The periodontal-female reproductive axis and infertility: a scoping review of epidemiological and mechanistic evidence

BACKGROUND: Periodontitis is a prevalent chronic inflammatory disease with recognized systemic implications. Its potential link to female reproductive disorders, including infertility, endometriosis, and recurrent implantation failure (RIF), has attracted growing attention, though the evidence remains heterogeneous and largely observational. This scoping review aimed to map available evidence on this relationship, identify shared biological mechanisms, and highlight gaps warranting future investigation.

METHODS: Following PRISMA-ScR guidelines, four databases (PubMed/MEDLINE, Scopus, Cochrane Library (CENTRAL) and Web of Science) were searched with no date restriction, supplemented by grey literature. Two independent reviewers screened records using the PCC framework; 22 studies were included.

RESULTS: Eight epidemiological studies showed heterogeneous findings; prospective data suggest a possible modest reduction in fecundability associated with periodontitis, though effect sizes vary, confidence intervals are wide, and exposures were largely self-reported. Serological evidence is consistent with an association between periodontal pathogen exposure and unexplained infertility. Mechanistic studies (in vitro and animal models) suggest plausible biological pathways, but human clinical validation is lacking.

CONCLUSIONS: Current evidence suggests a plausible, though unconfirmed, association between periodontal disease and female reproductive disorders. Methodological heterogeneity and the absence of interventional data preclude causal conclusions. Future research should prioritize standardized exposure assessment and randomized trials evaluating periodontal treatment before assisted reproductive technologies.