What Research Says About How Gluten May Be Impacting Your Fertility

Could a gluten-free diet help you beat infertility and finally get pregnant? Maybe. A big, big maybe.

Gluten is a popular enemy these days. It's blamed for everything from bipolar disorder to obesity. Look around online, and you’ll find dozens of websites claiming gluten causes infertility. These sites paint with a wide brush. Some imply that all or many cases of infertility are caused by gluten intolerance or undiagnosed celiac disease.

There’s no research to support these gluten-causes-infertility claims. Not on such a grand scale. But that doesn’t mean gluten isn’t to blame in specific cases.

Researchers are looking at how undiagnosed celiac disease and non-celiac gluten sensitivity (or gluten intolerance) may be a part of unexplained symptoms and diseases. Including infertility.

Here are six possible ways gluten may be to blame for why you can’t get pregnant.


Unexplained Infertility and Undiagnosed Celiac Disease

Photo of an undressed woman holding wheat in front of her abdomen, metaphor for infertility and gluten intolerance or celiac disease
Peter Dazeley / Photographer's Choice / Getty Images

Celiac disease is an autoimmune disease where the small intestines are damaged by gluten. When left untreated, celiac can cause nutritional deficiencies and seriously compromise a person’s health.

Celiac affects 1% of the general population. (Some say this number is low and that there are many undiagnosed cases.)

Some men and women with celiac disease have symptoms that lead to a diagnosis early in life. However, others will show no symptoms or very vague symptoms. Diagnosis may be delayed (or never happen).

Just because the symptoms are absent or vague doesn’t mean the damage to the person’s small intestine and general health is not happening.

Untreated celiac disease has been associated with a number of health problems, including cancer, severe nutritional deficiencies, and infertility.

Undiagnosed Celiac Disease, Recurrent Miscarriage, and Infertility

Could infertility be one of the “vague” symptoms indicating celiac disease?

Studies of the general infertile population have not found increased rates of celiac disease. However, all that changes when looking at unexplained infertility.

Depending on the study, women (and possibly men) with unexplained infertility are two to six times more likely to be diagnosed with celiac disease.

Women who experience recurrent miscarriage may also be more likely to be diagnosed with celiac disease than the general population.

What happens when those with undiagnosed celiac disease and start a gluten-free diet, in regards to pregnancy?

There aren’t a lot of studies looking at this.

One study of 84 celiac adults and 18 celiac adolescents looked at the effect on general reproductive health after starting a gluten-free diet.

Prior to the diet, many participants experienced delayed menarche (a woman’s first period), anovulation, and miscarriage.

After starting the gluten-free diet, some participants began ovulating and conceived naturally.

Participants who did not stick to the gluten-free diet continued to have delayed menarche or ovulation problems.

In a letter to the medical journal Gut, a professor reports the case of four women, ages 28 to 39, who had experienced infertility for two to 12 years.

After beginning a gluten-free diet, the women finally conceived. (The time period from starting the gluten-free diet to conception was between two and nine months.)

In this group of four women was a 39-year-old woman who had been trying to conceive for 11 years. She had experienced several failed IVF treatments.

After starting the gluten-free diet, she conceived nine months later. That first pregnancy ended too soon, but finally, two years after diagnosis and starting the diet, she delivered a healthy baby.

In another very small study, four women with previously unexplained infertility were diagnosed with celiac disease. They all started a gluten-free diet.

One patient conceived without fertility treatment just one month after changing her diet.

A second patient required surgery to remove a rapidly enlarging fibroid. One month after surgery, she was diagnosed with celiac disease and started a gluten-free diet. She conceived naturally four months after the surgery, three months after starting the diet.

The third patient conceived with gonadotropins and IUI eight months after celiac diagnosis and diet change.

The fourth patient conceived ten months after diagnosis and diet change via a frozen embryo transfer.

These case studies don’t offer strong enough evidence to say a gluten-free diet was the cause of their pregnancy success. Clearly, sometimes the diet wasn’t enough. Some required surgery or fertility treatment, possibly in addition to the diet change.

Still, it’s interesting. Especially when you consider that studies looking at those with known celiac disease — who are already on a gluten-free diet — seem to find that they are not more likely to experience infertility than the general population.


Non-Celiac Gluten Sensitivity and Fertility

Woman with upset stomach holds her abdomen, could be cause of infertility
BSIP/UIG / Universal Images Group / Getty Images

Non-celiac gluten sensitivity is an umbrella term meant to cover people who react to gluten but not due to celiac disease or a wheat allergy. Also known as gluten intolerance, this non-specific condition is not well understood.

Researchers aren’t sure if non-celiac gluten sensitivity (NCGS) is one condition or possibly a part of several conditions.

Of course, not every person who self-diagnoses themselves is truly gluten intolerant. It’s difficult to rule out the placebo effect.

It does seem that celiacs and those with wheat allergies aren’t the only ones who react poorly to gluten. Not everyone with NCGS is experiencing just a placebo effect.

(By the way, those articles your Aunt Bertha shares on Facebook declaring non-celiac gluten sensitivity a myth? Not so. No research has completely discounted the phenomena. Though people do get really inflamed by the topic, for some strange reason.) 

Studies of NCGS have found that these patients share some symptoms of celiac disease and even wheat allergy. What they don’t have is the small intestinal damage, visibly seen in celiac patients.

If untreated, celiac disease can lead to fertility problems, and those with NCGS share some celiac symptoms, could those with untreated NCGS also experience decreased fertility?

Could Non-Celiac Gluten Sensitivity Cause Infertility?

Research is seriously lacking in this area. There are two interesting studies to consider.

One study conducted at the University of California looked at the role chronic disease plays in fertility. Untreated (and possibly undiagnosed) celiac disease and inflammatory bowel disease (which includes ulcerative colitis and Crohn's disease) can cause infertility and pregnancy loss. For that matter, even those being treated for inflammatory bowel disease can experience infertility.

Infertility isn’t only caused by disease or malfunction rooted in the reproductive system. The body works as a whole, and when one thing goes wrong, it can impact other systems.

Non-celiac gluten sensitivity may one day be added to the list of gastrointestinal disorders associated with decreased fertility.

There’s an interesting case study reported by the Institute of Health & Society University of Worcester, United Kingdom.

The study tells the story of a couple trying to conceive unsuccessfully for four years. The woman was in her late thirties, had a history of IBS (something many people with NCGS seem to present with), asthma, and previous miscarriages. She had relatives with celiac disease and diabetes, but she herself did not have these conditions.

Overall, her health looked good. Her weight was normal; she was ovulating. She tested negative for sexually transmitted diseases, and her hormonal profile all looked fine.

But she couldn’t get pregnant.

Her partner’s health also looked good overall, except for suffering from IBS symptoms as well. Semen analysis did reveal poor sperm morphology (sperm shape). Doctors recommended IVF with ICSI to overcome the poor morphology.

Despite getting good quality embryos, the couple did not conceive.

Long story short, the couple decided to try a gluten-free diet. The woman’s intestinal discomfort didn’t improve on the gluten-free diet, but the man’s did.

In fact, the man’s semen quality also improved with the diet change. Enough for them to try IVF without ICSI.

While waiting to start the next treatment, the couple conceived naturally. Sadly, she miscarried 10 weeks later.

Finally, after a year on a gluten-free diet — after six years of trying to conceive, many failed IVF cycles, and multiple miscarriages — the couple was able to conceive with IVF. The pregnancy was complicated, and the baby was born prematurely at 30 weeks.

The gluten-free diet did seem to improve the male partner’s fertility in a measurable way, bringing his sperm morphology (sperm shape) numbers to normal.

Could the gluten-free diet be why she was finally able to remain pregnant long enough to have a baby?


Gluten, Natural Killer Cells, and Autoimmune Infertility

Wool doll natural killer cell engulging a wool cancer cell
Hiroshi Watanabe / Stockbyte / Getty Images

The topic of reproductive immunology is fascinating and not something many people are aware of.

Some cases of unexplained infertility, repeated IVF failure, and recurrent miscarriage may be connected to the body’s immune system overreacting.

While reproductive immunology is controversial, and research is ongoing, treatment of these fertility issues has helped couples conceive who could not find success previously.

Could gluten play a role?

Natural Killer Cells, Gluten, and Infertility

One area of reproductive immunology involves natural killer cells, or NK cells. They sound like a bad thing to have but actually,​ you want NK cells.

NK cells are an important part of the immune system. They are a type of white blood cell. They work to destroy possibly cancerous cells and virus-infected cells.

Problems begin when there are too many or when they start attacking healthy cells.

Having a high percentage of NK cells is suspected of being a possible cause of recurrent miscarriage and failed embryo implantation during IVF.

Reproductive immunologists also look at how lethal the NK cells are. In this case, more lethal is not good.

How does this relate to gluten?

A study of NK cells in the lab and in mice found that exposure to gliadin (part of the gluten protein) increased NK cell presence, toxicity, and activity.

There’s currently no research on how this works in the human body.

ANA, Infertility, and Gluten

Another area of reproductive immunology relates to the topic of anti-nuclear antibodies, or ANA. The presence of ANA cells indicates that your body may be attacking itself.

ANA levels are tested when an autoimmune disorder like lupus or rheumatoid arthritis is suspected.

However, otherwise healthy people sometimes test positive for ANA levels. It's not clear why.

The presence of ANA cells is suspected of causing problems with embryo implantation during IVF treatment.

How does this relate to gluten?

A study conducted in Italy looked at people with celiac disease, IBS, and non-celiac gluten sensitivity.

They found that people with celiac disease and non-celiac gluten sensitivity were more likely to test positive for anti-nuclear antibodies than those with just IBS.

More specifically, they found that...

  • 46% of those with non-celiac gluten sensitivity tested ANA positive
  • 24% of those with celiac disease
  • 2% of those with IBS 

Gluten and Endometriosis

Woman with hot water bottle who has cramps from endometriosis
STOCK4B / Getty Images

Endometriosis affects over 5.5 million women in North America. It can cause infertility and pelvic pain.

Women often go years before diagnosis.

No specific studies have looked at the effect gluten may have on pregnancy success in women diagnosed with endometriosis.

There is research on endometrial pain and gluten, including a case study of a woman with endometriosis and undiagnosed celiac disease.

Does Gluten Cause More Pelvic Pain?

A study in Italy looked at 207 women suffering from severe endometriosis-related pelvic pain.

All of the women were put on a gluten-free diet for one year. After the year, they were asked to report back on their pain levels.

One hundred fifty-six patients — or 75% — reported statistically significant improvements of their painful symptoms. About 25% didn’t report any improvements, and none reported increased pain.

The women also reported improvements in other areas of life, including general health perception, physical functioning, vitality, and mental health.

Could dropping gluten also improve pregnancy success in women with endometriosis?

That’s unknown at this time.

Endometriosis and Undiagnosed Celiac Disease

There is, however, an interesting case study of a woman with endometriosis and undiagnosed celiac disease.

Reported in the journal of Clinical and Experimental Obstetrics and Gynecology, a woman age 34 was experiencing infertility. She never had children before. She already had a diagnosis of endometriosis and IBS.

She underwent surgery three times ​to remove endometrial deposits and painful ovarian cysts. After surgery, she attempted to conceive for two years without success.

Next, Clomid and gonadotropins were tried, as well as IUI treatment. She did get pregnant during IUI but miscarried.

Then, her physician tested her for celiac disease.

The results came back positive, both in the blood work and via intestinal biopsy.

She was put on a gluten-free diet.

Her “IBS symptoms” (which were more likely celiac symptoms) improved.

However, most importantly, after six months, she conceived on her own without further treatment.

The pregnancy had no complications, and she delivered a healthy baby.


PCOS, Gluten, and Insulin Resistance

Woman testing her blood sugar
Tom Merton / Caiaimage / Getty Images

The role of diet and polycystic ovarian syndrome (PCOS) is continually being studied.

So far, the majority of PCOS diet research focuses on low carb and low glycemic index diets.

These diets often seriously reduce gluten, just because many gluten-containing products are high carb or are high on the glycemic index. These diets are not gluten-free.

No studies have looked at the potential connection between PCOS and gluten. 

However, studies have looked at a possible connection between gluten and diabetes.

PCOS is a known risk factor for diabetes, specifically insulin resistance.

In fact, the diabetes drug metformin is considered a treatment for PCOS related infertility.

The possible connection between gluten and diabetes may (by a far stretch) give us a hint of how gluten might impact those with PCOS.

Diabetes and Gluten

In studies with non-obese mice, being on a gluten-free diet reduced the risk of developing type-1 diabetes from 64% to 15%.

This may also be true in humans.

Research conducted in France looked at how celiac disease may be associated with autoimmune diseases, including diabetes.

Thousands of patients, from 27 different gastroenterology centers across France, participated.

Those who were diagnosed early with celiac disease — and therefore were on a gluten-free diet from a younger age — were significantly less likely to develop diabetes or autoimmune diseases.

About half as likely compared to those not keeping to a gluten-free diet.

In another report, this one a case study, a 6-year old boy was diagnosed with type-1 diabetes. He didn’t have celiac disease, but he went on a gluten-free diet.

He was able to go without insulin therapy and maintain stabilized blood sugar through his gluten-free diet alone.

Clearly, more research is needed. There’s currently no research on how this may all affect fertility or PCOS.


Should You Go Gluten-Free?

Healthy gluten-free dinner
Molly Aaker / Moment Open / Getty Images

Of course, the main question you’re probably wondering now is... should I go gluten-free?

Unless you have celiac disease, there is no definitive medical research showing that a gluten-free diet will help you get pregnant. Not yet, anyway.

We need more studies on the subject. One day, there may be more evidence connecting gluten intolerance to specific causes of infertility.

However, you don’t want to get pregnant one day. You want to get pregnant now.

As always, you should talk to your doctor first.

But if you want to try going gluten-free, maybe you should.

As long as you go gluten-free in a healthy way, it can’t hurt.

As the researchers of one study pointed out, when you compare the cost and potential adverse effects of fertility treatment to the cost and adverse effects of going gluten-free, why not encourage some couples to give it a try?

Especially those who don’t have any other answers have gastrointestinal symptoms, or who are experiencing failed fertility treatments.

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