title: Risk of infertility in patients with celiac disease: a meta-analysis of observational studies.
abstract: BACKGROUND
  Celiac disease is an autoimmune disorder of the small intestine associated with several extra-intestinal features, such as reproductive disorders. The relationship between celiac disease and infertility has been previously assessed, with conflicting results.
  
  
  OBJECTIVE
  We seek to determine the relationship between celiac disease and infertility.
  
  
  METHODS
  Data was extracted from case-control or cohort design studies from 1966 to December 2013 using the MEDLINE-Pubmed, EMBASE, LILACS and Cochrane Library databases. We analyzed two kinds of trials: those assessing the risk of infertility in subjects with already diagnosed celiac disease, and those evaluating the prevalence of undiagnosed celiac disease in subjects with a diagnosis of infertility.
  
  
  RESULTS
  The search yielded 413 potentially relevant studies for revision, 12 of which were finally included for analysis. A significant association was found between women with a diagnosis of infertility and undiagnosed celiac disease [OR 3.09 (95% CI 1.74-5.49)]. When considering those studies assessing the occurrence of infertility in subjects with already-diagnosed celiac disease, no difference was found between celiac disease patients and control subjects [OR 0.99 (0.86-1.13)].
  
  
  CONCLUSIONS
  Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients.
authors.affiliation: Gastroenterology Division, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica - CEMIC, Buenos Aires, Buenos Aires, Argentina.
authors.forename: Juan Sebastian
authors.initials: JS
authors.lastname: Lasa
authors.affiliation: Gastroenterology Division, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica - CEMIC, Buenos Aires, Buenos Aires, Argentina.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Zubiaurre
authors.affiliation: Gastroenterology Division, Internal Medicine Department, Centro de Educación Médica e Investigación Clínica - CEMIC, Buenos Aires, Buenos Aires, Argentina.
authors.forename: Luis Oscar
authors.initials: LO
authors.lastname: Soifer
mesh_terms: D002446:Celiac Disease / Q000150:complications*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D064887:Observational Studies as Topic; D015995:Prevalence; D012307:Risk Factors