Myths vs facts: tTG IgA and fertility

The tTG IgA test is a screening marker for celiac disease, an autoimmune condition triggered by gluten. Untreated celiac disease has been linked to fertility issues in both women and men, possibly due to malabsorption, hormonal imbalances, or chronic inflammation. Myth: A positive tTG IgA automatically proves that celiac disease is the cause of infertility. Fact: The test is only a screening tool; a definitive diagnosis requires duodenal biopsy. Moreover, many individuals with positive antibodies have no fertility problems, and other factors (e.g., endometriosis, sperm quality) may be more relevant. Myth: A negative tTG IgA rules out celiac-related fertility issues. Fact: In IgA deficiency, the test can be falsely negative; an IgG-based test is then needed. Seronegative celiac disease is also rare but possible. Evidence is moderate: studies show a slightly higher prevalence of celiac disease among those with unexplained infertility, but effect sizes are small. A gluten-free diet can improve fertility in confirmed celiac patients, but it is not a universal solution. Caution: Marketing may overstate the test's role; it does not replace a full fertility workup.