BACKGROUND AND OBJECTIVE: Previous studies suggest that women with coeliac disease (CD) have reproductive difficulties but the data are often inconclusive and contradictory. Fertility in women with biopsy-verified CD was examined. METHODS: Swedish population-based cohort study. Duodenal/jejunal biopsy data on CD (Marsh III; villous atrophy (VA); n=18,005 unique women) were collected from all (n=28) pathology departments in Sweden. From this dataset, 11,495 women with CD, aged 18-45 years, were identified at some point before the end of follow-up. Multinomial logistic regression and Cox regression were used to estimate fertility in these women compared with that in 51,109 age-matched reference women. Fertility was defined as the number of children according to the Swedish Multi-Generation Register. Results During follow-up, 16,309 births occurred in women with CD and 69,245 in the reference women. The cumulative number of children slightly increased in women with CD compared with the reference group. Adjusting for age, calendar period and parity and stratifying by education, the overall fertility hazard ratio (HR) in CD was 1.03 (95% CI 1.01 to 1.05). Specifically, the fertility HR was 1.05 (95% CI 0.96 to 1.14) for CD diagnosed in women before 18 years, 1.04 (95% CI 1.01 to 1.07) for CD diagnosed in women between 18 and 45 years and 1.02 (95% CI 0.99 to 1.04) for CD diagnosed in women > 45 years of age. Taking date of CD diagnosis into account, fertility was decreased 0-2 years before time of diagnosis (HR=0.63; 95% CI 0.57 to 0.70), was identical to that of controls 0-5 years subsequent to diagnosis and increased to 1.12 (95% CI 1.03 to 1.21) thereafter. Conclusion Overall, women with CD had a normal fertility, but their fertility was decreased in the last 2 years preceding CD diagnosis.