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Infertile Women May Want to Ask for Celiac Disease Test

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Women experiencing infertility may want to ask for a simple blood test to determine if they have celiac disease, according to a new study from researchers at Columbia University Medical Center in New York City.

Peter Green, MD, the director of the Celiac Disease Center at Columbia, and Janet Choi, MD, a fertility doctor at the Center for Women’s Reproductive Care at Columbia, co-authored the study, which demonstrated increased rates of celiac disease in women with unexplained infertility. The researchers evaluated 191 patients presenting with infertility and did routine infertility testing on the women, as well as serologic testing for celiac disease. The study was published in The Journal of Reproductive Medicine

“A simple blood test could either suggest or exclude celiac disease as a cause of infertility,” Dr. Green says. “Apart from this study, we’ve seen quite a few women who have been going through IVF and finally got diagnosed with celiac disease and ended up going on the [gluten-free] diet, and they conceived. So it seems a very reasonable test to be included in the battery of tests that women have who complain of infertility.”

Among the 188 patients who completed testing, the prevalence of undiagnosed celiac disease was 2.1 percent — not significantly higher than the expected 1.3 percent; however, the diagnosis of celiac disease in women with unexplained infertility was found to be significantly higher at 5.9 percent (three out of 51 women). Interestingly, all four patients found to have celiac disease conceived within a year of diagnosis.

Diagnosing celiac disease in an infertile woman potentially provides a low-cost and low-risk therapy to improve chances for conception by changing to a gluten-free diet. “Women get tested for a whole bunch of things, but celiac disease is usually not on the radar for fertility doctors,” Dr. Green explains. “That’s why we did the study.”

Once thought to be a rare childhood syndrome, celiac disease affects more than 2 million people in the United States. The digestive disease damages the small intestine and interferes with absorption of nutrients from food. A person who has celiac disease cannot tolerate gluten, which is a protein found in wheat, rye, and barley.

“Celiac disease is very much underdiagnosed in this country,” Dr. Green says. Symptoms include infertility, abdominal pain, bloating, iron deficiency anemia, osteoporosis, peripheral neuropathy (tingling in the hands and feet) and just general fatigue. “One of the problems is all the symptoms are common, and doctors see a lot of people with those problems, but rarely do they consider celiac disease. They are not unique symptoms — they can be caused by multiple other issues.”

People with celiac disease have higher than normal levels of certain autoantibodies in their blood. The blood test tests for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA).

If the blood test comes back positive, the patient very likely has celiac disease and would need a referral to a gastroenterologist.

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