Can Coeliac Disease Impact Fertility?

Dietitian Cassandra Lawless Answers Your Questions

Navigating an autoimmune condition like coeliac disease can be a challenge, especially when you're trying to conceive.

So to help demystify the connection between coeliac disease and fertility, we spoke to Cassandra Lawless, a fertility and pregnancy dietitian with a passion for helping people on their preconception journey.

From understanding how coeliac disease affects nutrient absorption to tips on gluten-free meals, Cassandra answers all your burning questions in this super informative Q&A.

Q: What is coeliac disease, and how does it relate to fertility?

"Coeliac disease is an autoimmune condition where the body reacts to gluten – which is found in major sources like wheat, rye, and barley but also hidden in a lot of products. It creates an immune response where the body attacks itself, specifically targeting the intestines."

Cassandra explains that this response damages the villi, the finger-like projections in the gut responsible for nutrient absorption. "When someone with coeliac disease eats gluten, the villi flatten out, reducing surface area and the ability to absorb nutrients."

This can impact fertility because "the nutrients at risk are exactly those that we want to optimise before getting pregnant," she adds. "The medical management of coeliac disease is following a really strict gluten-free diet, which will help heal the villi."

Q: Can coeliac disease affect my ability to fall pregnant?

"Untreated coeliac disease, or continuing to eat gluten despite a diagnosis, can cause damage to the villi and reduce absorption of nutrients like vitamin D, iron, B12, iodine, folate, and calcium," Cassandra says. "Those are all very important nutrients for fertility and reproductive health."

The good news? "Following your gluten-free diet will allow your intestinal villi to heal, and then you'll be able to absorb nutrients from your food again, which is crucial to fertility and reproductive outcomes."

Cassandra emphasises the importance of seeking expert guidance: "Make sure you're booking an appointment with myself or a fertility and pregnancy dietitian so we can ensure all those nutrients are fully optimised or we're correcting any deficiencies prior to pregnancy."

Q: I've been gluten-free for six months. Is that enough time to prepare for pregnancy?

"It can take up to 12 months for your intestinal villi to heal, and everyone is very individual," Cassandra explains. "Make sure you're talking to a gastroenterologist and getting that biopsy to see whether your intestinal villi has healed."

Cassandra points out that following a gluten-free diet is only part of the picture: "We also need to look at your overall eating because I find a lot of my clients who go on a gluten-free diet sometimes compromise on quality. Many gluten-free products tend to be lower in fibre, protein, and B vitamins. Here in Australia, they don't have to have added folate, so there's a higher risk of not getting enough."

Q: What if I've had coeliac disease for years and follow a strict gluten-free diet?

"If you've had coeliac disease for years, we still need to look at your overall eating regime and make sure all those important fertility nutrients are optimised prior to conception," Cassandra advises. "Yes, we need to be following a gluten-free diet, but it's also about your overall nutrition."

Q: My husband has coeliac disease but doesn't stick to a gluten-free diet. Could this affect our fertility?

"Yes, it can," Cassandra says. "When it comes to male nutrition, they're not immune to this affecting their fertility." She explains that the same process of villi damage occurs in men, reducing their ability to absorb critical fertility nutrients like vitamin D, zinc, iodine, folate, and calcium.

"If your husband has coeliac disease, I would very strongly recommend for them to be following a strict gluten-free diet as well because these nutrients are very important for reproductive health and sperm health."

Q: What are some quick and easy gluten-free snack and meal ideas?

"You can get seedy crackers or whole-grain brown rice crackers and pair them with protein like cheese, cottage cheese, or tinned tuna. Naturally gluten-free snacks like nuts, fruit, and yoghurt are great too."

For meals, Cassandra says: "You could do an easy protein like steak or fish paired with frozen vegetables and naturally gluten-free grains like rice, quinoa, or buckwheat. For something even easier, try a tinned tuna or salmon salad mixed with beans, fresh greens, olive oil, and vinegar."

For more gluten-free inspiration, she recommends following her on Instagram @cassandra_lawless. "I'm constantly popping meal and snack ideas on there because 90% of my recipes are gluten-free."

Final words of advice.

"If you've just been diagnosed with coeliac disease, know that it can be overwhelming and hard to navigate," Cassandra says. "Make sure you book an appointment with myself or a fertility and pregnancy dietitian."

"We can make sure you've got a clear guide and that we're maximising your preconception nutrients to optimise your reproductive health and fertility."