Special Investigation: Celiac Disease and Reproductive Health

Beyond Rice Cakes is generally an upbeat lifestyle column, dedicated to making you laugh at the hilarious things that often happen to people with celiac disease. I strive every month to make you feel good about being on a gluten-free diet and find new and creative ways to impress your non-celiac friends with delicious recipes. However, this month, I'm going to be a little more serious and examine how celiac disease can drastically impact the reproductive health of both men and women. I hope that you'll read this article carefully and then talk to your family and friends about it, so that together, we can help all people in the United States with celiac disease who also suffer from reproductive health issues.

I am only 24 years old, but I am blessed to have already found three exceptional role models who I admire and respect more than I ever could have imagined. All three of them are women who experienced devastating pregnancy complications because they spent so many years with undiagnosed celiac disease.

   

Alice Bast
I met NFCA Executive Director Alice Bast in July 2004 during the National Institutes of Health Celiac Disease Consensus Conference. I was working as a news reporter for the Palm Beach Post newspaper and writing an article on celiac. In my editor's mind, this was a very slow news day. Little did I know, that it would turn out to be one of the most important news days of my entire life.

As Alice was explaining the basics of the disease to me, she mentioned that migraine headaches are a symptom of celiac. When she said this, I think I dropped my notebook and pen on the floor. I was in shock. I had suffered debilitating migraines my entire life and had tried every headache medication available, all to no avail. I immediately got tested and sure enough, I had celiac.

The week after I received my positive blood test, I called Alice to thank her and learn more about the disease. Alice told me her personal story of being diagnosed with celiac, a story that to this day still brings tears to my eyes to think about.

Alice first experienced symptoms of celiac disease after returning from a trip to Mexico and deciding with her husband to have a second child. The first six months of the pregnancy were uneventful. She felt healthy and her unborn baby was quite a little kicker! But suddenly, at the end of the second trimester, Alice was struck with severely debilitating diarrhea. Several times she visited her obstetrician, complaining that she had not had a formed stool in over a month. He told her not to worry.

Two weeks before her due date, the diarrhea had gotten out of control and Alice continued to say that the baby was not moving correctly. Again, the doctor said that the baby was in a small space without much room to maneuver and that Alice shouldn't worry so much.

Two days later, Alice told her husband that the baby was dead, that all movement had ceased. He put his head on her tummy and as Alice says, "the panic in his eyes confirmed my fears." They drove to the hospital where Alice delivered a full-term stillbirth child. Alice and Will named the baby Emily.

It took Alice several more years and a near second stillbirth baby before she was diagnosed with celiac disease.

CNN Newsroom Anchor Heidi Collins
Heidi Collins and I first met in person in November 2006 at the International Celiac Disease Symposium in New York City. We immediately bonded over gluten-free food and the desire to help all Americans with celiac disease get accurately diagnosed. And…of course, the need to improve gluten-free food options!

Heidi's passion for helping people with celiac disease comes from more than a decade of suffering debilitating symptoms and, like Alice, losing a child.

Heidi's constant health issues grew nearly intolerable when she moved to CNN's New York office. She continued visiting doctors until finally after 15 years of one health problem after another, her general practitioner diagnosed her with celiac disease. With one simple blood test, Heidi had found a diagnosis that would allow her to work toward a cure for her chronic medical conditions and an answer as to why her pregnancy had failed.

Connie Maltin, my mom
My mom and dad are the two most amazing people in the world. They are the most supportive, kind and generous people I know, making them the perfect candidates for parenthood. My parents were married in February of 1973 after my mom convinced my dad that she made the best cookies in America….little did my mom know that those delicious cookies would cause her and my dad some of the greatest devastation imaginable….miscarriage.

Because of my mom's celiac, it took nine years to successfully have a child, ME, and it was still a close call. I was born two months early and weighed only about three pounds.

To help other families prevent the devastation that Alice, Heidi and my mom experienced, here is some basic information on infertility and reproductive health that explains the link to celiac disease.

Celiac Disease and Infertility Link:
Over the last 10 years, several studies have examined the link between celiac disease and infertility and found that women suffering from unexplained infertility may have clinically silent celiac disease.

• One study conducted by physicians at Thomas Jefferson University Hospital in Philadelphia found that the rate of recurrent spontaneous abortion (RSAB) and infertility in celiac disease patients is at least four times higher than the general population. They suggested that patients who experience unexplained infertility or RSAB should be screened for celiac.
• Another study from the Department of Medicine at Tampere University Hospital and Medical School at the University of Tampere Finland found that the rate of celiac disease among women reporting infertility was 4.1%. Although the exact reason for the increased risk remains unknown, the researchers suggested that female celiac patients who are not adhering to a gluten-free diet have a shortened reproductive period and early menopause. Males with celiac disease have shown gonadal dysfunction, which could also contribute to fertility complications.
• The link between celiac disease and infertility is currently being evaluated by researchers at Molinette Hospital in Turin Italy. Early reports from their research suggest that the prevalence of celiac disease among women with unexplained infertility is 2.5% to 3.5% higher than the control population. They suggest that celiac disease represents a risk for abortion, low birth weight babies and short-breast feeding periods, all of which can be corrected with a gluten-free diet.

What is infertility?
Infertility is defined as the biological inability of a woman or man to contribute to conception. Many experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile. According to the National Center for Health Statistics, roughly 12% of women in the United States—up to 7.3 million—had difficulty getting pregnant or carrying a baby to term in 2002.

Although it is commonly believed that infertility is heavily related to female factors, only about one-third of cases of infertility actually stem from the woman. About one-third of cases originate with the male partner and the remaining cases are a combination of unknown factors or a mix of male and female complications.

Infertility in Women:
Most women who suffer from infertility have a problem with ovulation, meaning there is a complication with the eggs being released to be fertilized. Other causes of infertility include:

• Ovulation issues
• Problems with the uterus lining
• Uterine fibroids
• Blocked fallopian tubes because of endometriosis, ectopic pregnancy, or pelvic inflammatory disease.

Factors that increase a woman's risk of infertility:

• Age
• Diet
• Athletic activity
• Stress
• Overweight or underweight
• Smoking
• Alcohol consumption
• Sexually transmitted diseases (STDs)
• Health problems that cause hormonal changes
• Celiac disease

Infertility in Men:
Infertility in men is generally caused by producing too few or no sperm. The problem may also be the sperm's ability to travel to the female's egg and fertilize it. This is typically caused by abnormal sperm shape that prevents it from traveling in the correct form.

Factors that increase a man's risk of infertility:

   

• Alcohol consumption
• Drugs
• Toxins in the environment such as lead and pesticides
• Smoking
• Chemotherapy and radiation treatment for cancer
• Celiac disease

Tests for Infertility:

   

• Hysterosalpingography: Physicians use x-rays to check for physical problems of the uterus and fallopian tubes. They inject a special dye through the vagina into the uterus, which shows up on the x-ray. This will allow the physician to determine if the dye moves normally through the uterus into the fallopian tubes. With these x-rays, doctors can find blockages that may be causing infertility.
• Laparoscopy: During this surgery doctors use a tool called a laparoscope to see inside the abdomen. The doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.

Treating Infertility:
There are several ways to treat infertility including:

   

• Medicine (clomiphene, Human menopausal gonadotropic, follicle-stimulating hormones, gonadotropic releasing hormones, metformin, and bromocriptine).
• Surgery
• Artificial insemination or assisted reproductive technology.
• Often times treatments are combined.

References:

   

• National Women's Health Information Center (NWHIC)
• American College of Obstetricians and Gynecologists (ACOG) Resource Center
• American Society for Reproductive Medicine
• Resolve: The National Infertility Association

Comments

[Kari]

I had undiagnosed endometriosis since I began menstrating at age 12. It was diagnosed as severe during a routine scope for infertility. After years of drugs, tests, and procedures, we were never successful in conceiving. I have had other auto immune issues such as psoriasis, dry eye syndrome, chronic inflammation, rhuematoid arthritis, Raynaud's syndrome. And most recently localized scleraderma. I sought the advice of a Naturopathic doctor and with 3 weeks of a gluten-free diet, I am convinced that I also suffer from Celiacs disease. Now the unanswered question is did the Celiac's have something to do with the endometriosis, that led to a hysterectomy and the inability to have a child of my own?? Hopefully continued research will make a link and fewer women will have to go thru what I did.

[omolola abiodun]

I am a Nigerian and presently staying in Nigeria i am 37 year old and i was sometimes diagonise of having uterine fibroid thus making conception difficult have been trying to concieve for the past 2 years and pregnancy is not forth coming. Please can you link me with any hospital in United states that specialises in treating fertility problem and also let me have an idea of the total and also visa procedure.

Thank you.