SPECIAL REPORT: COELIAC DISEASE AND FERTILITY

Coeliac disease is a complicated condition, and its effects can have a serious and surprising impact on other areas of your health. Along with type 1 diabetes, depression and osteoporosis, evidence suggests that undiagnosed or untreated coeliac disease may be an underlying cause of infertility. The good news is that there’s an effective antidote that reduces your risk of infertility to essentially the same as the general population. Even better, it’s likely to be something you’re already doing: eating a gluten-free diet.

Experts don’t understand exactly why undiagnosed or untreated coeliac disease affects fertility. One theory suggests you’re more likely to be deficient in nutrients the body needs for reproduction, such as folic acid, iron, zinc and selenium.

“When the villi of the small intestine are damaged by inflammation, which is caused by gluten consumption in people with coeliac disease, it can impact the absorption of key vitamins and minerals,” explains accredited practising dietitian Stefanie Valakas from The Dietologist, experts in fertility nutrition.

“There’s also some evidence to show that not everyone reaches villi ‘normality’ with coeliac disease, so potentially people aren’t always getting the best nutrients for fertility and pregnancy.”

These nutrient deficiencies may be compounded by a shorter fertility window for women with coeliac disease, says Dr Joseph Sgroi, an obstetrician, gynaecologist and fertility specialist based at Epworth Freemasons and Melbourne IVF.

“Coeliac disease predisposes a later onset of commencing your periods, and there can also be earlier menopause. Some women will also have an absence of periods,” he says.

For men, Dr Sgroi says coeliac disease can be associated with lower numbers of “normal-looking” sperm and sperm that swim in a forward direction, both of which can impact fertility. “

The other thing that coeliac disease produces is a level of what’s termed androgen resistance or testosterone resistance,” he says. “Testosterone is particularly important for the production of sperm, so if you’re resistant to that testosterone it can sometimes lead to poor sperm production.”

People with coeliac disease who follow a gluten-free diet don’t appear to be at greater risk of fertility problems than those who don’t have the condition.

“Overall fertility rates are, generally speaking, equal to the background population,” Dr Sgroi says. “The mere fact that you’re addressing the issue is correcting for a lot of the fertility issues.”

Many experts recommend screening for coeliac disease if you have unexplained fertility problems, even if there are no other symptoms present.

“With my patients who have longstanding infertility, I’m trying to rule out everything and anything to maximise the chances that they’ll be able to conceive in the future. So screening for these patients is important,” Dr Sgroi says.

Given that far more rare conditions are screened before and during pregnancy, Valakas says, screening for coeliac disease “should be on the agenda for those who are trying to conceive and struggling with fertility concerns or are faced with the devastation of recurrent pregnancy loss”.

Even if you’ve been diagnosed with coeliac disease and already follow a gluten-free diet, she recommends checking in with your doctor or dietitian before trying for a baby. “The issue we often see is an assumption that you can proceed as normal with growing your family,” Valakas says. “In some cases, for example, more folic acid may be required to mitigate the risk of malabsorption. Given how critical folic acid is in the prevention of neural tube defects in pregnancy, this isn’t a step you want to skip

Going gluten-free is a given when you have coeliac gabi elgood disease, but it’s not the only diet-related change you can make to improve your fertility. Here are some tips from two fertility dietitians: Stefanie Valakas and Sally Marchini of Marchini Nutrition.

Eat antioxidant-rich fruits and vegetables
“They provide dietary fibre and vitamin C, and each colour provides a wide range of antioxidants like polyphenols, which help to protect the sperm and egg from inflammation,” Valakas says.

Include green leafy vegetables for folate
“This supports healthy cell division, sperm health and healthy neural tube formation in the earliest parts of pregnancy,” Valakas says.

Reduce processed foods
Some gluten-free foods, like bread, don’t provide the same nutritional quality as the wheat-based version, so it’s important to look at your diet as a whole and make the most nutritious choices you can,” Marchini says. “Just because a food is gluten-free doesn’t mean it’s good for you.”

Enjoy fish and seafood
“Couples who eat seafood twice a week have higher rates of pregnancy,” Valakas says. “Omega-3 fatty acids may be at play here, alongside other key nutrients like zinc and selenium.”

Add healthy fats to your diet
“These include extra virgin olive oil, nuts and seeds, and avocado,” Valakas says. “Reproductive hormones like oestrogen, progesterone and testosterone need fats to be constructed, and research suggests this is a key dietary change to improve fertility health in women and men.”