“
“Celiac disease (CD) affects approximately 1% of the population in North America and Western Europe,1, 2 and 3 of whom 0.2% are clinically diagnosed, with women constituting approximately 60%–70% of the clinically diagnosed population.4 The literature reports

several mechanisms through which CD potentially could affect a woman’s fertility such as the presence of abnormal villous structure in the intestine and malabsorption of the nutrients leading to nutritional deficiencies (eg, in zinc, iron, folate, and selenium).5 These nutritional deficiencies are said to selleck affect fertility, however, there is no conclusive evidence on the extent to which this may cause fertility problems in CD.6 A lower Pembrolizumab ic50 level of ghrelin and leptin in women with CD also has been reported to play a role in fertility problems.7 In addition,

a shortened reproductive period with delayed menarche and early menopause also has been cited as an explanation for the reported increase in fertility problems related to CD.8 On the contrary, a study based on 99 women being evaluated for infertility in Sardinia found no delay in the age of menarche in women with diagnosed CD (mean age at menarche, 11.8 y).9 Based on these explanations, several small studies over the years have assessed the link between CD and fertility problems, with some reporting a higher

prevalence of CD in women seeking fertility treatments10 and 11 and some showing no increase compared with the general population.9, 12 and 13 Some of these studies found that although the prevalence of CD was not higher in women with infertility, when restricted to only women with unexplained infertility, the prevalence of CD was significantly higher than in the general population,9, 10 and 14 whereas others did not find any significant association even with unexplained infertility.12 and 13 These studies all were conducted on a very small number of women (the largest study included 535 women) primarily attending infertility specialist services, which represents a very selective group of women in the general ADAM7 population. In addition, these studies did not distinguish the burden of fertility problems in women with diagnosed from undiagnosed CD. Despite these inconsistent findings from small studies, a wide variety of reviews highlight infertility as one of the key nongastrointestinal manifestations in CD.15, 16 and 17 We therefore performed a large population-based study to compare the rates of new clinically recorded fertility problems in a group of women with and without celiac disease that are representative of the UK population.