Dr Widodo Judarwanto SpA

What are the major causes of subfertility?
  • Subfertility is defined as a failure to conceive after one year of unprotected regular sexual intercourse. One in six couples have an unwanted delay in conception, with many factors being described as possible causes.
  • The relationship between subfertiltiy and coeliac disease has been well described and may be the only presenting feature of coeliac disease
  • What is the relationship between untreated coeliac disease and subfertilily?
  • Studies have shown that the prevalence of unrecognised coeliac disease (as a cause of subfertility) in women presenting to subfertility clinics is in the range of 2.7-3%, a significantly higher prevalence than that found in the general population (1.06%). Molteni et al found that menarche was significantly delayed among untreated patients with coeliac disease. Sher and Mayberry confirmed this and also reported significantly earlier age of menopause. Undiagnosed coeliac disease is also associated with a poorer outcome for the foetus.
  • A cohort Danish study found that babies of patients with untreated coeliac disease had significantly lower birth weights than controls. This was not observed in newborns of treated patients, therefore suggesting treatment with a gluten-free diet is of importance in reducing the incidence of foetal growth restriction. The prevalence of low birth weight before and after a gluten-free diet prescribed to coeliac mothers fell from 29% to 0%.
  • An increased incidence of miscarriage among patients with untreated coeliac disease has also been reported. Following a gluten free diet, the miscarriage rate among patients with untreated coeliac disease was similar to that of controls. Conversely Kolho et al found no difference in the incidence of coeliac disease among patients with recurrent miscarriage screened for coeliac disease and among healthy controls.
  • References

· Kolho KL et al. Screening for celiac disease in women with a history of recurrent miscarriage or infertility. British Journal of Obstetrics and Gynaecology 1999;106:171-173.
· Norgard S et al. Birth outcomes of women with celiac disease; A nationwide historical cohort study. American Journal of Gastroenterology 1996;94:2435-2440.
· Tata LJ et al. Fertility and pregnancy-related events in women with celiac disease: A population-based cohort study. Gastroenterology 2005;128:849-855.
· Ciacci C et al. Coeliac disease and pregnancy outcome. American Journal of Gastroenterology 1996;91:718-722.
· Sanders DS et al. A primary care cross-sectional study of undiagnosed adult coeliac disease. Eur J Gastroenterology and Hepatology 2003;4:407-413.
· Meloni GF et al. The prevalence of coeliac disease in infertility. Hum Reprod 1999;14:2759-2761
· Collins P et al. Infertility and coeliac disease. Gut 1996;39:382-384.
· Molteni N et al. Obstetric and gynaecological problems with untreated sprue. Journal of Clinical Gastroenterology 1990;12:37-39.
· Sher KS and Mayberry JF. Female fertility, obstetric and gynaecological history in coeliac disease. Digestion 1994;55:243-246.

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