What role does tTG IgA play in fertility?

tTG IgA (tissue transglutaminase antibodies) is a biomarker for celiac disease. Untreated celiac disease can impair fertility through nutrient malabsorption (iron, folate, zinc) and chronic inflammation, affecting menstrual regularity, implantation, and sperm quality. Evidence comes from observational studies and case series; no RCTs prove that screening for tTG IgA improves fertility outcomes. A positive tTG IgA test suggests possible celiac disease, which should be confirmed by duodenal biopsy and treated with a gluten-free diet. Caveat: false positives occur (IgA deficiency, other autoimmune conditions); a negative test does not rule out non-celiac gluten sensitivity. tTG IgA is not a routine fertility test, but may be considered in unexplained infertility or recurrent miscarriage. Evidence: mechanistic/observational. Sources: none directly in context.