Correlation Between Celiac Disease Patients and Infertility

Amena Lafeta Muttlaq Al-Shareefi

doi:10.55640/ijmsdh-11-10-06

Open Access

Correlation Between Celiac Disease Patients and Infertility

Vol. 11 No. 10 (2025): Volume 11 Issue 10 | Pages: 46-64 | https://doi.org/10.55640/ijmsdh-11-10-06

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Amena Lafeta Muttlaq Al-Shareefi
Department of Pharmacognosy and Medicinal Plants, College of Pharmacy, University of Thi-qar, Thi-qar 64001, Iraq

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Published Date: 2025-10-09
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Correlation Between Celiac Disease Patients and Infertility. (2025). International Journal of Medical Science and Dental Health, 11(10), 46-64. https://doi.org/10.55640/ijmsdh-11-10-06

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Abstract

Celiac disease (CD) an autoimmune disorder triggered by gluten,can indeed have complex relationship with in fertility in both women and men .The inflammation and damage in the intestines can disrupt hormone levels ,potentially interfering with ovulation and the menstrual cycle.

The present study was designed to investigate some biochemical aspects of patients with (CD) in Al habobi Hospital in al-nasirya in Thi-Qar provine The present work included some Celiac disease patients who are already diagnosed as CD patients that by the consultant medical staff, according to clinical examination, symptoms,during the period from October 2024 to march 2025. Samples of the study included 20 patients which female and 20 healthy control to study Vitamin D3 , S. Ferritin levels and Concentrations of the sex hormones prolactin, testosterone, estradiol, follicle-stimulating hormone, and luteinizing hormone were measured from the serum samples of recumbent patients with age range of (18-36 years).

The recorded results indicated that their where Vitamin D3 levels were significantly higher in the control group (37.47 ± 10.18) compared to the (CD) patient group (16.27 ± 7.04). A strong statistical significance at P. value 0.01, suggesting that (CD) patients may have a notable deficiency in vitamin D3. S. Ferritin was also much higher in the control group (49.45 ± 23.47) than in (CD) patients (11.01 ± 4.36), with a strong statistical difference at P value 0.01 . This could indicate iron deficiency or altered iron storage in the (CD) patient group. FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) levels were both significantly lower in the (CD) patient group compared to controls. FSH was( 5.41 ± 2.13) in controls vs. ( 3.74 ± 1.96) in patients, and LH was (6.71 ± 2.49) in controls vs. (4.90 ± 1.65) in patients at P. value 0.05 . These hormones are crucial for reproductive function, and their reduction might reflect hormonal imbalance. Prolactin levels were higher in the (CD) patient group (12.51 ± 4.47) compared to the control group (7.04 ± 2.80) at P. value 0.01. Elevated prolactin can affect menstrual cycles and fertility. Testosterone was also significantly elevated in the (CD) patient group (1.76 ± 0.98) compared to controls (0.52 ± 0.57) at P. value 0.01. This may suggest a condition like polycystic ovary syndrome (PCOS), which is often associated with elevated androgens. Estradiol levels were similar between the two groups, with no statistically significant difference (39.98 ± 15.91) in controls vs.( 41.11 ± 8.75) in (CD) patients).The Pearson correlation analysis for (CD) patients group revealed a moderate negative correlation between Vitamin D3 and both seurm ferritin (r = -0.435) and prolactin (r = -0.433), suggesting that lower vitamin D3 levels may be associated with higher ferritin and prolactin levels. Other correlations involving vitamin D3—such as with FSH, LH, testosterone, and estradiol—were weak and not likely meaningful. Estradiol showed a weak negative correlation with ferritin, and a moderate positive correlation with LH (r = 0.378), possibly indicating a hormonal link. Prolactin showed a moderate positive correlation with ferritin (r = 0.481) and weak negative correlations with FSH and LH. The remaining correlations across testosterone, FSH, and LH were weak and did not demonstrate strong linear relationships. The Pearson correlation analysis in control showed weak to moderate relationships among the studied parameters in control group. Vitamin D3 levels were negatively correlated with FSH and testosterone, suggesting a possible inverse relationship, while its correlations with other hormones were weak and likely not significant. Estradiol showed a moderate negative correlation with ferritin, indicating that higher estrogen levels might be associated with lower iron storage. Testosterone levels were negatively correlated with ferritin but positively correlated with FSH, reflecting some hormonal interaction. Other correlations, such as those involving prolactin, LH, and FSH, were generally weak and did not suggest strong linear relationships.

References

.C, Catassi. E,F, Verdu. J,C, Bai. E, Lionetti . ''Coeliac diseas'', Lancet. 399, 2413–2426. (2022).

.A, Al-Toma. U, Volta. R, Auricchio. G ,Castillejo. D, S, Sanders. C ,Cellier. C,J, Mulder. K,E,A ,Lundin. '' European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorder'', United EurGastroenterol. J. 7, 583–613. ( 2019).

.T,R ,Halfdanarson . M,R ,Litzow . J,A, Murray . ''Hematologic manifestations of celiac diseas'', Blood. 2007;109:412–421. ( 2006).

.R, Martيn-Masot . M,T, Nestares . J,Diaz-Castro . I, Lَpez-Aliaga . M,J,M, Alférez . J, Moreno-Fernandez . J , Maldonado. '' Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review'', Nutrients.11:2557. (2019).

.A ,Lopez-Vazquez. L, Rodrigo. D, Fuentes. S, Riestra. C, Bousoٌo . S, Garcia-Fernandez. J, Martinez-Borra. S ,Gonzalez. C, Lopez-Larrea.''MHC class I chain related gene A (MICA) modulates the development of coeliac disease in patients with the high risk heterodimer'', DQA1*0501/DQB1*0201. Gut. (2002).

. Hershcovici T, Leshno M, Goldin E, et al: Cost-effectiveness of mass screening for celiac disease is determined by time-delay to diagnosis and quality of life on a gluten free diet. Aliment. Pharmacol. Ther. 1(8), 901–910 (2010).

.Stephen EH, Chandra A: Declining estimates of infertility in the United States: 1982–2002. Fertil. Steril. 86(3), 516–523 (2006).

. Green PHR, Stavropoulos SN, Panagi SG, et al: Characteristics of adult celiac disese in the USA: results of a national survey. Am. J. Gastroenterol. 96(1), 126–131 (2001).

. Batinic, B., Ljubic, A., Culic, S., et al. Iron status and reproductive outcome: A prospective study in women undergoing assisted reproduction. Journal of Maternal -Fetal & Neonatal Medicine, 33(1), 40–46. https://doi.org/10.1080/14767058.2018.

. Schappert SM, Burt CW: Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 2001–2002. Vital Health Stat. 13. 159, 1–66 (2006).

.M,M ,Leonard. A,Sapone. C, Catassi. A, Fasano.''Celiac disease and nonceliac gluten sensitivity A review'', JAMA. 318. 647–656. (2017).

. W, Quarpong. T,R, Card. J, West. M, Solaymani-Dodaran. R,F, Logan. M,J, Grainge. '' Mortality in people with coeliac disease: Long-term follow-up from a Scottish cohort'', United Eur. Gastroenterol. 7, 377–387.(2019).

.K, Lindfors. C, Ciacci. K, Kurppa. K,E,A, Lundin. G,K, Makharia. M,L, Mearin. M,J,A, urray. E,F, Verdu, K, Kaukinen.''Coeliac diseas'', Nature reviews.5, 3.(2019).

.P,Singh . S, Arora. A , Singh. ''Prevalence of celiac disease in Asia: a systematic review and meta-analysis'', J GastroenterolHepatol. 3: 1095–101.(2016).

–E,Lionetti. C, Catassi.''New clues in celiac disease epidemiology, pathogenesis, clinical manifestations, and treatmen'', Int Rev Immunol.30(4):219–31.(2011).

– R,Tortora . F, Zingone . A, Rispo. C, Bucci. P, Capone. N, Imperatore. ''Coeliac disease in the elderly in a tertiary centr'', Scand J Gastroenterol.51(10):1179–83.(2016).

– A ,FasanoI, Berti. T, Gerarduzzi. T, Not. R,B, Colletti. S,Drago. ''Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study'', Arch Intern Med.163(3):286–92.(2003).

- T, Dieckman. F, Koning. G, Bouma.''Celiac disease: New therapies on the horizon, Curr , Opin'', Pharmacol. 66, 102268.(2022).

- B, Jabri. L,M, Sollid.''T Cells in Celiac Disease'', J. Immunology. 198, 3005–3014. (2017).

- E, Alhassan. A,Yadav. C,P, Kelly. R ,Mukherjee.''Novel Nondietary Therapies for Celiac Disease'', Cell. Mol. Gastroenterol. Hepatol. 8, 335–345.(2019).

- G, Goel. J,A,Tye-Din. S,W, Qiao. A,K, Russell. T, Mayassi. C ,Ciszewski. V,K, Sarna. S ,Wang. K,E, Goldstein. J,L, Dzuris.''Cytokine release and gastrointestinal symptoms after gluten challenge in celiac disease'', Sci. Adv.5, eaaw7756.(2019).

. Tye-Din, J.A.; on behalf of the RESET CeD Study Group; Daveson, A.J.M.; Goldstein, K.E.; Hand, H.L.; Neff, K.M.; Goel, G.;Williams, L.J.; Truitt, K.E.; Anderson, R.P. Patient factors influencing acute gluten reactions and cytokine release in treated coeliacdisease. BMC Med, 18, 362. (2020).

-L,A, Cecilio. M,W, Bonatto.''The Prevalence Of Hla Dq2 And Dq8 In Patients With Celiac Disease, In Family and in General Population'', Arq. Bras. Cir. Dig. 28, 183–185.(2015).

-G, Mazzarella.''Effector and suppressor T cells in celiac disease'', World J. Gastroenterol. 21, 7349–7356.( 2015).

-R, La Scaleia. M, Barba. G, Di Nardo. M, Bonamico. S ,Oliva. R,Nenna. F, Valitutti. M, Mennini. M, Barbato. M, Montuori.''Size and dynamics of mucosal and peripheral IL-17A+ T-cell pools in pediatric age, and their disturbance in celiac disease'', Mucosal Immunology. 5, 513–523. (2012).

-I, Parzanese. D, Qehajaj. F, Patrinicola. M, Aralica. M, Chiriva-Internati S, Stifter. L, Elli. F, Grizzi.''Celiac disease: From pathophysiology to treatment'', World J. Gastrointest. Pathophysiol. 8, 27–38.(2017) .

-J,F, Ludvigsson. J,C, Bai. F, Biagi. T, Card. C,Ciacci. P,J, Ciclitira. P,H,R,Green. M, Hadjivassiliou. A, Holdoway. D, van Heel.''Diagnosis and management of adult coeliac disease: Guidelines from the British Society of Gastroenterology'', Gut. 63,1210–1228.(2014).

-F, Cataldo. G, Montalto.''Celiac disease in the developing countries: A new and challenging public health problem'', World J.Gastroenterol. 13, 2153–2159. (2007).

-S, Vivas. L, Vaquero. L, Rodrيguez-Martيn. A, Caminero.''Age-related differences in celiac disease: Specific characteristics of adult presentation'', World J. Gastrointest. Pharmacol. Their. 6, 207–212.(2015).

-K,E, McGowan. D,A, Castiglione. J,D, Butzner.''The Changing Face of Childhood Celiac Disease in North America: Impact of Serological Testing'', Pediatrics. 124, 1572–1578.(2009).

-S,Vivas. J,M,R, de Morales. M, Fernandez. M, Hernando. B,Herrero. J, Casqueiro. S, Gutierrez.''Age-Related Clinical,Serological, and Histopathological Features of Celiac Disease'', Am. J. Gastroenterol. 103, 2360–2365. (2008).

. Volta, U.; De Giorgio, R.; Granito, A.; Stanghellini, V.; Barbara, G.; Avoni, P.; Liguori, R.; Petrolini, N.; Fiorini, E.; Montagna, P et al. Anti-ganglioside antibodies in coeliac disease with neurological disorders. Dig. Liver Dis. (2006), 38, 183–187.

-Y, Sahin.''Celiac disease in children: A review of the literature'', J. Clin. Pediatric. 10, 53–71.(2021).

-G, Caio. U, Volta. A, Sapone. D,A,Leffler. R, De Giorgio. C, Catassi. A, Fasano. ''Celiac disease: A comprehensive currentreview'', BMC Med. 17, 142. (2019).

-J,F,Ludvigsson. D,A, Leffler. J,C, Bai. F, Biagi. A, Fasano. P,H,R, Green. M, Hadjivassiliou. K,Kaukinen. C,P, Kelly. J,N, Leonard.''The Oslo definitions for coeliac disease and related and related terms'',Gut. 62, 43–52. (2013).

-M, Khatib. R,D, Baker. E,K, Ly. R, Kozielski. S,S, Baker.''Presenting Pattern of Pediatric Celiac Disease'', J. Pediatr. Gastroenterol Nutr.62, 60–63. (2016).

-C, Gallegos. R, Merkel. ''Current Evidence in the Diagnosis and Treatment of Children With Celiac Disease'', Gastroenterol. Nurs Off. J. Soc. Gastroenterol. Nurses Assoc. 42, 41–48. (2019).

-I,D, Hill. A, Fasano. S, Guandalini. E, Hoffenberg. J, Levy. N, Reilly. R, Verma. ''NASPGHAN Clinical Report on the Diagnosisand Treatment of Gluten-related Disorders'', J. Craniofacial Surg. 63, 156–165.(2016).

-S,Husby. S, Koletzko. I, Korponay-Szabَ. K, Kurppa. M,L, Mearin. C ,Ribes-Koninckx. R, Shamir. R, Troncone. R, Auricchio. G,Castillejo. ''European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020'', J. Craniofacial Surg. 70, 141–156. (2020).

-F, Panetta. G, Torre. F,Colistro. F,Ferretti. A, Daniele. A, Diamanti.''Clinical accuracy of anti-tissue transglutaminase asscreening test for celiac disease under 2 years'', ActaPaediatric. 100, 728–731.(2011).

- D, Poddighe. D, Abdukhakimova.''Celiac Disease in Asia beyond the Middle East and Indian subcontinent: Epidemiological burden and diagnostic barriers'', World J. Gastroenterol. 27, 2251–2256.(2021).

-L, Downey. R, Houten. S, Murch. D, Longson. ''Recognition, assessment, and management of coeliac disease: Summary of updated NICE guidance'', BMJ 351, h4513. (2015).

-M,Fewtrell. J,Bronsky. C, Campoy. M, Domellِf. N,Embleton. N,F, Mis. I, Hojsak. J,M,Hulst. F, Indrio. A, Lapillonne. ''Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition ESPGHAN) Committee on Nutrition'', J. Pediatric. Gastroenterology Nutrition . 64, 119–132.(2017).

-J,A, Silvester. A, Therrien. C,P, Kelly.''Celiac Disease: Fallacies and Facts'', Am. J. Gastroenterol. 116, 1148–1155. (2021).

.Wasilewski T, Łukaszewicz-Zając M, Wasilewska J, Mroczko B. Biochemistry of infertility. Clin Chim Acta. (2020);508:185–190.

.Datta J, Palmer MJ, Tanton C, Gibson LJ, Jones KG, Macdowall W, et al. Prevalence of infertility and help seeking among 15 000 women and men. Hum Reprod. (2016);31(9):2108–2118.

.WHO. Infertility is a global public health issue. Available from: https:// www.who.int/reproductivehealth/topics/infertilityperspective/en/. (26 Nov 2019).

.Slade P, O'Neill C, Simpson AJ, Lashen H. The relationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic. Hum Reprod. (2007);22(8):2309–2317.

.Ajayi OO, Charles-Davies MA, Arinola OG. Progesterone, selected heavy metals and micronutrients in pregnant Nigerian women with a history of recurrent spontaneous 2.abortion. Afr Health Sci. (2012); 12(2): 153–159.

.Morris JS, Adjukiewicz AB, Read AE. Coeliac infertility: an indication for dietary gluten restriction? Lancet. (1970); 1(7640): 213–214.

.Khizroeva J, Nalli C, Bitsadze V, et al. Infertility in women with systemic autoimmune diseases. Best Pract Res Clin Endocrinol Metab.(2019); 33(6): 101369.

.Sharif K, Watad A, Bridgewood C, et al. Insights into the autoimmune aspect of premature ovarian insufficiency. Best Pract Res Clin Endocrinol Metab. (2019); 33(6): 101323.

.Sen A, Kushnir VA, Barad DH, et al. Endocrine autoimmune diseases and female infertility. Nat Rev Endocrinol. (2014); 10(1): 37–50 .

.Casella G, Orfanotti G, Giacomantonio L, et al. Celiac disease and obstetrical-gynecological contribution. Gastroenterol Hepatol Bed Bench. (2016); 9(4): 241–249.

.Kreutz JM, Adriaanse MPM, van der Ploeg EMC, et al. Narrative review: nutrient deficiencies in adults and children with treated and untreated celiac disease. Nutrients. (2020); 12 (2).

.Grieger JA, Grzeskowiak LE, Wilson RL, et al. Maternal selenium, copper and zinc concentrations in early pregnancy, and the association with fertility. Nutrients. (2019); 11(7).

.Fallah A, Mohammad-Hasani A, Colagar AH. Zinc is an essential element for male fertility: a review of Zn roles in men’s health, germination, sperm quality, and fertilization. J Reprod Infertil. (2018); 19(2): 69–81.

.Michels KA, Wactawski-Wende J, Mills JL, et al. Folate, homocysteine and the ovarian cycle among healthy regularly menstruating women. Hum Reprod. (2017); 32(8): 1743–1750.

.Mahadev S, Laszkowska M, Sundström J, et al. Prevalence of celiac disease in patients with iron deficiency anemia-a systematic review with meta-analysis. Gastroenterology. (2018); 155(2): 374–382.

.Castaño M, Gómez-Gordo R, Cuevas D, et al. Systematic review and meta-analysis of prevalence of coeliac disease in women with infertility. Nutrients. (2019); 11(8).

.Grode L, Bech BH, Plana-Ripoll O, et al. Reproductive life in women with celiac disease; a nationwide, population-based matched cohort study. Hum Reprod. (2018); 33(8): 1538–1547.

.Gunn B, Murphy KE, Greenblatt EM. Unexplained infertility and undiagnosed celiac disease: study of a multiethnic canadian population. J Obstet Gynaecol Can. (2018); 40(3): 293–298.

.Grode LB, Agerholm IE, Humaidan P, et al. Unrecognised coeliac disease among men and women undergoing fertility treatment: a screening study. United European Gastroenterol J.( 2018); 6(10): 1477–1484.

.Singh P, Arora A, Strand TA, et al. Diagnostic accuracy of point of care tests for diagnosing celiac disease: a systematic review and meta-analysis. J Clin Gastroenterol. (2019); 53(7): 535–542.

.Esteve M, Rosinach M, Llordés M, et al. Case-finding in primary care for coeliac disease: Accuracy and cost-effectiveness of a rapid point-of-care test. United European Gastroenterol J. (2018); 6(6): 855–865.

.Grode L, Møller Jensen T, Parkner T, et al. Diagnostic Accuracy of a Point-of-Care Test for Celiac Disease Antibody Screening among Infertile Patients. Inflammatory Intestinal Diseases. (2019); 4(3): 123–130.

.Kotze LM, Mallmann A, Miecznikowski RC, et al. Reproductive aspects in brazilian celiac women. Arq Gastroenterol. (2020); 57(1): 107–109.

.Cakmak E, Karakus S, Demirpence O, et al. Ovarian reserve assessment in celiac patients of reproductive age. Med Sci Monit. (2018); 24: 1152–1157.

.Samsami A, Ghasmpour L, Moradi Alamdarloo S, et al. Women with Autoimmune Thyroiditis have Lower Reproductive Life Span or Not? A Cross- Sectional Study. Int J Community Based Nurs Midwifery. (2020); 8(4): 305–310.

.Lerchbaum, E., & Obermayer-Pietsch, B. (2012). Vitamin D and fertility: A systematic review. European Journal of Endocrinology, 166(5), 765–778.

.Li, H. W., Brereton, R. E., Anderson, R. A., Wallace, W. H., & Ho, P. C. (2019). Vitamin D deficiency is common and associated with poor ovarian reserve in Asian infertile women. PLoS One, 14(5), e0215124.

.Liu, N. Q., & Hewison, M. (2012). Vitamin D, the placenta and pregnancy. Archives of Biochemistry and Biophysics, 523(1), 37–47.

. Irani, M., & Merhi, Z. (2014). Role of vitamin D in ovarian physiology and its implication in reproduction: A review. Reproductive Biology and Endocrinology, 12(1), 80.

.Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266–281.

.Pal, L., Berry, A., Coraluzzi, L., et al. (2016). Therapeutic implications of vitamin D and calcium in overweight women with PCOS. Gynecological Endocrinology, 32(5), 340–344.

.Anifandis, G., Dafopoulos, K., Messini, C. I., Polyzos, N. P., & Messinis, I. E. (2018). The impact of vitamin D supplementation in women undergoing in vitro fertilization: A prospective cohort study. Gynecological Endocrinology, 34(1), 51–54.

.Beard, J. L., Hendricks, M. K., Perez, E. M., et al. (2005). Maternal iron deficiency anemia affects postpartum emotions and cognition. The Journal of Nutrition, 135(2), 267–272.

. Batinic, B., Ljubic, A., Culic, S., et al. (2020). Iron status and reproductive outcome: A prospective study in women undergoing assisted reproduction. Journal of Maternal-Fetal & Neonatal Medicine, 33(1), 40–46.

.Gaskins, A. J., Mumford, S. L., Chavarro, J. E., et al. (2014). A prospective study of serum iron levels and fertility outcomes among women undergoing assisted reproduction. Human Reproduction, 29(3), 500–507.

.Schaefer, E., & Barkan, D. (2021). Iron homeostasis in the endometrium: Emerging roles in reproduction and fertility. Frontiers in Physiology, 12, 628122.

-N, Gujral. ''Celiac disease: Prevalence, diagnosis, pathogenesis and treatment'', World J. Gastroenterol.18, 6036–6059.( 2012).

- Stazi, A.V.; Trecca, A.; Trinti, B.''Osteoporosis in celiac disease and in endocrine and reproductive disorders'',World J. Gastroenterol.( 2008), 14, 498–505.

-H,M, Ndez-Bañares. H, Monzón. M, Forné. ''A short review of malabsorption and anemia'', World J. Gastroenterol.15, 4644–4652.(2009).

-J,M, Kreutz. M,P,M, Adriaanse. E,M,C, Van Der Ploeg. A,C,E, Vreugdenhil.''Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease'', Nutrients. 12, 500.(2020).

- S, Dong. T,P, Singh. X, Wei. H, Yao. H, Wang.''Protective Effect of 1,25-Dihydroxy Vitamin D3 on Pepsin-Trypsin-ResistantGliadin-Induced Tight Junction Injuries'', Dig. Dis. Sci. 63, 92–104.(2018).

-N, Charoenngam. M,F, Holick.''Immunologic Effects of Vitamin D on Human Health and Disease'', Nutrients. 12, 2097.(2022).

-G, Mailhot.J,H, White.''Vitamin D and Immunity in Infants and Children'', Nutrient. 12, 1233. (2021).

- N,S, Akimbekov. I, Digel. D,K, Sherelkhan. Lutfor. M,S, Razzaque.''Vitamin D and the Host-Gut Microbiome: A BriefOverview'', ActaHistochem. Cytochem.53, 33–42.( 2021).

-M,B, Zimmermann. J, Köhrle.''The Impact of Iron and Selenium Deficiencies on Iodine and Thyroid Metabolism: Biochemistryand Relevance to Public Health'', Thyroid. 12, 867–878. (2002).

-H, Gunshin. B, MacKenzie. U,V, Berger. Y, Gunshin. M,F, Romero. W,F,Boron. S,Nussberger. J,L, Gollan. M,A, Hediger.''Cloning and characterization of a mammalian proton-coupled metal-ion transporter'', Nat. Cell Biol. 388, 482–488. (1997).

-M, Shayeghi. G,O, Latunde-Dada. J,S, Oakhill. A,H, Laftah. K ,Takeuchi. N, Halliday. Y, Khan. A, Warley. F,E, McCann. R,C, Hider. ''Identification of an Intestinal Heme Transporter'', Cell. 122, 789–801.(2005).

- H,J, Freeman.''Iron deficiency anemia in celiac disease'', World J. Gastroenterol. 21, 9233–9238.( 2015).

-U, Krupa-Kozak.''Pathologic bone alterations in celiac disease: Etiology, epidemiology, and treatment'', Nutrition.30, 16–24.(2014).

.Tarek, M., Abdelrahman, R., & Helmy, H. (2020). Subclinical iron deficiency as a hidden cause of female infertility: A pilot study. Middle East Fertility Society Journal, 25, 10.

[ 95].Li J, You Y, Yue W, Jia M, Yu H, Lu T, Wu Z, Ruan Y, Wang L, Zhang D. Genetic evidence for possible involvement of the calcium channel gene CACNA1A in autism pathogenesis in Chinese Han population. PLoS One 10: e0142887, (2015).

.Luk J, Torrealday S, Neal Perry G, Pal L. Relevance of vitamin D in reproduction. Hum Reprod 27: 3015–3027, (2012).

.Mousa A, Abell S, Scragg R, de Courten B. Vitamin D in reproductive health and pregnancy. Semin Reprod Med 34: e1–e13, (2016).

. Muscogiuri G, Altieri B, de Angelis C, Palomba S, Pivonello R, Colao A, Orio F. Shedding new light on female fertility: the role of vitamin D. Rev Endocr Metab Disord 18: 273–283, (2017).

. Paffoni A, Ferrari S, Viganٍ P, Pagliardini L, Papaleo E, Candiani M, Tirelli A, Fedele L, Somigliana E. Vitamin D deficiency and infertility: insights from in vitro fertilization cycles. J Clin Endocrinol Metab 99: E2372–E2376, (2014).

. Franasiak JM, Lara EE, Pellicer A. Vitamin D in human reproduction. Curr Opin Obstet Gynecol 29: 189–194, (2017).

.Miyazaki S, Yuzaki M, Nakada K, Shirakawa H, Nakanishi S, Nakade S, Mikoshiba K. Block of Ca2+ wave and Ca2+ oscillation by antibody to the inositol 1,4,5-trisphosphate receptor in fertilized hamster eggs. Science 257: 251–255, (1992).

.Influence of Vitamin D supplementation on reproductive: https://pmc.ncbi.nlm.nih.gov/articles /PMC989671.

.Vitamin D and Fertility Related? - Reproductive Health and Wellness Center: https://reproductivehealthwellness.com/vitamin-d-and-fertility.

.Vitamin D in Reproductive Health Disorders: A Narrative Review Focusing on Infertility, Endometriosis, and Polycystic Ovarian Syndrome - MDPI: https://www.mdpi.com/1422-0067/26/5/2256.

.Vitamin D and Infertility: The Evidence | Fertility & Reproduction - World Scientific Publishing: https://www.worldscientific.com/doi/10.1142/S266131821950004X

.Effects of Vitamin D on Fertility, Pregnancy and Polycystic Ovary Syndrome—A Review: https://pmc.ncbi.nlm.nih.gov/articles/PMC9029121.

.How Vitamin D Affects Your Fertility: https://www.shadygrovefertility.com/article/how-vitamin-d-affects-your-fertility

.Does Treating Iron Deficiency Improve Fertility Outcomes? - The ObG Project: https://www.obgproject.com/2025/04/17/does-treating-iron-deficiency-improve-fertility-outcomes .

.Association between iron deficiency and fertility - PubMed: https://pubmed.ncbi.nlm.nih.gov/39817704.

.Ferritin And Iron Deficiency: How Low Iron Levels Affect Fertility - Lola&Lykke: https://lolalykke.com/sv/blogs/mamma-manualer/ferritin-and-iron-deficiency-fertility.

.Do Iron Levels Affect Fertility & Conception?: https://kinfertility.com.au/blog/iron-and-fertility.

.Can Iron Levels Impact Fertility and Conception? - Ferty9: https://www.ferty9.com/blog/iron-deficiency-impacts-fertility.

Abdullah UH, Lalani S, Syed F, Arif S, Rehman R. Association of vitamin D with outcome after intra cytoplasmic sperm injection. J Matern Fetal Neonatal Med 30: 117–120, (2017).

. Aquila S, Guido C, Middea E, Perrotta I, Bruno R, Pellegrino M, Andٍ S. Human male gamete endocrinology: 1alpha, 25-dihydroxyvitamin D3 (1,25(OH)2D3) regulates different aspects of human sperm biology and metabolism. Reprod Biol Endocrinol 7: 140, (2009).