PATHOPHYSIOLOGICAL BASES OF THE RELATIONSHIP BETWEEN PERIODONTAL DISEASE AND FEMALE FERTILITY

• DOI: https://doi.org/10.22533/at.ed.

• Palavras-chave: Female infertility; Periodontitis; Oxidative stress; Endometrium; Ovarian reserve; Systemic health.

• Keywords: Female infertility; Periodontitis; Oxidative stress; Endometrium; Ovarian reserve; Systemic health.

• Abstract: Female infertility is a multifactorial condition affecting approximately 17.5% of the world’s population. Recently, periodontitis, a chronic inflammatory disease resulting from oral biofilm dysbiosis, has been identified as a critical systemic risk factor. The translocation of pathogens such as Porphyromonas gingivalis (Pg) and the release of pro-inflammatory cytokines (TNF-α, IL-1β) into the bloodstream establish a mechanistic link that compromises the homeostasis of the female reproductive system. To elucidate the immunoinflammatory and molecular mechanisms by which periodontal disease interferes with female fertility, emphasizing the impacts on ovarian physiology and endometrial receptivity. The study is based on a critical analysis of scientific evidence, integrating epidemiological data from the WHO, international classifications of periodontal diseases, and findings from multicenter clinical studies. Furthermore, it utilizes the support of animal experimental models for the analysis of histomorphometric and molecular variables (follicular reserve and hormone receptor expression) that could not be detailed in humans due to ethical limitations. In the reviewed articles, evidence demonstrates that periodontitis significantly increases the time to conception (TTC) from 5.0 to 7.1 months. In addition, at the ovarian level, the inflammatory load induces oxidative stress and mitochondrial dysfunction, promoting follicular apoptosis and oocyte DNA damage. In the uterus, Pg infection and the increase in matrix metalloproteinases (MMP-8) cause an abnormal upregulation of estrogen (ER-α) and progesterone (PR) receptors, preventing decidualization and embryo implantation. Additionally, periodontal comorbidity acts as an inflammatory amplifier in patients with PCOS and endometriosis, exacerbating the severity of these conditions. Periodontitis acts as an aggressive systemic modulator of reproductive function. The integration between the periodontium and the reproductive axis is sustained by an inflammatory-oxidative cascade that impairs both oocyte quality and the endometrial microenvironment. Therefore, periodontal health must be considered an inseparable pillar of family planning, making dental screening essential in assisted reproduction protocols to optimize the chances of conceptual success.