Karaca Nilay, Yılmaz Rabiye, Aktun Lebriz Hale, Batmaz Gonca, Karaca Çetin
Department of Obstetrics and Gynecology, Center of Invitro-fertilization, Türk Diyanet Vakfı 29 Mayıs Hospital, İstanbul, Turkey.
Turk J Gastroenterol. 2015 Nov;26(6):484-6. doi: 10.5152/tjg.2015.0123. Epub 2015 Oct 26.
BACKGROUND/AIMS: Celiac Disease (CD) is a chronic autoimmune disease characterized by small intestinal malabsorbtion and diarrhea, triggered by the ingestion of food products containing gluten. There are studies reporting that some nutritional deficiencies and some factors related to immunity may cause a decrease in fertility as well as some problems in sperm parameters. The prevalence of CD in unexplained infertility (UEI) couples is not as high as that mentioned in some reports. There is no accurate knowledge about the prevalence of CD in a UEI couple.
A total of 68 couples with UEI who were admitted at Türk Diyanet Vakfı 29 Mayıs Hospital Center of in vitro fertilization (IVF) between January and June 2014 were included in this prospective pilot study. The diagnosis of UEI was made with basic infertility tests. A history of CD was questioned in the initial evaluation. Anti-gliadin, anti-endomysial, and tissue transglutaminase antibodies as well as total IgA were tested. Gastroscopy was performed in patients with positive serologic tests. Histopathological CD diagnosis was made according to Marsh criteria.
The mean age of the study population was 33.40±4.59 years. Out of the 65 couples who were included into the study group, one of the five couples was positive for the autoantibodies (7.69%). Out of these 65 couples, none of them had autoantibody positivity at the same time in both partners. Anti-gliadin antibodies were found to be positive for two females out of five couples and in three male partners of the same group. Out of these five couples, only one male partner had all the antibodies as positive (1.5%). In the histopathological examination of patients with positive autoantibodies, only the patient in whom all autoantibodies were positive had findings compatible with Marsh IIIa gluten enteropathy. Only one couple had a diagnosis of CD (1.5%).
In many studies, CD was shown to affect the reproductive system of women. CD may also cause a decrease in fertility in men by affecting sperm motility and androgen levels. Our study is based on a limited sample size. Our data should be confirmed in a larger cohort of subjects. These results suggest that investigation of both couples with a diagnosis of UEI may be more beneficial in clarifying the etiology.
背景/目的：乳糜泻（CD）是一种慢性自身免疫性疾病，其特征为小肠吸收不良和腹泻，由摄入含麸质的食品引发。有研究报告称，一些营养缺乏以及一些与免疫相关的因素可能导致生育力下降以及精子参数出现一些问题。不明原因不孕症（UEI）夫妇中CD的患病率并不像某些报告中提到的那么高。对于UEI夫妇中CD的患病率尚无准确认知。
本前瞻性试点研究纳入了2014年1月至6月期间在土耳其宗教基金会5月29日医院体外受精（IVF）中心就诊的68对UEI夫妇。通过基本不孕症检查做出UEI的诊断。在初始评估中询问CD病史。检测抗麦醇溶蛋白、抗肌内膜和组织转谷氨酰胺酶抗体以及总IgA。血清学检测呈阳性的患者进行胃镜检查。根据马什标准做出组织病理学CD诊断。
研究人群的平均年龄为33.40±4.59岁。纳入研究组的65对夫妇中，五对夫妇中有一对自身抗体呈阳性（7.69%）。在这65对夫妇中，双方同时自身抗体呈阳性的情况不存在。五对夫妇中有两对女性以及同一组的三名男性伴侣抗麦醇溶蛋白抗体呈阳性。在这五对夫妇中，只有一名男性伴侣所有抗体均呈阳性（1.5%）。自身抗体呈阳性患者的组织病理学检查中，只有所有自身抗体均呈阳性的患者有与马什IIIa型麸质肠病相符的表现。只有一对夫妇被诊断为CD（1.5%）。
在许多研究中，CD被证明会影响女性生殖系统。CD也可能通过影响精子活力和雄激素水平导致男性生育力下降。我们的研究基于有限的样本量。我们的数据应在更大的受试者队列中得到证实。这些结果表明，对诊断为UEI的夫妇双方进行调查可能对明确病因更有益。
