Gluten’s Effects on Pregnancy (Part II): Infertility

Gluten can affect many aspects of pregnancy. From fetal development to the risk of miscarriages and infertility.

This is the second post in a 3-part series. For additional readings on gluten’s effect on pregnancy please see my other articles:

Gluten’s Effects On Pregnancy (Part I): Celiac Disease
Gluten’s Effects On Pregnancy (Part III): Mental Health

There is a lot of research still to be done on gluten’s effect(s) on pregnancy. Based on what we currently know about gluten sensitivities and celiac disease, strict adherence to a gluten-free diet is essential for those couples struggling to become pregnant.

In Canada, 16% of couples have challenges trying to conceive. (1)

That is nearly six million Canadian couples who experience challenges conceiving. Of the six million couples affected, 20%, or over one million couples, suffer from a condition called “unexplained infertility” – infertility resulting from no known cause.

Infertility is the medical label given to a couple that is not able to become pregnant after a certain amount of time. (2) The amount of time depends on the individual’s age. For men and women under the age of thirty-five, infertility is labeled after trying to conceive for over one year. For those between the ages of thirty-five and thirty-seven, infertility is labeled after six months of trying to become pregnant. For those over the age of thirty-eight, infertility is labeled after less than six months of trying to conceive. (3)

For many couples, preexisting health conditions interfere with the body’s ability to conceive. Examples of these health conditions include:

• Thyroid conditions (hypothyroid, Hashimoto’s, hyperthyroid)
• Sexually transmitted infections (past or present)
• Endometriosis
• Pelvic inflammatory disease (PID)
• Polycystic ovarian syndrome (PCOS)
• Overweight or obesity

Unexplained infertility occurs when there are no hormone irregularities, low sperm counts, or other medical conditions known to affect conception. In unexplained infertility, gluten could be the potential culprit. 

What causes infertility?

In its most simple form, infertility can be broken down into two categories:

1. Female infertility
2. Male infertility

This initial exploration will explore the conventional mechanisms behind infertility. Later in the post, I will explore the connection between gluten and unexplained infertility.

Conventional female infertility 

When the cause of infertility exists within the female partner, it is referred to as female infertility. Female infertility factors contribute to approximately 50% of all infertility cases, and female infertility alone accounts for approximately one-third of all infertility cases. (4)

The most common causes of female infertility include:

• Problems with ovulation
• Damage to the fallopian tubes or uterus
• Abnormal cervical mucus
• Problems with the cervix
• Age
• Unknown causes

Conventional male infertility

When the problem lies with the male partner it is referred to as male infertility. Male factors contribute to approximately 30% of all infertility cases, and male infertility alone accounts for approximately one-fifth of all cases. (5)

The most common causes of male infertility include:

• A hypothalamus or pituitary disorder
• Gonad disorder
• Sperm transport disorder
• Unknown causes

The most common cause of infertility in both men and women is labeled as an unknown cause. Unknown causes of infertility are thought to affect nearly 50% of couples. Could a gluten related disorder be to blame?

Gluten and female infertility

We commonly associate celiac disease and gluten sensitivities with abdominal discomfort and diarrhea. Yet it is increasingly becoming recognized as a silent disorder affecting many different body systems. To learn more about the silent nature of gluten disorders, please see this post.

Women diagnosed with celiac disease and/or gluten intolerances are still able to get pregnant. However, the research suggests that these individuals have significant increases in spontaneous abortion, premature delivery, and delayed age of menarche. (6)

Additionally, the presence of celiac disease in infertile women is higher than in the rest of the population. (7,8)

When there are no conventional signs of celiac disease (malnutrition, bloating, abdominal pain, diarrhea, etc.) it is often not investigated. Unfortunately, troubles conceiving could be the symptom of celiac disease in some individuals. 

If you’re having troubles conceiving, and you’ve explored the conventional avenues, a deeper dive into gluten related disorders is a great next step. Often, these women have none of the conventional symptoms of celiac disease. Instead, they exhibit hormonal changes that can include delayed menarche (age of first menstruation), amenorrhea (lack of menstruation) and early menopause. 

These symptoms may, in fact, be the symptoms of silent celiac disease or gluten sensitivities.

In a UK study of 74 women diagnosed with celiac disease, it was found that those still consuming gluten had: (9)

• A shorter reproductive period
• Higher rates of  infertility
• Higher incidences of spontaneous abortions

Those who maintained a gluten-free diet also had a higher birth weight of their babies.

An Italian study noted vast changes in reproductive health in those with untreated celiac disease. These included: (10,11)

• Delayed menarche
  • Menarche is the first occurrence of menstruation.
  • In those with untreated celiac disease, it started at 13 years old. In those without celiac disease, menarche occurred at age 12.
  • It is thought that this delay can contribute to infertility later in life.
• Amenorrhea
  • Amenorrhea is the absence of menstruation.
  • This occurred in 38.8% of patients with untreated celiac disease while only in 9% of those without celiac disease.
• Reduced rate of intercourse
  • Those with untreated celiac disease had significantly less sexual intercourse when compared to those adhering to a gluten-free diet.

Through combining these research studies, we can begin to see connections between gluten and infertility. For those females with celiac disease or a gluten sensitivity, strict adherence to a gluten-free diet is essential to becoming pregnant.

Gluten and male infertility 

The common presentation of childhood celiac disease and gluten sensitivities are described as “failure to thrive”. In children, this often results in insufficient weight gain, shorter statures, and other growth hormones abnormalities.   

The hormonal abnormalities seen in celiac disease will often affect a male’s fertility.

Studies have shown that men with celiac disease and gluten sensitivities tend to have a reduction in male sex hormones (testosterone) and a reduced sperm count. (12) Fortunately, both the sperm count and testosterone levels seem to normalize simply by adhering to a gluten free diet.

How does gluten affect fertility?

At the time of this writing, the specific mechanisms that underly both male and female infertility and their relationship to gluten are not well understood.

The current hypothesis suggests that in males, nutritional imbalances are to blame. Specifically, vitamins A and E. Both of which affect sperm development. Additionally, since those with celiac disease and/or gluten sensitivities also tend to have leaky gut (intestinal permeability) there is thought to be a malabsorption of specific micronutrients required for the metabolism of sex hormones.

In females, the theory remains the same. Nutrient imbalances brought on by celiac disease and gluten sensitivities are thought to increase the risk for amenorrhea. Specifically, iron and b-vitamin deficiencies caused by malabsorption.

Next steps 

There is a lot of research still to be done in this area. Based on what we currently know about gluten sensitivities and celiac disease, strict adherence to a gluten free diet is essential.

If your lab results are all within normal ranges and you’re still having trouble conceiving, exploring celiac disease and gluten sensitivities is a worthwhile endeavor.

Start by taking a quick family history.
Does anyone in your immediate family have celiac disease?
How about an autoimmune disease?
If so, you’re at an increased risk for having either celiac disease or gluten sensitivities.

You can request a celiac screen from your doctor. This is a blood test, and if positive, will involve an intestinal biopsy to confirm the presence of celiac disease. Please keep in mind that while this test does rule in or out celiac disease, it does not indicate the presence (or absence) of gluten sensitivities.

If you’ve ruled out celiac disease with your doctor, and you’re still having troubles, I’d recommend a 30-day paleo reset diet. Additionally, you can work with a functional medicine provider who can recommend additional testing to determine if you have a hidden gluten sensitivity.

Now, I want to hear from you!

What dietary changes helped you to conceive naturally?

Looking for more information? Check out our other blog posts about gluten.