INFERTILITY AND CELIAC-DISEASE

Background-Coeliac women may suffer from gynaecological and obstetric complications. It is possible that these complications are the first s ymptom of coeliac disease. Aims-To investigate the occurrence of subcl inical coeliac disease in patients with infertility or recurrent misca rriages. Subjects-Women of reproductive age who were attending the hos pital because of either primary or secondary infertility, or two or mo re miscarriages. Women undergoing sterilisation served as control subj ects. Methods-The diagnostic investigation for infertility included th e endocrine status, diagnostic laparoscopy, investigation of tubal pat ency, postcoital test, and semen analysis of the partner. Circulating antibodies against IgA class reticulin and gliadin were used in screen ing for coeliac disease. In positive cases, the diagnosis was confirme d by small bowel biopsy specimens. Results-Four (2.7%) of 150 women in the infertility group, and none of the 150 control subjects were foun d to have coeliac disease (p=0.06). All four women with coeliac diseas e suffered from infertility of unexplained origin. Altogether 98 women had no discoverable reason for infertility. Thus, in this subgroup th e frequency of coeliac disease was 4.1% (four of 98), the difference f rom the control group being statistically significant (p=0.02). None o f the coeliac women had extensive malabsorption, but two had iron defi ciency anaemia. One women with coeliac disease has had a normal delive ry. None of the 50 women with miscarriage had coeliac disease. Conclus ion-Patients having fertility problems may have subclinical coeliac di sease, which can be detected by serological screening tests. Silent co eliac disease should be considered in the case of women with unexplain ed infertility.