Gluten: when it genuinely matters

Cutting gluten is one of the most common self-directed changes women make while trying to conceive. The evidence supports something more specific: screening for celiac disease, not blanket avoidance.

Pooled prevalence of biopsy-confirmed celiac disease in women with infertility is around 0.7%, with seroprevalence of 1.3–1.6% — modest, but some individual studies report 4–8% in unexplained infertility specifically. NICE recommends testing for celiac disease in women with unexplained reduced fertility or recurrent miscarriage. It is a cheap blood test for a fully treatable condition.

Untreated celiac disease is associated with infertility, recurrent miscarriage, intrauterine growth restriction, low birth weight and preterm delivery — and a gluten-free diet significantly reduces those elevated risks. But in people who have been diagnosed and treated, infertility prevalence does not exceed the general population.

The practical order matters. Celiac testing requires you to still be eating gluten. If you remove it first, the test can come back falsely negative and you lose the answer. Ask for the test before making the change.