In a recent paper in Gut, describing a Swedish population-based cohort, Zugna et al found that women with coeliac disease had normal fertility, but their fertility had decreased in the 2 years preceding the diagnosis of coeliac disease.This study provides important answers to fertility problems in patients with coeliac disease by analysing a nationwide database. The results, however, must be interpreted with caution. This paper may be considered confusing because the role of coeliac disease as one of the causes of infertility has been underestimated taking into account population studies in general. Infertility, spontaneous abortion and delayed puberty represent subclinical coeliac disease presentations and, in our opinion, could be resolved on a gluten-free diet (GFD). In fact, there is a significant difference in patients with coeliac disease when comparing the period before initiating a GFD and after commencing the diet.
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