Rachael Lilley discusses fertility and how oral health can have a significant impact on the success rate of fertility treatment.
Fertility issues will affect about one in seven couples in the UK touching our patients’ lives in many ways.
It can be isolating and uncomfortable to talk about. Many couples after a certain point will look at alternative methods to help them achieve their dream of having a family.
Infertility struggles were not something that I thought I would ever face personally. But as my husband and I went through the process it became clearer that I needed to do more research into how treatments might affect me periodontally, and my patients too.
First things first, it is recommended that you should speak to your doctor if you have been trying to get pregnant for one year without success (or six months if you are over 35). This is to start investigating why this may not be happening for you and your partner.
Couples who are trying to conceive are usually advised to maintain a healthy lifestyle by not smoking or drinking alcohol, maintain a healthy body weight, exercise regularly, reduce stress and eat a nutrient rich diet.
Interestingly our patient’s oral health will also have a significant impact on their fertility levels and the success of fertility treatment.
Even more interestingly, many patients and healthcare professionals alike are unaware of the fact that treating gingival inflammation and periodontal disease could improve our patient’s chances of conceiving in the future. As well as improving their health generally and preventing tooth loss.
When we talk about infertility the spotlight tends to be on women. Yes, there is a statistically significant relationship between higher levels of decayed, missing and filled teeth, higher levels of plaque/biofilm, bleeding on probing and clinical attachment loss in women with unexplained infertility (Telatar, 2021).
However, women are not on their own with this.
Research conducted by Klinger showed a significant association between deeper periodontal pockets and increased clinical attachment loss. This is alongside increased levels of sperm sub motility (Klinger, 2011).
It is also thought that treating periodontal disease in men could improve their systemic health. Therefore their sperm motility as part of their reproductive health – although more research into this field is required.
Okay so treating gingival inflammation should, in theory, contribute to conceiving naturally, amazing news! But what about our patients who have received extra help in terms of medication or IVF procedures. And what even is IVF anyway?
We have all seen that extreme close-up of a little egg being injected with sperm in a petri dish. But actually there are several possible interventions couples can have when natural conception is not an option for them.
- IUI – intra uterine insemination. Prepared sperm is placed into a woman’s womb around the time of ovulation
- IVF – in vitro fertilisation. Eggs are recovered, mixed with sperm outside the body. If fertilisation occurs the fertilised embryo is then placed into the womb where it will hopefully implant into the lining of the uterus
- ICSI – intra cytoplasimc sperm injection. Injection of a single sperm directly into a mature egg. This is then placed back into the womb and implantation will hopefully occur.
Surprisingly, all these methods will have an impact upon and be impacted by periodontal health.
Medication such as clomiphene (Clomid), follicle stimulating hormone (FSH) and luteinising hormone (LH) amongst others can either be taken orally or injected as part of fertility treatment. These medications are usually used to bring about the onset of and support ovulation.
Haytac found that these types of medications used to induce ovulation caused a statistically significant increase in gingival inflammation and bleeding on probing. This increased in severity the longer the patient was taking the drugs that had been prescribed (Haytaç, 2004).
As dental professionals we know that this could potentially lead to an increased incidence of future periodontal disease. As well as clinical attachment loss in these patients. Regular monitoring and maintenance of patients taking these drugs is, therefore, essential (Lalasa et al, 2014).
It has also been found that periodontal inflammation and pocketing can lead to bacteraemia. This releases cytokines, which can potentially lead to reduced implantation rates of fertilised embryos in women having IVF treatment. However this area still needs more research.
Ultimately fertility treatments are an expensive, emotional rollercoaster. Advising both our male and female patients to look after their periodontal health before, during and after treatment is simply good sense. Even to help against the periodontal problems that could potentially occur due to the stress of these treatments alone.
Fertility issues can still be a bit of a taboo subject. Many of our patients could be having treatment without informing us as dental professionals. I believe though that a comprehensive gum health assessment as a couple should be the start and an essential part of your fertility journey.
Also, it is so important that those taking drugs to stimulate ovulation especially over long periods or over several cycles of IVF should be advised of the dental implications. Regular dental visits should be discussed by your medical professional as part of a fertility treatment plan.
Even making our patients aware of these potential links could be hugely motivational for patients encouraging them to take charge of their oral health. This helps improve their fertility, along with helping to prevent and manage future fertility problems. Although it should be noted that this area does require more research.
This, of course, is not the case for everyone. Over the years I have seen many periodontally compromised patients go on to naturally conceive many healthy and happy babies. But if your patients do happen to mention that they have unexplained infertility or are going through fertility treatment, treating existing gum issues may not be a bad place to start.
Yildiz Telatar (2021) Periodontal and caries status in unexplained female infertility: A case–control study, Journal of Periodontology
Klinger (2011) Periodontal status of males attending an in vitro fertilization clinic Journal of Clinical Periodontology – Wiley Online Library
Haytaç (2004) The Effects of Ovulation Induction During Infertility Treatment on Gingival Inflammation, Journal of Periodontology
Lalasa G, Murthy KV, Pavankumar S, Raju GR (2014) Periodontal status in infertile women attending in vitro fertilization clinics Indian J Dent Res
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