If you’re trying to conceive or struggling through infertility, you’re probably already watching your health and diet closely, obsessing over supplements, perfecting your exercise routine—anything to increase the odds of a successful and healthy pregnancy.
Today, I have one more thing to add to your list. But don’t worry, it’s not too hard: brush et floss!
The American insurance and healthcare system keeps medicine and dentistry largely separate, but over the last two decades, there’s been a growing body of research examining the relationship between oral health and the health of the rest of your body. Studies looking at fertility are finding–if not an understanding–a consensus that gum disease correlates with less healthy sperm, longer time to conceive, and fertility issues like SOPK, endometriosis, prééclampsie, preterm labor, and low birth weight.
The mechanisms of cause and effect are still being unraveled, but here’s what we know so far about the connections between oral health and fertility, and what you can do to promote both.
Oral health and fertility in men
The link between periodontitis (which is a gum infection more serious that gingivitis) and male fertility is understood to be a pretty simple progression. The infection in a man’s mouth leads to swelling and inflammation as his immune system fights the bacteria in his gums. The bacteria from the gums enter his blood stream (a condition known as systemic bacteremia), and his immune system responds to the chronic inflammation with a constant state of fight, leading to lower sperm motility, and DNA fragmentation of the sperm [1].
This response makes sense if you think about it. Just as pregnancy is less likely to occur in women who are experiencing stress, inflammation, and infection, fertility for men can likewise be decreased when they experience stress, inflammation, and/or infection. In other words, both a woman’s et a man’s body know that these are bad times for a pregnancy to occur.
Just as pregnancy is less likely to occur in women who are experiencing stress, inflammation, and infection, fertility for men can likewise be decreased when they experience stress, inflammation, and/or infection. In other words, both a woman’s et a man’s body know that these are bad times for a pregnancy to occur.
Oral health and fertility in women
Scientists have found that women with periodontal disease (PD) can take, on average, an extra two months to conceive. This isn’t the end of the world, considering that the clinical advice is so simple: brush better, floss more often, and see a dentist regularly [2].
Il est intéressant de noter qu'un examen of the literature in 2022 found that IVF pregnancies did not have the statistically significant increase in conception time that naturally-occurring pregnancies showed [3]. However, this paper did also note that the procedures to stimulate ovulation for IVF have been found to exacerbate gum inflammation. Other factors increasing your risk of developing gum disease include smoking, diabetes, AIDs, and of course, family history.
Why does female oral health impact fertility?
Scientists haven’t yet been able to pinpoint the exact causes and effects at play between female fertility outcomes and periodontal disease, but there are a few proposed mechanisms of action to explain the observed correlations between periodontitis and both infertility and pregnancy complications.
Un mechanism is the bacteria that infect the gums go on to infect the rest of her body, making her uterus less hospitable to a pregnancy (bacteria vs. baby). Evidence of this mechanism exists through findings of PD bacteria in the placenta and amniotic fluid of pregnancies that have ended in pre-term birth.
Another way in which PD interferes with reproductive health is that a gum infection triggers a cytokine response, kicking the immune system into overdrive, and causing harm to the developing fetus in an already established pregnancy (immune system vs. baby) [3].
Whatever the mechanism of action by which PD impacts fertility outcomes, the picture is further complicated by the fact that gum disease is also correlated with other gynecological concerns like polycystic ovary syndrome (PCOS), endometriosis, and vaginose bactérienne, all of which can impact a woman’s ability to get pregnant [4]. This presents us with something of a chicken-and-egg scenario: Does a woman have PCOS because of her PD? Or does she have PD because of her PCOS?
Or, to further complicate the picture, maybe the woman with PD is married to a man who shares her brushing habits, and their infertility stems from his lower quality sperm? The studies to sort it all out haven’t been done yet, but thankfully, the solution is the same regardless… at least according to your dentist!
Periodontal disease in pregnancy is even more serious
On top of the struggle to get pregnant, another very real concern with PD and fertility is how it can affect an existing pregnancy.
Hopefully, your OB has already stressed to you the importance of seeing your dentist while you’re pregnant. Pregnancy and breastfeeding put your mouth at increased risk of cavities and infections, while also making your gums more likely to bleed. This is a time to be extra sure not to skip your routine cleanings.
If you do have a gum disease that devolves into the more serious periodontitis, the consequences to mother or baby could be severe or life-threatening. PD is correlated with higher risk of preeclampsia, preterm birth, and low birth weight. Again, the mechanism of this connection is unclear, but ce que nous savons is that an infection in the mouth can have adverse effects throughout the body [5].
Be sure to let your obstetrician know if you’re dealing with gum disease so that they can advise you on any increased risks. The good news on this front: treating gum disease in pregnant women has been found to diminuer their risk of preterm birth and low birth weight.
Be sure to let your obstetrician know if you’re dealing with gum disease so that they can advise you on any increased risks. The good news on this front: treating gum disease in pregnant women has been found to diminuer their risk of preterm birth and low birth weight.
The bottom line on oral health and fertility
Periodontitis, despite its long-ranging and potentially serious consequences, is ultimately a preventable and treatable disease. Good brushing and flossing habits and access to quality dental care can make all the difference.
The researchers studying the connections between oral health and fertility plan to do future studies to evaluate why those connections exist, and what other kinds of interventions can improve the health of mother, father, and baby. Their advice in the meantime is for pregnancy healthcare professionals to encourage dental check-ups for their patients, and to help them find access to oral healthcare, especially when circumstances make it difficult.
In the meantime, take this as a reminder to floss more often, brush better, or make that dentist appointment you’ve been putting off. Your own health and the health of any future children you may have will thank you!
