Janet Choi Links Celiac Disease to Infertility

Janet Choi has established a clear link between undiagnosed celiac disease and a significant percentage of infertility cases.

Columbia University fertility researcher Janet Choi has established a clear link between undiagnosed celiac disease and a significant percentage of infertility in female subjects in a study published in the May-June 2011 issue of The Journal of Reproductive Medicine.

Choi was the lead author of a study that evaluated 191 female patients presenting with infertility. Each participant underwent serologic screening for celiac disease as well as routine infertility testing. The 4 patients who had positive serum test results were advised to seek evaluation with a gastroenterologist. All 4 patients were confirmed to have celiac disease. They then underwent nutritional counseling to change over to a gluten-free diet.

Significantly, all 4 patients found to have celiac disease conceived within a year of diagnosis and abstaining from foods containing wheat gluten.

Celiac disease is an autoimmune disorder caused by a reaction to gliadin, a gluten protein found in wheat, and similar proteins found in other common grains like barley and rye. Upon exposure to gliadin the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to villous atrophy, a truncating of the villi lining the small intestine, severely compromising absorption of nutrients. The only known treatment is a gluten-free diet. Symptoms include chronic diarrhoea, failure to thrive (in children), and fatigue. Symptoms in other organ systems have also been reported. The condition is thought to affect between 1 in 1,750 and 1 in 105 people in the United States.

Among the 188 patients who completed testing, the prevalence of undiagnosed celiac disease was 2.1%. While this rate was not significantly higher than the expected 1.3%, the diagnosis of celiac disease in women with unexplained infertility was found to be significantly higher at 5.9% (3 of 51 women).

Though the study numbers are small, the findings suggest that, at least for some women with infertility, dietary measures may help bolster fertility.

“Diagnosing celiac disease in an infertile woman would be particularly beneficial if the low-cost (and low-risk) therapy of pursuing a gluten-free diet could improve chances for conception,” says Choi, a reproductive endocrinologist at the Center for Women’s Reproductive Care at Columbia University.

Co-author Dr. Peter Green, director of the Celiac Disease Center at Columbia University Medical Center, said that these results should be added to the increasing body of knowledge concerning the impact of undiagnosed celiac disease on women’s reproductive health.

Janet Choi, M.D., is an assistant professor of obstetrics and gynecology at Columbia University Medical School. She is a graduate of Columbia Medical School.

Celiac Disease Center at Columbia University Medical Center provides comprehensive medical care for adults and pediatric patients with celiac disease, including nutrition and attention to the multiple associated conditions that occur in celiac disease. The Center is involved in the care of thousands of patients with celiac disease and gluten intolerance. Additional information is available online at www.celiacdiseasecenter.org.