The research of incidence of celiac disease and autoimmune thyroid disease in cases with diagnosis of unexplained infertility, endometriosis or recurrent abortion Hasan Çılgın1, Yaprak Kandemir Deniz2 1Kafkas Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Kars 2Fırat Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Elazığ

The aim of this study was to determine the probable roles of celiac disease and autoimmune thyroid disease in the etiopathogenesis of infertility by examining the frequency of celiac disease and autoimmune thyroid disease in unexplained infertility , endometriosis and recurrent abortus cases followed by infertility diagnosis.

Celiac disease, a malabsorption syndrome, is characteristic with development of intense inflammation of mucosa of small intestine after gluten containing foods. In addition to malabsorption, it is a metabolic disorder. It may cause infertility in women of reproductive age, spontaneous abortion, preterm labor, intrauterine growth restriction and preeclampsi.

Autoimmune thyroiditis affects many functions of the reproductive life, too. It can impact negatively on ovulation, fertilization and implantation. It leads to abortion and complications of late pregnancy.

This prospective, randomized, cross sectional study was conducted with 126 infertile women attended Firat University Hospital Department of In vitro fertilization. Patients were divided into 3 groups as follows: unexplained infertility (n=42, group1), endometriosis (n=42, group2) and recurrent abortion (n=42, group3). Criteria for the inclusion of volunteers in the survey Uterine anomaly entity, The presence of a genetic factor causing recurrent miscarriages, Bilateral tubal factor presence, Patients with gynecological malignancy detected during infertility evaluations, Early menopausal cases, In recurrent abortus cases, abortions are out of the first trimester.

There was no statistically significant difference in age, height, weight and body mass index parameters between the groups. There was a significant difference between group3 and group1 and group2 in terms of abortus and gravida. The duration of infertility was the longest in group1 and the shortest in group3. Abdominal surgical history was significantly higher in group2 than group1 and group3. The prevalence of gastrointestinal symptoms classified as Rome III criteria were highest in group2, median in group3 and lowest in group1.

There was no significant difference between the groups in terms of antral follicle. There was no statistically significant difference in baseline FSH, LH, estradiol and prolaktin levels at day 3. The comparison of celiac autoantibodies in participants revealed out significant difference between group 1 and group 3 for parameter of antigliadin antibody IgG levels.

For thyroid function tests and thyroid autoantibodies, significant difference was only observed for parameter of free T3 between group1 and group2. Although no statistical significance was found between the groups in terms of anti thyroid peroxidase (+) and anti-thyroglobulin (+) antibodies in all of our patients, group3 was highest and Group2 and 1 were the same.

Anti-thyroglobulin positivity was found in 16 of 126 patients and anti thyroid peroxidase positif in 19 patients. 8 of our patients had thyroid dysfunction.Two of them had anti-thyroglobulin and three had anti thyroid peroxidase positive.

In the unexplained infertile group, anti-thyroid peroxidase antibody was positive in six patients. Three of these patients had hypothyroidism and one had hyperthyroidism. One of the three hypothyroid patients had positive anti-thyroglobulin antibody. Six patients in the endometriosis group had anti- thyroid peroxidase antibody positive. Two patients had hypothyroidism in this group.

One patient was anti-thyroglobulin and anti thyroid peroxidase antibody positivity, and the other patient was autoantibody negative. Seven patients in the recurrent abortion group were positive for anti-thyroid peroxidase antibody. Hypothyroidism is present in 2 of these and thyroid autoantibodies are negative. Anti-thyroid peroxidase positives were present in 2 of 3 patients diagnosed with celiac disease but the patients were euthyroid in terms of thyroid functions.

In our study, 3 of 126 infertile patients (2 In our study, 3 of 126 infertile patients (2.3%) were found to have celiac disease . However 2 of Celiac cases (4.7%) were in recurrent abortion and the others (2.3%) were in endometriosis group. In the 42 unexplained infertile patients group, celiac disease was not detected. In conclusion, the prevalence of celiac disease was higher in infertile population compared to normal population (2% vs 1%), with a rate of 4.7% in recurrent abortion cases.

Infertile women are in a group of patients who need to be examined for subclinical hypothyroidism. It is recommended that infertile women's TSH levels are kept at 2.5 mIU / L or less as it is in every woman before pregnancy. It may be useful to look at thyroid antibodies as well as thyroid function tests in recurrent abortus cases and idiopathic infertility.

We think that if celiac disease is diagnosed before pregnancy and appropriate supportive care is given, a successful end can be achieved without exposure to maternal and fetal complications.

Thank you for your attention