CHRONIC TONSILLITIS AND FEMALE INFERTILITY: A PATHOPHYSIOLOGICAL ANALYSIS OF POTENTIAL MECHANISMS AND THE CONCEPT OF TONSILLAR-OVARIAN INTERACTION

Background The potential effects of chronic tonsillitis (CT) on female reproductive function have been discussed in the context of systemic inflammation and focal infection. However, the clinical significance of its hypothesized association with infertility remains unestablished. Aim To critically evaluate clinical and experimental evidence and formulate a testable hypothesis of tonsillar-ovarian interaction. Materials and Methods A narrative literature review was conducted with consideration of the SANRA criteria. PubMed was searched through 29 September 2026 without a lower publication date limit. Additional searches covered scientific journal websites, research repositories, and reference lists of retrieved publications. A total of 61 publications were included in the analysis. Direct clinical evidence and indirect mechanistic evidence were synthesized separately, taking into account study design, population, reproductive outcomes, and limitations. No meta-analysis was performed. Results None of the included publications established active CT as an independent risk factor for female infertility. Direct clinical studies primarily assessed pregnancy loss, intermediate physiological measures, and outcomes following tonsillectomy. Their interpretation is limited by observational designs, probable overlap between some study populations, and incomplete reporting of methods. The association between tonsillectomy and a higher rate of subsequent pregnancy does not establish a causal effect of surgery. Indirect evidence suggests four groups of potential mechanisms: alterations in ovarian endocrine function, endometrial immune regulation, hematogenous microbial translocation, and oxidative damage. However, findings from models of oral inflammation, systemic inflammation, and other pathological conditions do not establish analogous processes in women with CT. Conclusions Tonsillar-ovarian interaction remains a hypothesis requiring direct clinical and experimental investigation. The evidence reviewed does not justify incorporating tonsillar assessment into routine infertility evaluation or treating CT to increase the probability of pregnancy. Prospective studies assessing the probability of conception and time to pregnancy, with adjustment for potential confounding factors, are needed.