From the AGA Journals

Large study shows no link between celiac disease and fertility problems



With the exception of those diagnosed between the age of 25 and 29 years, women with celiac disease are no more likely than are women without celiac disease to have fertility problems, according to findings from a large population-based study in the United Kingdom.

Of more than 2.4 million women with prospective primary care records available during their childbearing years (ages 15-49 years) between 1990 and 2013, 6,506 were diagnosed with celiac disease. The women with celiac disease had a similar rate of recorded fertility problems as did those without celiac disease (4.4% vs. 4.1%), Nafeesa N. Dhalwani of the University of Nottingham and City Hospital Nottingham, U.K., and colleagues reported in the December issue of Gastroenterology (doi:10.1053/j.gastro.2014.08.025).

Source: American Gastroenterological Association

Further, the rates of infertility in those with celiac disease were similar to those without celiac disease both before and after diagnosis except in those aged 25-29 years at the time of diagnosis; the rates in those women were 41% higher, compared with those without celiac disease who were the same age (incidence rate ratio, 1.41), the investigators said.

“However, the absolute excess risk [for those diagnosed at age 25-29 years] was only 0.5% (5.2/1,000 person-years), they said.

Women included in the analysis were identified from the Health Improvement Network database. Rates of new clinically recorded fertility problems among those with and without diagnosed celiac disease were stratified by timing of celiac disease diagnosis after adjustment for sociodemographics, comorbidities, and calendar year.

The findings contrast with those from a number of smaller studies that demonstrated an association between infertility and celiac disease, but those studies included small numbers of women, including many who were receiving infertility specialist services, the investigators said, explaining that the women may not have been representative of the general population, and that other small studies found no link between celiac disease and fertility problems.

Celiac disease affects about 1% of the population in North America and Western Europe, and between 60% and 70% of those who are diagnosed are women. Several mechanisms through which celiac disease might affect a woman’s fertility have been described in the literature, but no conclusive evidence exists to support them, they noted.

Despite this lack of evidence and the inconsistent findings from small studies, a number of reviews include infertility as a key nongastrointestinal manifestation of celiac disease. The current findings suggest that most women with celiac disease – whether diagnosed or undiagnosed – do not have a substantially greater likelihood of having clinically recorded fertility problems than do those without celiac disease.

“Therefore, screening when women initially present with fertility problems may not identify a significant number of women with celiac disease, beyond the general population prevalence. This may not always apply to subgroups of women with severe celiac disease. However, in terms of the clinical burden of fertility problems at a population level, these findings should be reassuring for women with celiac disease and all stakeholders involved in their care,” the investigators concluded.

This study was supported by CORE/Coeliac UK, and by a University of Nottingham/Nottingham University Hospitals National Health Service Trust Senior Clinical Research Fellowship. The authors reported having no disclosures.

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