title: Infertility and celiac disease: do we need more than one serological marker?
abstract: OBJECTIVE
  Celiac disease (CD) prevalence is higher in women with infertility. Our study aims were to evaluate the prevalence of undiagnosed CD in Arab infertile women and to explore the usefulness of using more than one serological marker in the diagnostic screening for CD in this population.
  
  
  METHODS
  Women with unexplained infertility (n = 192) and age-matched healthy controls (n = 210) were prospectively enrolled. Serum was tested for human tissue transglutaminase antibodies (TTG), antiendomysial antibodies (EMA), and immunoglobulin A. Intestinal biopsy was offered to women with positive serology or immunoglobulin A (IgA) deficiency.
  
  
  RESULTS
  CD was diagnosed in five infertile women (2.65%) and in one control (0.5%) (p = 0.11). Gastrointestinal complaints were present in 60% (three of five) of women with CD and 11.8% (22 of 187) of women without CD (p = 0.017). Anemia was reported in 80% of infertile women with CD and 4.8% of infertile women without CD (p = 0.0001).
  
  
  CONCLUSIONS
  Undiagnosed CD is prevalent in Arab infertile women as well as in Arab women in general. CD in Arab infertile women is frequently associated with gastrointestinal complaints and anemia. EMA testing is sufficient in suspected cases.
authors.affiliation: Pediatric Gastroenterology and Nutrition Service, Department of Pediatrics, French Hopsital, Nazareth, Israel.
authors.forename: Hussein
authors.initials: H
authors.lastname: Shamaly
authors.forename: Ahmad
authors.initials: A
authors.lastname: Mahameed
authors.forename: Asher
authors.initials: A
authors.lastname: Sharony
authors.forename: Raanan
authors.initials: R
authors.lastname: Shamir
mesh_terms: D000293:Adolescent; D000328:Adult; D018912:Arabs; D001323:Autoantibodies / Q000032:analysis / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D017098:IgA Deficiency / Q000150:complications; D007070:Immunoglobulin A / Q000032:analysis / Q000276:immunology; D007247:Infertility, Female / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D007421:Intestine, Small / Q000473:pathology; D007557:Israel / Q000453:epidemiology; D008403:Mass Screening; D015995:Prevalence; D011446:Prospective Studies; D011503:Transglutaminases / Q000276:immunology
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D007070:Immunoglobulin A; D011503:Transglutaminases