Coeliac Disease in Subfertile Couples in the Netherlands

Abstract

Background: Subfertility has been assumed as a long-term complication of unrecognized and/or untreated coeliac disease (CD). No data exist on the association between subfertility and CD in The Netherlands. Aims: To determine; 1.) the prevalence of (un)recognized CD in subfertile male-female couples in the Netherlands; 2.) if routine antibody screening for CD should be performed in patients visiting a fertility clinic. Methods: Subjects included 1038 male-female couples (n=2076) who visited the fertility clinic of the Leiden University Medical Centre in the Netherlands, between 2003-2009. All patients were serological screened, and unrecognized CD was defined in cases with simultaneous positive test results for antibodies against anti-tissue transglutaminase and endomysium. Clinical data was collected; gender, age, height, weight and diagnosis of subfertility. All patients were anonymized. The prevalence of unrecognised CD was compared to the one in the general adult population in the Netherlands (0.35%) (1) Results: The prevalence of unrecognized CD in subfertile male-female couples was 0.48% (10/2076), 0.3% female and 0.4% male (p=NS). In 1.5% of the women with an ovulation disorder CD was diagnosed (p=0.04). Compared to the control group, similar CD prevalences were found within the other subfertility categories unexplained subfertility, tuba pathology and androgenic disorder (p=NS). Conclusion: In our well-powered study cohort of subfertile male-female couples, the prevalence of unrecognized CD is comparable to the general population in the Netherlands. Unrecognized CD was 5 times more often detected in women with ovulation disorder compared to the control group, which suggest a possible association between CD and subfertility in females. No association was found in subfertile men and couples with unexplained subfertility. We would suggest performing serological screening for CD in females who are visiting the fertility clinic in the Netherlands.