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Celiac.com 12/27/2023 - Researchers Aljoharah Al Saud and Ziad F. Rayes deliver a case study report on the uncommon but impactful coexistence of celiac disease and antiphospholipid syndrome, two conditions with links to infertility. Respectively, they are associated with the Family Medicine and Polyclinics, Alfaisal University College of Medicine, and Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, in Riyadh, SAU. The journey began for a 23-year-old woman with seemingly unrelated symptoms—urticaria and vitamin D deficiency. Initially diagnosed with idiopathic urticaria, her health story unfolded over 13 years. Recurrent miscarriages became a recurring theme, casting shadows on her dream of motherhood. The puzzle pieces started to fit together when antiphospholipid syndrome was identified after multiple pregnancy losses. Symptoms of Osteoporosis The patient's persistence paid off as she successfully underwent in vitro fertilization, leading to a diamniotic dichorionic pregnancy. However, post-delivery brought an unexpected twist—severe back pain unveiling acute wedge fractures, a sign of osteoporosis. Diving deeper into investigations, elevated antigliadin and anti-tissue transglutaminase antibodies emerged, revealing the presence of celiac disease. A gluten-free diet became the transformative key, bringing not only relief from symptoms but also notable improvements in bone mass density. This case serves as a poignant reminder of the intricate links between seemingly unrelated health issues. The intersection of celiac disease and antiphospholipid syndrome highlights the importance of thorough investigations in cases of unexplained infertility and unexpected osteoporosis. Beyond its diagnostic implications, this case underscores the critical need for early identification of celiac disease. Swift action can mitigate its potentially detrimental effects on fertility and bone health. As healthcare continues to unveil the complex interplay of various conditions, stories like these emphasize the significance of holistic and timely approaches to diagnosis and treatment, ensuring a healthier and more informed future for individuals navigating the intricate landscape of their well-being. Read more in cureus.com

Celiac.com 11/05/2019 - After failing to conceive naturally over several years, the woman, Helen Tzouganatos, turned to IVF doctor Professor Mark Bowman. Tzouganatos says she and her husband had "tried every fertility trick in the book – expensive ovulation kits, herbal remedies, acupuncture, eating more of this and less of that, taking a holiday, taking another holiday – and nothing worked." During her intake, Tzouganatos told Dr. Bowman that she had no "serious" health issues just unexplained anemia since childhood, abdominal cramps and lactose intolerance. To his credit, Dr. Bowman immediately suspected she was a celiac. He ordered a celiac blood screen. When the results came back positive, everything became clear. "You’re a celiac and that is why you’re infertile," Dr. Bowman told her. "You need to cut gluten immediately.” Tzouganatos began a gluten-free diet immediately, and, after six rounds of IVF treatment, she conceived her son Vasili, followed by a daughter, Sofia, conceived on the second frozen embryo transfer 17 months later. Statistical data indicate that one in 70 Australians have celiac disease yet 80 per cent are undiagnosed. Tzouganatos is lucky that her celiac disease was discovered quickly by her IVF doctor, after sneaking under the radar for so long. Any women experiencing unexplained infertility, especially in conjunction with other celiac-related symptoms should be screened to rule out celiac disease. Quick adoption of a gluten-free diet can often lead to full healing and normal, or greatly improved fertility. Read more at SMH.com.au

Celiac.com 11/12/2018 - Here’s an uplifting celiac story. Now, this happened a while back, but it's all just coming to light in the way that so many warm and fuzzy family stories do. It starts like this: Once upon a time, a simple check for celiac disease opened the door to parenthood for couple. Just over ten years ago, AnnMarie Bradley from Celbridge, Co Kildare, thought she’d never become a mother. After two devastating miscarriages over a decade, Bradley, who is 47 years old, and her husband Christopher (48) were at wit’s end. "I was just heartbroken,” said Ms Bradley. Then, a simple visit to her doctor changed everything. A blood test indicated she might have celiac disease, which further evaluation confirmed. She began a gluten-free diet, and less than a year later, Bradley was pregnant with her son, Cameron. “Being a mother had been everything I'd wanted," she said. Cameron is nearly 16 now, and has an 11-year old sister, Emily. And they all lived happily and gluten-free ever after. In the UK, the Coeliac Society advises women struggling to conceive to consider celiac testing. Read more at: Independent.ie

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.

Celiac.com 05/03/2018 - Time to spring into action and take control of your celiac disease and dermatitis herpetiformis! This means I have to "Scare you Silly" about not fully conforming to the gluten-free diet. Anemia, tiredness, and vitamin deficiency will continue to dog you if your gluten-free diet is non-compliant. You know those "just can't resist" items in your diet, the ones where the ingredient list does not actually say it is gluten-free, which may leave you open to cross-contamination that is common in the food industry? There is an estimated three million Americans with celiac disease, yet the vast majority still remain undiagnosed. The prevalence of celiac disease in Canada and the United States is growing, not diminishing! The high prevalence of celiac disease is also found in individuals with other disorders such as Type 1 diabetes, autoimmune thyroid disease and Down Syndrome. The prevalence of celiac disease in Type 1 diabetes around the world is 3 – 16%. According to Shelley Case, Author of Gluten-Free Diet: A Comprehensive Resource Guide: "Studies by Columbia University in New York and the Canadian Celiac Association revealed that adults suffer from the disease for an average of 10 - 12 years before being correctly diagnosed." The rare, but wise, physician who has diagnosed celiac disease correctly also sends the patient to be checked for diabetes and thyroid disease. Do you know what Gluten Ataxia is? Ataxia is a symptom in many conditions that affect the nervous system. Ataxia causes clumsiness or loss of balance and coordination that is not due to muscle weakness. Ataxia symptoms can be worrisome, and more so if you have been cheating on your celiac diet. Symptoms may vary but can include: Trouble using fingers, hands, arms and/or/legs Trouble speaking Trouble moving eyes Poor coordination and/or balance Tingling in extremities Gait problems Damage to the cerebellum (the part of the brain that controls coordination). Gluten ataxia is a rare immune-mediated disease in which the body's immune system attacks the nervous system as a reaction to the ingestion of gluten. It is a rare condition, but it can be related to celiac disease as well as non-celiac gluten sensitivity. Those with gluten ataxia often do not always have digestive issues or other symptoms. A strict gluten-free diet usually improves symptoms for those with gluten ataxia. Early diagnosis and treatment through the gluten-free diet can help stop progression and further cerebellum damage. People who have dermatitis herpetiformis know only too well what that gluten-containing doughnut or tart can do to their bodies. The DH sores are so itchy, and well, just sore, that prior to my first diagnosis I thought I had head lice and self-treated myself it on three separate occasions! Though DH is a miserable disorder to have, and the sores appear in the same places time and time again leaving scars, it at least leads to a faster diagnosis once a dermatologist sees the itchy sores, which often appear in bunches on your scalp, upper arms, shoulders and shins. While other people are watching television you are itching at sores in your head, picking off scabs, and in general feeling very miserable until the DH sores eventually heal. A biopsy of one of the lesions by that dermatologist can show dermatitis herpetiformis, but sometimes only after two or even three biopsies. The IgA deposits remain under the skin and that is why the DH sores keep coming back to the same place in your body. They are still there, and just come to the surface when you ingest gluten. Some with DH have to remain on dapsone for the rest of their lives. I have been on dapsone for over 30 years, even though I attempted on several occasions to stop taking it. To me it is a wonder drug, but one that I have to be careful not to abuse, because dapsone can cause anemia, and something similar to anorexia because when you ingest it regularly you do not feel hungry, and thus lose weight. To heavy people this may seem like the perfect weight loss program. Believe me, it isn't. It can also cause Methemaglobinemia which, when ingesting will prevent your arteries from functioning as an oxygen carrier and can seriously affect your body so that oxygenated blood does not reach your starved blood cells. You either carry a SAT Machine to measure the oxygen levels in your blood, or go to the Emergency Department where they can check your saturation levels. If below 90 they will admit you, run a battery of tests, and you may be put into a side room somewhere to get an infusion of Methane Blue to flush out your blood system, and you may need to have a blood transfusion. If you are away on holidays this can be a very serious condition where you are unaware you have Methemaglobinemia, except for a feeling of being out of breath, and NEED to get to hospital as soon as possible so your SAT levels can be monitored. Scaring you straight means not cheating day after day and then hoping a few dapsone will improve the condition. It won't—if you have passed the safe guideline of one pill daily. It is not simply a matter of taking dapsone in a 5 - 4- 3 - 2 - 1 as I was advised to do by an internist when I was first diagnosed with dermatitis herpetiformis. Ingestion over five days will no longer help you, and to my chagrin, can cause the condition to worsen. It is a serious condition; you can actually die from lack of oxygen in your blood! These few descriptions do not cover the fall out (of your hair) and the scarring of the sores on your legs and upper arms the Prednisone that they want to give you can cause a "roid rage" similar to what weight lifters have when they purposely ingest Prednisone to build up their muscles and become extremely irritable because of the Prednisone. ONE helpful clear lotion that I have to buy across the border in the U.S.A. is Scalpacin or Renewal, the latter being the generic name for Salicylic Acid (3%) which lessens the intense itching when applied directly to the sores (not to be ingested!). It says only 3% Salicylic Acid and I will confess that when I first "latched" onto this amazing "scalp itch and Dandruff relief liquid" I often applied twice daily to all the sores in my scalp and on my body. Did you know that approximately 3% of the general population in the U.S.A., according to Dr. Peter Green, have celiac disease? Once a patient develops one autoimmune condition the odds of developing another are greatly increased. Autoimmune disorders run in families, and different diseases may affect different parts of the body. A friend of our grandson was diagnosed as having celiac disease simply because she went to her doctor with complaints of a stomach ache. The doctor could have easily asked her if she had exams coming up, sent her for a blood test to rule out an appendicitis and left it at that, but he was a wise doctor who asked more questions and ordered the celiac blood tests. When that cameback positive he actually followed it up with a biopsy of the jejunum. She, as a teenager, was positive for celiac disease, but that doctor could have easily not ventured past the stomach ache at that first visit and gone no further with his investigations. Fortunately, vigilance paid off this time. He was thorough enough to refer her to a dietitian, but you know, she still cheats! I believe the reason she cheats is because she does not suffer from any of the symptoms of celiac disease right now, and does not have dermatitis herpetiformis. Amazing how vigilant you become with your diet when you break out in painful sores over 25% of your body, and experience diarrhea, stomach aches, nausea and vomiting! We never got into the other diseases she could possibly get from cheating on the gluten-free diet. Sjogren's Disease, Turner Syndrome, Type 1 diabetes, Williams Syndrome, Juvenile idiopathic arthritis, lactose intolerance, migraines, peripheral neuropathy, liver disease, are but a few of the disorders that can be connected to celiac disease. Have you ever looked up the symptomatology of these autoimmune diseases? Time you did! Did you know that there is a Celiac Disease Center at Columbia University which is one of the leading authorities for unexplained infertility issues, and that the prevalence of celiac disease in women with unexplained fertility is higher than the general population? Celiac disease may also be asymptomatic, meaning you show no symptoms at all. This is one of the reasons why it may be difficult for some people and their doctors to connect the dots between celiac disease and unexplained fertility. I worked with obstetrician/gynecologists for years and never found one that, when doing the laboratory testing, included a test for celiac disease, yet it is common knowledge now that a celiac disease screening should definitely be part of the work-up that is done for infertility issues. People of reproductive age spend an enormous amount of money, time and energy trying to become pregnant and carrying the baby to term. There are more women depressed because they cannot conceive or those that cannot bring a baby to term. Several studies over the past ten years have found a link between celiac disease, infertility and spontaneous abortion. It is not known yet whether the nutritional issues (malabsorption) that occurs with untreated celiac disease is the cause of the reproductive issues, or if the immune system may be to blame. 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 does not produce enough sperm or produces abnormal sperm. Note that undiagnosed or untreated celiac disease can lead to a host of seemingly unrelated problems, including osteoporosis, depression, and anemia. Medical researchers “along with some observant obstetrician/gynecologists are realizing that undiagnosed celiac disease may also be a cause of otherwise unexplained infertility in both men and women." A study undertaken in England, which has one of the world's largest celiac populations, indicates that fertility often returns after you start the gluten-free diet. There are many causes for infertility, but up to 30 percent of couples who are infertile will be told that no specific reason for their infertility can be found. When this happens a diagnosis of unexplained infertility is given. In recent years, awareness of celiac disease has increased. You may not be able to quote "Celiac Disease is a chronic autoimmune disorder", but it is a good sentence to spread around to those who ask you, "Do you follow the gluten-free diet because it is trendy or you want to lose weight"? As awareness for celiac disease has increased, some researchers have started looking at a possible like between celiac disease and unexplained infertility. Some of the known causes are: Low sperm count, - sperm with mobility or motility issues Enlarged veins in the scrotum called varicocele. Klinefelter syndrome, a genetic disorder. Although Klinefelter syndrome carries with it the risk testicular cancer, autoimmune diseases have been associated with this disorder, which is a chromosomal disorder. KS might increase the risk of some autoimmune diseases. It has been suggested that some autoimmune diseases may be more common in people with Klinefelter syndrome than in others, but the evidence so far is sparse. A research paper out of Oxford, England entitled "Associations between Klinefelter's Syndrome and Autoimmune Diseases” came to the conclusion that those with Klinefelter syndrome have increased risk of some autoimmune diseases. If you have the test for celiac disease, at least the blood test, and if your partner has the ultrasound done for it you can go into the obstetricians office with a list of questions, including family history, research you have undertaken yourself. I have seen so much heartache while nursing, watching a couple lose their baby prior to delivery, and those than cannot conceive but cannot afford invitro- fertilization. The damage that undiagnosed or untreated celiac disease can result in ongoing gastrointestinal symptoms such as vomiting, chronic diarrhea, stomach pain, and cramps. A number of these symptoms may also affect the reproductive system of women, for example: Delayed onset of menstruation Irregular periods No periods at all, known as amenorrhea Chronic pelvic pain And yes, endometriosis (where part or parts of the uterine lining attaches itself to the uterus and begins to grow) needs to be mentioned here. Many women who have this painful disease have been told that their only way of ridding themselves of this very painful disorder is to get a total hysterectomy. This is not always the case. There are now medications to help rid the uterus of endometriosis. Many obstetricians will perform a laparoscopy to determine the extent of the endometriosis, endeavour to lyse the adhesions from the wall of the uterus. Often this is all that is needed to ensure an introduction from the egg to the sperm and conception takes place. Other, more difficult cases can be referred to an infertility specialist, but be prepared for large costs. Many infertility specialists will tell you that if you can obtain a pregnancy while still struggling with endometriosis it often alleviates the problem. Did you know that men with celiac disease may have gonadal dysfunction, which could complicate fertility issues? (That was a big learning surprise for me!) This ultrasound test can be ordered by your family physician, a gonadal ultrasound to rule out a cystocele. Finding out that your husband has a cystocele is not Earth shattering—it involves a small corrective surgery. Did you know that Semen issues (specifically sperm morphology) found in men with celiac disease improved after following a gluten-free diet? Few studies have been conducted on celiac disease and male infertility. There is also a lack of scientific information and research studies on the potential link between non-celiac gluten sensitivity (NCGS), also commonly referred to as "gluten intolerance" and infertility. While research needs to be done, those with non-celiac gluten sensitivity are thought to possibly be at an increased risk of reproductive issues. However, the connection between NCGS and infertility is not yet known or proven. One case review did suggest that a strict gluten-free diet may improve fertility for those with NCGS. According to Healthline experts do not fully understand the effects of celiac disease on the reproductive system. The effects may be caused by malabsorption of nutrients, the impact it has on the immune system, or another currently unexplained reason. Some studies have noticed a link in untreated celiac disease in the mother and recurrent miscarriage, pre-term birth, and low birth weight. In a meta analysis that looked at studies on infertility and celiac disease, researchers noted that women with infertility were over three times more likely to have celiac disease than the control group. You have to admit that is a large number, and what upsets me is the fact that numerous obstetrician/gynecologists do not automatically send this part of the women's population for celiac disease screening. Yet women with unexplained infertility, were six times more likely to have celiac disease than women in the control group. Despite these studies, not all experts in the field are convinced about the connection. They state that more research is needed. BUT wouldn't you want to know that there is strong evidence that infertility and celiac disease are connected, and at least make your own decision with regards to getting tested? The tests undertaken by people with infertility are difficult to endure, are not only embarrassing but invasive. If celiac disease or gluten sensitivity runs in your family, or you suspect you have celiac disease, make a list of your symptoms. You'll want to discuss your concerns with your doctor and ask to be screened for celiac disease. A Reproductive Endocrinologist is who you would be referred to here in Canada, but you may have another title in the United States. If you are vigilante about eliminating gluten from your diet, you will stop the damage celiac disease is doing to your body. This may include lessening or eliminating the impact it may be having on your reproductive system. Sources: https://www.ncbi.nim.nih.gov/pubmed/25564410 Celiac Disease A Hidden Epidemic, Dr. Peter H.R. Green American College of Obstetricians and Gynecologists (ACOG) Resource Center: http://www.acog.org American Society for Reproductive Medicine: http://www.asrm.org Reproductive Changes Associated with Celiac Disease: https://www.ncbi.nim.nih.gov/pmc/articles/PMC3001971/ Healthline https://www.ncbi.nml.nih.gov/pmc/articles/PMC4600520/

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

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.

Celiac.com 09/30/2011 - A new study indicates that women who suffer unexplained infertility suffer higher rates of undiagnosed celiac disease than those who do not experience unexplained infertility. The study appeared in the May-June issue of the Journal of Reproductive Medicine. Using serologic screening for celiac disease as well as routine infertility testing, Janet M. Choi, M.D., of Columbia University in New York City, led a study team that included B. Lebwohl, J. Wang, S. K. Lee, J. A. Murray, M. V. Sauer and P. H. R. Green. Together, they assessed 191 women with infertility. The researchers confirmed four women with positive serum test results to have celiac disease. That's 2.1 percent of the 188 patients who completed testing. The women received nutritional counseling to adopt a gluten-free diet. Now, this prevalence rate was not significantly higher than the expected 1.3 percent seen in the general population. However, three cases of undiagnosed celiac disease were seen among the 51 women with unexplained fertility, for a significantly higher prevalence rate of 5.9 percent. Interestingly, all four women found to have celiac disease successfully conceived within a year of diagnosis and treatment. From these results, the team concludes that women with unexplained infertility face a higher risk of undiagnosed celiac disease. They also suggest that this is a risk factor that can be mitigated, and treated. Source: The Journal of Reproductive Medicine

Celiac.com 07/11/2011 - Is celiac disease associated with infertility? Although some reports suggest that as much of 8% of women with unexplained infertility have celiac disease, others found no correlation between the two conditions. And there is little hard evidence that celiac disease is an actual cause of infertility. To begin to bring some clarity to this issue, Khoshbaten et al. tried to determine the prevalence of celiac disease among couples with unexplained infertility in Iran. Their results are reported in the Journal of Obstetrics and Gynaecology Research. Infertile couples were recruited in Tabriz, Iran, between October 2006 and September 2007. After a complete evaluation of their endocrine status, one hundred couples with unexplained infertility were chosen for this study. Two hundred couples with at least one child and no reproductive problems served as controls. Thirteen infertile subjects - 5 men and 8 women - had elevated levels of tissue transglutaminase antibodies, compared to eleven controls - 4 men and 7 women. Fourteen infertile subjects and eleven controls were found to be IgA deficient; of these, three of each had elevated tissue transglutaminase IgG. Based on this serology, the researchers note that the likelihood of celiac disease in infertile patients is 2.39 times higher than in controls; the frequency of celiac disease is 8% in infertile patients, compared to 3.5% in controls. Only five infertile subjects and four controls with elevated tissue transglutaminase antibodies agreed to have duodenal mucosal biopsies; the remainder had no gastrointestinal complaints or other symptoms, so they opted out of the endoscopy. According to the biopsy, celiac disease was indicated in three cases of unexplained infertility compared to one case in the control group. Previous studies have demonstrated that men with celiac disease have an increased incidence of hypogonadism, sexual dysfunction, and poor semen quality. Women with celiac disease can have major menstrual problems. Systemic diseases like celiac can exert subtle effects on the reproductive system in both genders. A gluten free diet can alleviate infertility if it is caused by nutritional imbalances due to celiac disease, such as malabsorption of zinc, selenium, iron, and folate. This Iranian study, like previous studies in Finland, Italy, Israel, and the US, thus seems to come down on the side of celiac disease, as measured by serological markers, being more significantly frequent among couples with unexplained infertility than in controls. Source: Khoshbaten M, Nejad MR, Farzady L, Sharifi N, Hashemi SH, and Rostami K. Fertility disorder associated with celiac disease in males and females: fact or fiction? J. Obstet. Gynaecol. Res. 2011.