INTRODUCTION:

Periodontitis is considered as a familiar inflammatory oral condition, which is related with various systemic diseases and several unfavorable reproductive consequences, that include reduced birth weight of child, preeclampsia, preterm labour, restriction of foetal growth, and perinatal death.¹Periodontal disease is characterized by tissue damage due to the bacterial interaction.²Inflammatory periodontal disease is caused by combination of various microbes.³ To add upon, number studies have found that there is relationship among fertility problems and infections in oral cavity which comprises infertility among both men and women. Subfertility is a condition which is seen among individuals who have reduced fertility rate, on the other hand infertility is condition among individuals who experience non-success to become pregnant during one year of sexual intercourse.⁴

The fundamental need of an human being is parenthood.⁵Infertility among individuals are more commonly seen in developing countries.⁶ About 40% male and 40% female factors contribute for infertility.⁷Fertility complication are related with economic load, and account for problems in various families. These crisis leads to marriage disputes, resulting in divorce and even severe problem among society in which women are stereotyped.⁸One in twelve couples are affected by infertility around the globe.⁹ Furthermore, complication of reproductive functions leads to number of emotional and psychological condition which includes hopelessness in marital life, guilt, depression, considering worthlessness in life and anxiety which is more prominent among women¹⁰ Infertility is always generalized on woman, even men can be a cause of failure in fertilization. Based on study by Kellersarian and his colleagues in the year 2016 found that, it “48.5 million couples around the globe couldn’t get a child, and around 40% to 50% of the problem are related with infertility factor seen on male.¹¹As women depend on male in many countries so women are taken major blame.¹²According to the data it is not fair to blame women are the major reason for not getting a child and considering them as infertile.¹¹ Study in United states stated that 10 percent of women faced difficulty to become pregnant.¹³

Based on studies, there is a relationship seen among lower fertility and oral infections. Enhancement of oral hygiene by proper dental treatments will help to overcome the barrier on bearing a child. Keeping circumstances in mind, this review focus to identify the relationship among infection on oral cavity and fertility problems. This review helps to indicate the relationship among certain pathogen of periodontal disease with fertilization.¹⁴

Association of Bacteria with Infertility:

Various bacteria are related with periodontal disease which includes Tannerela forsynthia, Prevotella intermedia, Porphyromonas ginigvalis, Treponema denticola and Aggregatibacter actinimucentemcomitans. These are the gram-negative bacteria’s which are responsible in development of biofilm and accumulation of plaque. Paju and his colleagues in the year 2017, found that P. gingivalis may play a part in trying-to-conceive condition and perhaps show distinctive feature for relationship among infertility and periodontal disease. And even noticed that P. gingivalis seen in saliva and increased level of salivary antibodies up against periodontal organisms that remarkably elevates the failed fertilization risk between women of young age. The study furthermore stated that there is high risk among women to not get pregnant if they possess elevated of IgA antibodies in opposition to P. gingivalis in addition to periodontal disease indication.¹⁵2.2 % to 26% of women around age between 18 to 45 have reproductive abnormality.¹⁶Hart and his colleagues in the year 2012 established that women with periodontal disease who were trying to conceive prolonged by two months. It was found that women with periodontal disease has the similar prolonged trying to conceive as like women who are obese. Based on the study, it was stated that numerous single nucleotide polymorphisms like IL-1, IL-6, TNF-alpha have effect on pregnancy a, and have showed that there is relationship with periodontal disease and prolonged trying to conceive. The prevalence of single nucleotide polymorphisms differs among different ethnicities.¹⁷

Association Between Periodontitis and Infertility:

Periodontitis leads to systemic inflammation which might obstruct fertility by stopping ovulation; stopping embryo implantation or might cause discontinued implantation. Interleukin 1 comprises of polypeptides which are responsible for inflammation.¹⁸ It has been found that IL-1 family cytokines which are seen in chronic periodontitis condition might hinder the hypothalamic-pituitary-gonadal axis, declining the gonadotrophin discharging hormone and luteinizing hormone levels that results in failure of ovulation.¹⁹ In addition, producing progesterone that is required to victorious implantation of the embryo is adjusted by cytokines as IL-1 and growth factors.²⁰ Correspondingly, it has been found that cytokines like IL-1β, IL-6 and TNF-α are responsible in regulating the synthesis, release and processing of endometrial prostaglandin F2α to safeguard corpus luteum during early time of pregnancy.²¹

Periodontitis and Erectile Dysfunction:

Oguz and his colleagues in the year 2013, found that there is remarkable association was found among erectile dysfunction and chronic periodontitis between adults ageing 30-40 years. Based on the to the results by the study, notable relationship was found among chronic periodontitis seriousness and disability of penile erection.²² Keller and his colleagues in the year 2012 carried out a study and established an elevated risk of chronic periodontitis among individuals with erectile dysfunction. To add upon, the relationship was much severe between the individuals ageing <30 and >69 years.²³ To make the relationship stronger the results found in study carried out by Zadik and his colleagues in the year 2009 was also showing that there is a strong relationship among chronic periodontal diseases and erectile dysfunction, which agrees and goes through with various theories that relate with endothelial dysfunction systemic inflammation, and atherosclerosis.²⁴Similar study by Zuo and his colleagues in the year 2011 stated that declination of endothelial nitric oxide synthase expression in tissue of penis which plays vital role in erection that is due to periodontitis systemic inflammatory change, which is considered be one of causative factor of erectile dysfunction.²⁵Eltas and his colleagues in the year 2013 evaluated the result of treating periodontal disease enhanced the erectile dysfunction at base between first- and third-months interval of intervention given. Based on the study, treating periodontal condition remarkably put up to treat erectile dysfunction.²⁶ To add upon Uppal and his colleagues in the year 2014 and Matsumoto and his colleagues in the same year also established that there is notable relationship among erectile dysfunction and chronic periodontitis.^27,28 Furthermore, study by Eastham and his colleagues in the year 2015, stated that oral health might be one of the threat elements of sexual health.²⁹ There is similarity of inflammation response by the response markers among women is seen in connection to infertility of male. It was established that bacteriospermia might be commenced by infection in oral cavity which circulate through blood. Existence of IL-6 in the seminal fluid might be related to infertility.³⁰ Periodontal disease has a relatable relationship with declined quality of sperm. There is inclination bacterial concentration during the ejaculation, this condition lowers the male fertility. In addition, Kellesarian and his colleagues in the year 2016 studied to identify whether there is reasonable relationship among male factor infertility and oral disease. And there was plausible association was found among infertility of male and dental infection condition like chronic periodontitis, necrotic pulp and caries. Study by Bustos-Obregron and his colleagues in the year 1983 stated that, once that sperm parameters like density, morphology and motility were enhanced once finishing broad dental treatment. Wife of 33% of individuals who underwent extensive treatment could get pregnant by in vitro fertilization.¹¹

CONCLUSION:

The importance of periodontal disease towards various systemic conditions have been studied vastly. Although, there is a vacuum on studies that examine the outcome of periodontal disease on affluent of fertilization among individuals who have trouble to deliver child. Although some studies have proved about the inter relationship to certain extent, study must be carried out to know how the conditions relate to each other. Finally, based on few researches done currently it is been found that there are possibilities showing the association among infertility and periodontal disease with men and women that may hinder the marital life of individuals. Still studies must be done in greater distance to show the results to prove stronger.

FUNDING:

No funding was received for carrying out the present study.

CONFLICTS OF INTEREST:

The authors declare no conflict of interest.

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Received on 01.10.2020 Modified on 04.03.2021

Research J. Pharm. and Tech. 2021; 14(8):4463-4465.

DOI: 10.52711/0974-360X.2021.00775