Interleukin (IL)-18, an IL-1 family cytokine, is a pleiotropic immune regulator. IL-18 plays a strong proinflammatory role by inducing interferon γ and is associated with diverse reproductive related gynecological diseases. This article reviews the physiological role of IL-18 and its correlation with gynecological reproductive diseases, and discusses the impacts of IL-18 on female reproductive physiology from the perspective of endometrial receptivity, folliclar development, and reproductive immunity.