Sarah Keogh, Registered Dietician
April 2025
One of the things that surprises people is that coeliac disease can cause infertility. Untreated coeliac disease can make it harder for both men and women to become parents; it increases the risk of miscarriage and can even cause still birth. Despite this, it is not common for people struggling with fertility to be tested for coeliac disease.
So when do you need to be tested?
Don’t wait for gut symptoms
One of the big problems when it comes to coeliac disease and fertility is that people are still waiting for gut symptoms. Around 60% of people with coeliac disease will have some sort of gut issue – from diarrhoea to constipation, bloating, stomach pain and excess wind.
However, 40% of people may have very mild or no gut symptoms but still have coeliac disease. Meaning you can have coeliac disease even if your gut seems just fine. So, what else can you look out for?
Other signs of coeliac disease include:
Low iron, low vitamin B12, low folate, or low vitamin D.
An itchy, blistery skin rash, often on both elbows or both knees (although it can be anywhere on your body).
Migraine, fatigue, brain fog and poor coordination.
Mouth ulcers and poor tooth enamel.
Or you can have no symptoms at all.
If you are struggling with fertility, then it is worth ruling out coeliac disease for both partners even if neither of you have any symptoms.
Is it in the family?
Coeliac disease is genetic and if you have a family member with coeliac disease you have more than a 1 in 10 chance of being coeliac yourself. If you have an aunt or cousin, then you have a 1 in 20 chance of being coeliac.
Other conditions linked to coeliac disease?
People with Type 1 diabetes or underactive thyroid are both more likely to have coeliac disease. The genes that cause coeliac disease are the same genes that cause type 1 diabetes and underactive thyroid. So, if anyone in your family has these conditions, you are more likely to have coeliac disease.
Irritable bowel syndrome
Irritable bowel syndrome is often undiagnosed coeliac disease. Lots of members of the Coeliac Society report that they had a “funny tummy” for years before being diagnosed but thought it was just a bit if irritable bowel. It turns out that around 20% of people with irritable bowel syndrome, actually have coeliac disease.
Lactose intolerance
Coeliac disease can cause lactose intolerance. This is usually temporary and most people can go back onto lactose after about 6 months on a strict gluten free diet. Studies show that 24% of people with lactose intolerance actually have coeliac disease.
How does the gluten free diet help with fertility?
Folic Acid/Folate
One of the big nutrients affected by coeliac disease is folate or folic acid. Folic acid is essential for a healthy pregnancy. Women need to take a supplement of 400 micrograms of folic acid for 3 months before becoming pregnant and throughout the pregnancy. Coeliac disease reduces the absorption of folic acid from your diet and women with coeliac disease often have low levels in their blood. Once you are on a strict, gluten free diet, your body will start to absorb folic acid again, but it can take up to 2 years for levels to go back to normal. If you are planning a pregnancy at this time, you may need a much higher dose of folic acid – often 5000 micrograms per day. You will need a prescription from your doctor for this.
Iron
Low iron is linked with an increased risk of miscarriage and can make it more difficult to become pregnant. As with folic acid, you will start to absorb iron properly again once you are on a gluten free diet. However, if you have had low iron in your blood (haemoglobin) or low ferritin (your iron stores) you will probably need an iron supplement for 3-6 months to get your levels back to normal. Do speak to your dietitian about how to do this and what dose to take.
Antibodies
When someone with coeliac disease eats gluten. It triggers their body to make antibodies that can attack different parts of the body. This can happen in the gut where people will get gut symptoms. However, it can also happen in the bones, nervous system and womb. Avoiding gluten helps to keep all you the body healthy for people with coeliac disease and studies show a big improvement in fertility once people are on a gluten free diet.
Does a strict gluten free diet benefit men and fertility?
Definitely! When the gut is not absorbing nutrition, then it is more difficult for men to make healthy sperm in good numbers. Being diagnosed with coeliac disease and starting a strict gluten free diet helps nutrition to get to where it needs to, to improve sperm count and motility.
How to get tested?
1. Keep eating gluten – you need to be eating gluten for at least 6 weeks before being tested for coeliac disease.
2. See your GP for a coeliac blood test. Ask your doctor to check for iron, folate, vitamin B12 and vitamin D at the same time.
3. If you blood test is positive, you will need a biopsy – which is painless and is a quick day visit to the hospital.
4. Once you are diagnosed make sure you see a registered dietitian for detailed advice on a strict gluten free diet and fertility nutrition.
Any questions? Email us at info@coeliac.ie or follow us on Instagram @coeliacireland.
