30, following a strict gluten free diet to hear that my chances of fertility are low. 

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    Guest MChekowski

    Posted

    CMcCulley you have given me hope ?, I'm 39 was dignosed with celiac disease at 31, and just went through a false pregnancy

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    Guest K. Jordan

    Posted

    My personal health history is a rejection of this study. I was diagnosed with celiac disease by blood test and biopsy at the age of 40, six months after the birth of my second child, after suffering symptoms of celiac disease since early childhood. (My worst celiac disease symptoms were in childhood until puberty, and then again post-pregnancies.) I was healthy during both my pregnancies and gave birth to full-term, healthy newborns at ages 37 and 40. I was also super fertile, conceiving both babies in the first month of trying. Now at 51 I have not yet reached menopause. Just wanted to put my story out there so as to not create too much fertility fear in the female celiac community.

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, and science. He previously served as Health News Examiner for Examiner.com, and provided health and medical content for Sharecare.com.

    Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book Dangerous Grains by James Braly, MD and Ron Hoggan, MA.

  • Related Articles

    Jefferson Adams
    Celiac.com 04/20/2011 - To follow up on research suggesting that men with celiac disease have impaired sperm quality, a team of researchers recently set out to examine fertility in men with biopsy-verified celiac disease.
    The research team included Daniela Zugna, Ph.D., Lorenzo Richiardi, M.D., Ph.D., Olof Akre, M.D., Ph.D., Olof Stephansson, M.D., Ph.D., and Jonas F. Ludvigsson, M.D., Ph.D.
    The study included 7,121 men from a national Swedish population-based cohort. All of the men had celiac disease, as defined according to duodenal-jejunal biopsy data with the presence of Marsh III villous atrophy. 
    The study followed men born between 1914 and 1990 until they turned 54, or until the study ended in 2008, whichever came first.
    Using multinomial logistic regression and Cox regression,  the researchers calculated the number of children each man had fathered, and when those children were born relative to his celiac diagnosis. The team compared the estimated fertility of the study group against data from 31,677 age-matched reference male control subjects.
    Across the board, for every given time span, both before and after celiac disease diagnosis, men with celiac disease showed no higher rates of infertility. In fact, men with celiac disease fathered children at the same rate as these without, and showed similar rates for not fathering children.
    At the end of the study, men with celiac disease had 9,935 children compared with 42,245 among controls. About 35 percent of men with and without celiac disease had no children.
    Adjusting for age, time period, and parity and stratifying by education, men with biopsy-verified celiac disease showed an overall fertility hazard ratio of 1.02 (95% confidence interval, 0.99–1.04).
    So, overall, this study found normal fertility rates in men with diagnosed celiac disease compared to those without.
    Because the team studied only Swedish-born men still living in Sweden as adults, the authors note that the data may not apply to all men. However, the large study population makes the results more convincing.
    It's important to remember that this study covers male fertility, and that several studies have shown that women with celiac disease do suffer reproductive and/or fertility issues at higher rates than women without celiac disease.
    SOURCE:
    Fertility and Sterility
    Volume 95, Issue 5 , Pages 1709-1713.e3, April 2011
    doi:10.1016/j.fertnstert.2011.01.132


    Diana Gitig Ph.D.
    Increased Prevalence of Celiac in People with Unexplained Infertility
    Celiac.com 12/20/2011 - There has been some controversy surrounding the idea that there is a higher prevalence of undiagnosed celiac disease in people with infertility, with some studies finding it but others not. Most of these studies have been performed in Europe; only two to date have taken place in the United States. Peter Green’s group at Columbia recently tried to establish the actual prevalence of undiagnosed celiac disease in the infertile population in the United States, to determine if it would make sense to routinely screen a subgroup of infertile patients for celiac disease. Their results are published in The Journal of Reproductive Medicine.
    Study participants were recruited from the population who came to Columbia’s Center for Women’s Reproductive Care to deal with their infertility issues, which they had been coping with for at least a year. One hundred eight-eight women, ages 25-39, volunteered to participate in the study. They underwent serological screening for tissue transglutaminase (tTG IgA) and endomysial antibodies (EMA IgA), and measurement of total IgA and both IgA and IgG antigliadin antibodies was done to control for the potential IgA deficiency in some individuals. Four of the 188 patients enrolled in the study were diagnosed with celiac disease, making the prevalence of celiac disease in this population 2.1%. Yet a subgroup analysis of the prevalence of celiac disease in women with unexplained fertility revealed a prevalence of 5.9%, which achieves statistical significance.
    All four women reported suffering from gastrointestinal symptoms before their diagnosis, and they had a significantly increased prevalence of Irritable Bowel Syndrome as well. The authors admit that this is quite a small sample, and because screening was voluntary, it is also a selected population.
    But even so, they suggest that physicians should inquire about GI symptoms when patients present with infertility, and that screening for celiac is appropriate in those with unexplained infertility who complain of gastrointestinal distress. They even go so far as to posit that all women with unexplained infertility be screened for celiac, even if they don’t have gastrointestinal trouble.
    All four women conceived within ten months after starting on a gluten free diet, two naturally and two with help. And all of them went on to deliver healthy babies.
    Source:

    Choi JM, Lebwohl B, Wang J, Lee SK, Murray JA, Sauer MV, Green PH. Increased prevalence of celiac disease in patients with unexplained infertility in the United States. J Reprod Med. 2011 May-Jun; 56(5-6):199-203.

    Jefferson Adams
    Celiac.com 11/05/2012 - Over the last 40 years, studies have shown higher rates of menstrual abnormalities and pregnancy complications among women with celiac disease.
    However, the data from these studies have been inconsistent, and inconclusive regarding the actual effects of celiac disease on female fertility. To get a better picture of the relationship between celiac disease and female fertility and pregnancy, researchers recently conducted a more comprehensive study.
    The research team was led by Stephanie M. Moleski, MD, of Thomas Jefferson University Hospitals in Philadelphia. Dr. Moleski presented an abstract of the study data at the American College of Gastroenterology Annual Meeting 2012.
    In the abstract, she points out that women with biopsy-proven celiac disease had significantly higher rates of fertility and pregnancy complications and gave birth to less children than those without the disease.
    Because it is an abstract, the study data and conclusions should be regarded as preliminary until they appear in a peer-reviewed journal, where they can be given a fuller context and be more widely scrutinized.
    For their study, Dr. Moleski and her colleagues recruited patients treated for celiac disease at Thomas Jefferson University Hospitals, as well as members of the National Foundation for Celiac Awareness and the Gluten Intolerance Group, to respond in an anonymous Internet-based survey about fertility and pregnancy. Women without celiac disease also completed the survey and served as a control group.
    The survey included questions about celiac diagnosis and history, menstrual history, fertility, spontaneous abortions, and pregnancy outcomes.
    Approximately 1,000 women who completed the survey. Of those, 473 had physician-diagnosed celiac disease, while 298 women had the been confirmed for celiac via small-bowel biopsy. The researchers used the group with biopsy-proven disease to compare against 560 women without celiac disease.
    The data showed that 41.2% of women with celiac disease had increased difficulty conceiving compared with 36.5% of control subjects (P=0.03). Women with celiac disease also had more consultations with fertility specialists and higher rates of spontaneous abortion, preterm delivery, and cesarean section, compared with control subjects.
    Additionally, women with celiac disease were shown to have a shorter duration of fertility, to have a later onset of menarche and be younger when they experienced menopause, said Dr. Moleski.
    The data also revealed important differences between women with and without celiac disease. In all, 22.4% of women with celiac disease had consulted with fertility specialists, compared with 19% of those without (P=0.04). Also, 43.3% of celiacs had a history of spontaneous abortion, compared with 36.6% of non-celiacs (P=0.02).
    Compared with the control group of non-celiacs, women with celiac disease also had higher rates of cesarean delivery, 26.4% versus 23.8% of non-celiac women.
    Lastly, rates of preterm delivery were 23.2% for celiac women, and 14% for those without celiac disease (P=0.007), while the group with celiac disease was was also slightly older at the onset of their first period (12.7 versus 12.4 years, P=0.01).
    Among women reporting a history of spontaneous abortion, more than 80% of miscarriages occurred prior to diagnosis of celiac disease, said Dr. Moleski.
    She concluded that the retrospective analysis done by her team shows a clear relationship between celiac disease, fertility, and pregnancy outcomes, and suggests that the results demonstrate "a need for increased awareness of this association among patients and physicians."
    Sources:
    Medpagetoday.com American College of Gastroenterology, 2012; Moleski SM, et al "Infertility and pregnancy outcomes in celiac disease" ACG 2012; Abstract 15.

    Jefferson Adams
    Higher Celiac Disease Rates in Women With Infertility
    Celiac.com 03/04/2015 - Women with infertility face higher rates of celiac disease, according to a recent data analysis.
    Until now, data connecting celiac disease and infertility has been contradictory. There are currently no recommendations regarding celiac disease screening in female patients with infertility.
    A research team recently conducted a meta-analysis to find out whether women with infertility have a higher risk for celiac disease. The team included Prashant Singh MBBS; Shubhangi Arora MBBS; Suman Lal MD; Tor A. Strand MD, PhD; and Govind K. Makharia MD, DM, DNB, MNAMS.
    To source information for their analysis, the team performed a literature search using the MeSH keywords "celiac disease," "gluten," and "infertility." They based celiac diagnosis on positive patient serology and biopsies showing villous atrophy. The team extracted celiac disease data in 3 groups of women with "all cause" infertility, unexplained infertility, and a group of control subjects. They then calculated pooled odds ratio (OR) and prevalence, with 95% confidence intervals (CI).
    Of 105 relevant studies, they included five studies for calculation of pooled odds ratio. Four additional studies, where data on controls were not available, were also considered for calculation of pooled rates of celiac disease.
    The analysis showed that women with infertility had 3.5 times higher odds of having celiac disease compared with the control group (OR=3.5; 95% CI, 1.3-9; P<0.01). Similarly, odds for celiac disease in women with "unexplained infertility" were 6 times greater than for control subjects (OR=6; 95% CI, 2.4-14.6).
    Of 884 women with infertility, 20 had celiac disease indicating a pooled prevalence of 2.3% (95% CI, 1.4-3.5).
    Of 623 women with "unexplained infertility," 20 had celiac disease. The pooled prevalence of celiac disease in women with unexplained infertility was 3.2% (95% CI, 2-4.9).
    Celiac disease is more common in women with what is called "all-cause" infertility and "unexplained" infertility, than in general population.
    Infertility and unexplained infertility can point to hidden celiac disease.
    Source:
    Journal of Clinical Gastroenterology. doi: 10.1097/MCG.0000000000000285

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    • Maureen and Cyclinglady, Of the foods you listed. . .. I would focus on the Chocolate. Chocolate has Tyramine in it and it could/can cause rashes that  might be confused for DH. Sometimes Tyramine get's confused for/in high sulfite foods as triggers. Here is a great overview article on this topic. http://www.chicagotribune.com/lifestyles/health/sc-red-wine-headache-health-0608-20160525-story.html you might also have trouble with headaches if it tyramine is causing you your trouble. People who have trouble Tyramine might also have trouble with consuming cheeses. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738414/ As for the Milk causing/triggering your DH don't rule Adult onset dairy allergy. While rare it does occur in the literature/research when you search it out. I am including the research here in the hopes it might help you or someone else entitled "Adult onset of cow's milk protein allergy with small‐intestinal mucosal IgE mast cells" https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.1996.tb04640.x It is generally thought most of grow out of a Milk Allergy at approx. 3 years old. But for some lucky one (I guess) we never do apparently.  (I speak for my friend on this board JMG).  He found out he was having trouble with dairy as an adult better never realized until about 6 months ago. With delayed onset allergies it is often hard to tell if it (allergen) is effecting us because we might not associate it with our dairy consumption because it might happen a day or two latter. See this WHFoods article about food allergens/sensitivies.  It is very long/exhaustive but it is very helpful if you have time to study it in more detail. http://www.whfoods.com/genpage.php?pfriendly=1&tname=faq&dbid=30 I will quote some key points for your information. Symptoms of Food Allergies "The most common symptoms for food allergies include vomiting, diarrhea, blood in stools, eczema, hives, skin rashes, wheezing and a runny nose. Symptoms can vary depending upon a number of variables including age, the type of allergen (antigen), and the amount of food consumed. It may be difficult to associate the symptoms of an allergic reaction to a particular food because the response time can be highly variable. For example, an allergic response to eating fish will usually occur within minutes after consumption in the form of a rash, hives or asthma or a combination of these symptoms. However, the symptoms of an allergic reaction to cow's milk may be delayed for 24 to 48 hours after consuming the milk; these symptoms may also be low-grade and last for several days. If this does not make diagnosis difficult enough, reactions to foods made from cow's milk may also vary depending on how it was produced and the portion of the milk to which you are allergic. Delayed allergic reactions to foods are difficult to identify without eliminating the food from your diet for at least several weeks and slowly reintroducing it while taking note of any physical, emotional or mental changes as it is being reintroduced." Here is their information on Tyramine's. Tyramine "Reactions to tyramine (an amino acid-like molecule) or phenylalanine (another amino acid-like molecule) can result from eating the following foods: Fermented cheeses Fermented Sausage Chocolate Sour Cream Red wine Avocado Beer Raspberries Yeast Picked Herring Symptoms of tyramine intolerance can include urticaria (hives), angioedema (localized swelling due to fluid retention), migraines, wheezing, and even asthma. In fact, some researchers suggest that as many as 20 percent of migraines are caused by food intolerance or allergy, and tyramine intolerance is one of the most common of these toxic food responses." Here is an old thread on tyramine and especially how it can trigger headaches. https://www.celiac.com/forums/topic/95457-headache-culprit-is-tyramine/ I would also suggest your research a low histamine food diet.  Rashes/hives etc. can be triggered my disregulaton of histamine in the body. The other thing in chocolate that might be causing your problems is Sulfites. Here is a website dedicated to a Sulftie allergy. http://www.allergy-details.com/sulfites/foods-contain-sulfites/ Chocolate bars are on their list of sulfite contaning foods but probably most noted in dried fruits and red wine. Knitty Kitty on this board knows alot about a sulfite allergy. I want to go back to the possible dairy allergy for a second as a possible trigger. . .because it has been established as connected to DH . . .it is just not well known. Here is current research (as I said earlier) most dairy allergies are studied in children but it does occur in approx. 10 pct of the GP unless your of Asian descent where it is much more common. https://www.ncbi.nlm.nih.gov/pubmed/29555204 quoting the new research from this year on children. "When CMP (Cow's Milk Protein) was re-introduced, anti-tTG increased, and returned to normal after the CMP was withdrawn again." and if adults can also (though rarely) it seem develop "Adult onset of cow's milk protein allergy with small‐intestinal mucosal IgE mast cells" (see research linked above) as the research shows  you should at least trial removing dairy from your diet if you haven't already and see if your DH doesn't come back when you re-introduce it. It just takes 15 or 20 years for medical doctor' to incorporate new research/thinking into clinical practice.  And note the research on this happening in adults is 20+ years old and as far I know doctor's . . . are not aware of this.  I know I wasn't until recently and I research things alot of to help myself and my friends. But I know you can't do what you don't know about.  So this is why I am trying to share what I learned so that other might be helped and this research might not  lay hidden another 20 years before doctor's and their Celiac/DH patients become aware of it. And if it helps you come back on the board and let us know so it can help others too! If it helps you it will/can help someone else! if they know it helped you then they will/can have hope it might help them too and why I share and research these things for others'. . . who don't know or don't have time to research this for themselves. I hope this is helpful but it is not medical advice. Good luck on your continued journey. I know this is a lot of information to digest at one time but I hope at least some of if it helpful and you at least have a better idea of what in your chocolate could be causing your DH (idiopathic) as the doctor's say (of an unknown cause mild) DH symptom's. Or at least it is not commonly known yet that Milk can also cause trigger (DH) in children and adults who have a Milk allergy undiagnosed. . .because we don't don't typically think  or associate it with adults like maybe we should if we are not of Asian descent. Maureen if this doesn't help you you might want to start a thread in the DH section of the forum. As always  2 Timothy 2: 7   “Consider what I say; and the Lord give thee understanding in all things” this included. Posterboy by the grace of God,
    • I hooe you can get some answers with your new GI doc.
    • Many of us deal with doctor issues and diagnosis, you got a really bad draw indeed. Most doctors dismiss Celiac as their is no money in the cure for them IE a gluten free diet and not medications.

      Keep up updated on your new doctor and testing, good to see you finally found one that listens and can help, I got through on doc #5 I think it was.
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