Unrecognised coeliac disease among men and women undergoing fertility treatment: A screening study

Abstract

Background Coeliac disease is an autoimmune disease triggered by dietary gluten and has been associated with several conditions influencing female and male reproduction. Due to unspecific symptoms, coeliac disease can be unrecognised for years. Objective To estimate the prevalence of unrecognised coeliac disease among couples referred to fertility treatment. Methods Cross-sectional screening for coeliac disease in men and women referred to fertility treatment using IgA tissue transglutaminase antibodies as a marker of coeliac disease and small-bowel biopsies to confirm the diagnosis. Participants answered a questionnaire on gluten intake, gastrointestinal symptoms and reproductive history. Results A total of 893 participants (51% women) were screened and eight were coeliac disease antibody positive. Small-bowel biopsies were obtained from seven antibody positive participants and unrecognised coeliac disease was confirmed in one woman and three men, corresponding to a prevalence of 0.45% (95% confidence interval 0.12–1.14). The total prevalence, combining already diagnosed and unrecognised CD cases, was 0.63% (95% confidence interval 0.29–1.12). Conclusion The prevalence of unrecognised coeliac disease in a group of infertile patients was equivalent to that of the Danish general population and low compared with that observed in the majority of other screening studies of infertile patients. Surprisingly, it should be noted that more men than women had coeliac disease. This result does not support a need for routine screening among infertile patients.

Exploring undiagnosed celiac disease in women with recurrent reproductive failure: The gluten‐free diet could improve reproductive outcomes

“…Considering comparison with other works, 11,13 there is no reason to expect a different CD prevalence in this group of women, but a different situation may involve the response to the GFD. Women were recruited from an infertility clinic, and thus, our sample is enriched in women with advanced age and bad reproductive outcomes.…”

“…A biopsy-avoiding approach could contribute to wrong diagnosis. 13 Note that these values are lower than the observed in women with reproductive problems. The other authors, as we do, consider the described CD prevalence in adults from the same population: 0.35% in Holland 11 and 0.48% in Denmark.…”

“…13 A well-established protocol to identify sero-negative cases is mandatory, although new markers would be very helpful for this group. with CD.…”

“…This wide range of clinical manifestations contributes to the considerable delay to reach diagnosis and to the well-known underdiagnosis of CD. [9][10][11][12][13] First, despite diverse studies reporting bad reproductive outcomes in CD women, 5,14 three population-based studies failed to find higher probability of fertility problems in CD, [15][16][17] although one of them described decreased infertility in the 2 years preceding CD diagnosis. The association between infertility and autoimmune diseases has long been recognized.…”

“…8 Including infertility in the group of CD-associated conditions caused a big controversy, and a consensus has not been reached due to the contradictory results found in the literature. [9][10][11][12][13] First, despite diverse studies reporting bad reproductive outcomes in CD women, 5,14 three population-based studies failed to find higher probability of fertility problems in CD, [15][16][17] although one of them described decreased infertility in the 2 years preceding CD diagnosis. 17 Moreover, the prevalence of CD is about 1% worldwide, and in infertile women, it differs from some studies to others, being reported similar to the general prevalence in several works.…”