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Celiac Disease in Women With Infertility: A Meta-Analysis
Prashant Singh1, Shubhangi Arora, Suman Lal
1*Department of Medicine, Massachusetts General Hospital †Department of Medicine, Brigham and Women's Hospital, Boston, MA ‡Max Healthcare, Gurgaon ∥Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India §Medical Services Division, Innlandet Hospital Trust, Lillehammer, Norway.
Insights
Celiac disease (CeD) is more common in women experiencing infertility. This includes those with unexplained infertility, suggesting a potential link that warrants further investigation and screening.
Area of Science:
- Gastroenterology
- Reproductive Medicine
- Clinical Research
Background:
- Celiac disease (CeD) is a systemic autoimmune disorder with diverse clinical manifestations.
- Existing data on the association between CeD and infertility remains contradictory.
- Current clinical guidelines lack recommendations for screening infertile women for CeD.
Purpose of the Study:
- To determine if women with infertility have an increased risk of developing Celiac disease.
- To conduct a comprehensive meta-analysis evaluating this association.
Main Methods:
- A systematic literature search was conducted using keywords: "CeD," "gluten," and "infertility."
- CeD diagnosis was confirmed via positive serology and duodenal biopsy showing villous atrophy.
- Data were extracted and analyzed for pooled odds ratios (OR) and prevalence with 95% confidence intervals (CI).
Main Results:
- Women with infertility demonstrated a 3.5-fold increased odds of having CeD compared to controls (OR=3.5).
- The odds were even higher for women with unexplained infertility (OR=6).
- Pooled prevalence of CeD was 2.3% in women with infertility and 3.2% in those with unexplained infertility.
Conclusions:
- Celiac disease is significantly more prevalent in women experiencing infertility, including unexplained cases.
- These findings suggest a potential link between CeD and female infertility.
- Consideration for CeD screening in infertile women may be warranted.
Background:
Celiac disease (CeD) is a systemic disease with manifestations not limited to small intestine. The data on association between CeD and infertility is contradictory. There are no recommendations for the screening of female patients with infertility for CeD.
Aim:
We conducted a meta-analysis to find out whether women with infertility are at higher risk of CeD.
Methods:
Literature search was performed using the MeSH keywords "CeD," "gluten," and "infertility." Diagnosis of CeD was based on positive serology and biopsies showing villous atrophy. Data were extracted about CeD patients in 3 groups-women with infertility (including unexplained infertility), unexplained infertility, and controls. Pooled odds ratio (OR) and prevalence, with 95% confidence intervals (CI), were calculated.
Results:
Of 105 relevant studies, 5 studies were included for calculation of pooled OR. Four additional studies, where data on controls were not available, were also considered for calculation of pooled prevalence of CeD. Women with infertility had 3.5 times higher odds of having CeD in comparison with control population (OR=3.5; 95% CI, 1.3-9; P<0.01). Similarly, women with "unexplained infertility" had 6 times higher odds of having CeD than controls (OR=6; 95% CI, 2.4-14.6). Of 884 women with infertility, 20 had CeD indicating a pooled prevalence of 2.3% (95% CI, 1.4-3.5). Of 623 women with "unexplained infertility," 20 had CeD. The pooled prevalence of CeD in women with unexplained infertility was 3.2 (95% CI, 2-4.9).
Conclusions:
CeD is more prevalent in women with "all-cause" infertility and "unexplained" infertility than that in general population.
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