Monday, June 21, 2010

Gluten Sensitivity & Infertility

A reader who is a clinician himself writes: “I believe that gluten sensitivity may be a risk factor in pregnancy contributing to complications such as miscarriage, preterm labor and even stillbirth. Have you seen anything to support this concept?”

I have seen a great deal of information supporting this. Studies going as far back as 1996 speak of the association between gluten and fertility. While most of the studies were done with celiac patients we have seen clinically that this association appears to be true for gluten sensitive patients as well.

In 2001, Gynecologic & Obstetric Investigation presented an article entitled: “Celiac disease: fertility and pregnancy”. The authors noted that celiac disease may manifest clinically with an array of non-digestive symptoms such as dermatitis herpetiformis; dementia; depression; various neurological symptoms, osteoporosis; dental enamel defects, and anemia of various types. They also stated that important data have accumulated regarding the association between celiac disease, fertility and pregnancy.

The critical observation was made that: Many primary care obstetricians, gynecologists and perinatologists are not aware of these important relationships.

The authors made a review of the scientific literature and what was revealed was that patients with untreated celiac disease sustain significant delayed menarche (age when a women begins menstruating), earlier menopause, and increased prevalence of secondary amenorrhea (absence of menstrual bleeding).

They continued to state that patients with untreated celiac disease incur higher miscarriage rates, increased fetal growth restriction and lower birth weights.

Their conclusion was that improvement of celiac, with implementation of a gluten-free diet, may decrease miscarriage rates, improve fetal nutritional support and overall prenatal (period from 20 weeks of pregnancy to 1 month old) outcome.

In the Italian medical journal, Minerva Ginecologica, an article entitled: “Celiac disease and spontaneous abortion” was published in 2002.

The authors very correctly pointed out that celiac disease is only diagnosed in a small percentage of adult cases compared to the real situation because it is manifested with few symptoms, is in an atypical form, or occurrence is completely silent.

The aim of their study was to investigate the association between celiac disease and abortion, and evaluate whether patients suffering from recurrent spontaneous abortion might present an atypical or subclinical form of the disease.

Five women were positive for celiac disease. Four of these women formed part of a group of patients with a positive history of spontaneous abortion and one was from the control group.

Analysis of the cases from this study and those reported in the literature shows that tests to identify celiac should be extended to the population with a risk of developing spontaneous abortion.
These subjects should include those with a family history or clinical symptoms, in particular women with a history of multiple abortions.

In 1996 the European Journal of Gastroenterology & Hepatology published an article entitled: “Gynaecological and obstetric disorders in celiac disease: frequent clinical onset during pregnancy or puerperium” (period after birth continuing for 6 weeks).

The author’s aims were to determine:
1. The prevalence of gynaecological and obstetric problems in patients with celiac disease and the influence of strict gluten restriction on their occurrence,
2. The effect of pregnancy on the clinical course of celiac disease, and
3. The clinical features of those patients with onset of celiac during pregnancy and puerperium.

As mentioned in earlier research findings, this study also found that untreated celiac patients exhibited significantly later menarche, earlier menopause, increased prevalence of secondary amenorrhea and increased incidence of spontaneous abortions.

Patients who had adhered, in the long term, to a gluten-free diet had gynecological and obstetric history indistinguishable from controls.

They summarized by stating that the early diagnosis and treatment of celiac disease may avoid significant gynecological and obstetric complications.

And finally, an article just released a couple of weeks ago, May 25, 2010 in Fertility & Sterility, “Primary infertility as a rare presentation of celiac disease.”
The authors reported a case of a 30-year-old woman presenting with primary infertility who on investigation was found to have celiac disease. After being on a gluten-free diet for 8 months she had a successful conception.
Their conclusions, much along the lines of the previous studies were as follows: We suggest that celiac disease should be checked in infertile patients of unexplainable etiology with anemia, as just changing their diet can solve their fertility problem.
Well that last sentence does sum it up very nicely. Let’s reiterate: Just changing the diet can solve the ______ problem.
Yes in this case we’re speaking of infertility, hormonal imbalance, spontaneous abortion, etc. But as you well know if you read this blog, there are very many symptoms/diseases we could insert into that sentence.
Infertility is a growing problem. It affects as many as 1 in 6 couples. Imagine if we could decrease those numbers by increasing the awareness of gluten intolerance. Now add delayed menarche, earlier menopause, and increased prevalence of secondary amenorrhea and spontaneous abortion to that list. How many women might that affect?

It’s exciting to think of the good effects that could be created by making the women who suffer as well as the doctors who treat them aware of this association.
It’s frustrating that we haven’t arrived at that awareness level yet…
Not meaning to be redundant as I say this at the end of most posts, but we have to continue our grass roots movement. Awareness IS increasing, we just have to continue to work hard.
Speaking of increasing awareness, check out the July issue of “Better Homes & Gardens”, page 202. The article is called “Gluten’s Laws” and yours truly is featured. “Better Homes & Gardens” has the third largest distribution of all magazines in this country. See, we ARE making headway!
Please let me know if I can be of any further assistance.
To your good health,
Dr Vikki Petersen
Founder of HealthNOW Medical Center
Co-author of “The Gluten Effect”



References:

Gynecol Obstet Invest. 2001;51(1):3-7. “Celiac disease: fertility and pregnancy”
Minerva Ginecologica, 2002 Apr;54(2):151-9. “Celiac disease and spontaneous abortion”
Eur J Gastroenterol Hepatol. 1996 Jan;8(1):63-89. “Gynaecological & obstetric disorders in CD: frequent clinical onset during pregnancy or puerperium”
Fertil Steril. 2010 May 25. [Epub ahead of print] “Primary infertility as a rare presentation of celiac disease.”

5 comments:

AJ Ponder said...

The whole issue of gluten sensitivity is frustrating with the medical profession significantly at odds with the latest research, complicating not only pregnancies, but very serious illnesses. Cheers for keeping everyone aware of what it going on.

Peter said...

Great article Dr. Petersen.
I have personally seen gluten induced infertility in my own clinic. In every case, the couples were successful after eliminating gluten and addressing nutritional deficiencies associated with it. I have attached a diagram on nutritional deficiencies and fertility for anyone who is interested.
http://towncenterwellness.com/wp-content/uploads/Infertility-diagram.pdf

Keep up the good work!
Dr. O

linda said...

Great article. I'm an IVF patient. After 8 IVFs I discovered that I'm gluten intolerant (diagnosed with lymphocytic colitis which ONLY responded to removing gluten from my diet - now symptom free). IVF 9 produced a near perfect embryo (zero fragmentation) but still didn't "stick". I've been gluten free for about 7 months and about to do IVF#10. I truly feel that I'm on the right path but at my age (46) my diagnosis has probably come way too late.

@Dr O: Great flowchart! I've got most of my supplements covered but see that I'm lacking in B vitamins.

solutions tohealth said...

My mom has Celiac and it's genetic so I suspect that I have it also, although I've never been officially diagnosed. Instead of going thru a colonoscopy I just went on the diet myself 2 years ago. It seems terrible, but it's really not that hard to do. There's been a huge improvement in my overall health, especially with my cycle. When I asked my OB-GYN about the link between IF and Celiac, she kinda down-played it and didn't really feel there was enough proof that it was a major concern. I'm sure there are different oppinions on that. I know that I feel a million times better, and my cycle became more regular and less painful. I am a huge believer that nutrition plays a huge role in your health.
women fertility

Anonymous said...

I underwent several IVF's and altho both my husband and I were medically the perfect couple to produce babies, nothing happened for 8 years. Finally a friend made me aware of some symptoms I had of gluten intolerance, fairly mild but i tried the gluten free diet and those symptoms went away completely within a few weeks and on the 6th IVF we had success three months after stopping gluten. 18 mths later, did frozen embryo cycle and pregnant first time with our second baby at aged 42. I am convinced my infertility was from the gluten sensitivity and it is very frustrating that fertility specialists dont check for this, and when I told them, they kind of fob you off. I feel at the end of the day one has to do your own reserch and try things out for yourself, you are the only one ultimately responsible for your health and of course are the only one to lose in the end if you dont do some homework. Do not rely on the doctors and specialists! Gluten sensistivity is a VERY real thing.