Dr Lynn Burmeister: ‘I see patients with unexplained infertility with undiagnosed coeliac disease’
Fertility specialist Lyn Burmeister explains how this condition could be a treatable contributor to infertility issues – but why it’s otherwise not worth cutting out gluten.
Dr Lynn Burmeister Fertility specialist
Most people know coeliac disease as a gut problem. It’s an auto-immune reaction to gluten that causes abdominal pain, bloating or diarrhoea, and can severely impact quality of life, especially when left untreated. But what many don’t realise is how this immune-mediated condition can quietly influence reproductive health long before any digestive symptoms ever appear.
In Australia, about one in 70 people have coeliac disease, yet only about one-fifth know it. While 50 per cent of the population carry the ‘coeliac gene’, only 1 per cent will have the disease.
At our clinics, I see women who have coeliac disease, both diagnosed and undiagnosed, and though it’s far from the most common contributor to infertility, your body is out of balance and stressed. What we know from both Australian and global research, which is also evidenced in our clinics, is there is a clear subset of women with unexplained infertility or recurrent pregnancy loss, who will turn out to have undiagnosed coeliac disease. It’s not the cause in the majority, but in those cases it’s often a treatable contributor. If you’re trying to get pregnant and you have an existing condition – like coeliacs – it needs to be managed and treated, because when your body is busy fighting itself, it’s not fully focused on getting pregnant.
Dr Lynn Burmeister says she sees patients who are undiagnosed coeliac. For successful fertility treatment, we need to look after the whole person, and that means getting conditions like coeliac disease under control. The connection between coeliac disease and fertility isn’t straightforward, and the evidence isn’t unanimous, which reflects just how complex both human reproduction and auto-immune disease are. Large population studies haven’t found a clear overall reduction in fertility among women with coeliac disease compared with those without it. However, a compelling body of scientific evidence indicates several ways untreated coeliac disease can interfere with reproductive health:
Nutrient malabsorption: Coeliac disease damages the small intestinal lining, which can lead to deficiencies in iron, folate, zinc and other micronutrients essential for ovulation, conception and early pregnancy.
Inflammation and immune activation: As an auto-immune condition, coeliac disease triggers chronic inflammation that may disrupt hormone regulation, menstrual cycles and ovarian function. Emerging research suggests higher risks of conditions like ovarian dysfunction, PCOS and endometriosis among women with coeliac disease.
Reproductive outcomes: Undiagnosed coeliac disease has been linked with increased rates of miscarriage and reduced pregnancy rates, and some adverse obstetric outcomes. Importantly, several studies show that treatment with a gluten-free diet tends to normalise these risks. Together, this means coeliac disease, especially when unrecognised, caninterfere with fertility through nutritional, hormonal and immune pathways. Importantly, the evidence does not support a gluten-free diet for fertility improvement in people without coeliac disease.
Importantly, a gluten-free diet is not something that will improve fertility if someone doesn’t have coeliac disease. We know that if coeliac disease has been ruled out through appropriate testing, there’s no proven benefit to gluten avoidance purely for conception, but we always suggest removing refined carbohydrates (like cakes, chips andlots of pasta) from your diet when you’re trying to conceive, and adopting a Mediterranean diet, high in healthy fats instead.
For those with coeliac disease:
•A strict, lifelong gluten-free diet is the best way to keep symptoms under
control. It allows the gut to heal, improves nutrient absorption and reduces
systemic inflammation, all of which support overall health and fertility.
•Nutrient deficiencies should be corrected. Iron, folate and vitamin D levels
are particularly important in the preconception period and early pregnancy.
•Screening for coeliac disease is often recommended in those with
unexplained infertility, recurrent miscarriage, persistent iron deficiency
despite supplementation, or a family history of coeliac disease.
•For those who suspect non-coeliac gluten sensitivity (a condition distinct
from coeliac disease), the science on reproductive effects is still very limited,
but if you eat something and it doesn’t make you feel good, it’s better to avoid it.
Tips:
Get appropriate testing first.
Blood tests for coeliac-specific antibodies (and confirmatory biopsy if
indicated) should be done before starting a gluten-free diet to avoid false
negatives.
If diagnosed with coeliac disease:
Follow a strict gluten-free diet lifelong, work with a dietitian to rebuild your
micronutrients status, which are important for ovulation and early pregnancy
and monitor iron, folate, vitamin D and B12 levels through blood tests with
your GP or specialist.
Your specialist may consider coeliac testing if you have:
Unexplained infertility or recurrent miscarriage, persistent iron deficiency or
B-vitamin deficiencies, or a family history of coeliac disease.
Don’t self-diagnose gluten intolerance as a fertility fix.
Avoiding gluten without confirmed coeliac disease may not help fertility and
can complicate nutritional intake.