Smoking and Infertility A PATIENT’S FACT SHEET from the ASRM

The health risks of tobacco smoking are well known
with regard to diseases of the heart, lungs, and blood
vessels. Substantial harmful effects of cigarette smoke on fertility have become apparent, but are not generally appreciated. Cigarette smoking has a negative impact on the ability to become pregnant and carry a pregnancy to term.

Impact of cigarette smoking on re p roduction in women: Virtually all scientific studies support the conclusion that smoking has an adverse impact on fertility. The prevalence of infertility is higher, and the time it takes to conceive is longer, in smokers compared to nonsmokers. Active smoking by either partner has adverse effects, and the impact of passive cigarette smoke exposure is only slightly smaller than for active smoking. Research indicates that cigarette smoking is harmful to a woman’s ovaries, and the
degree of harm is dependent upon the amount and the
period of time a woman smokes. Smoking appears to
accelerate the loss of eggs and reproductive function and
may advance the time of menopause by several years.
Components in cigarette smoke have been shown to
interfere with the ability of cells in the ovary to make
estrogen and to cause a woman’s eggs (oocytes) to be
more prone to genetic abnormalities. Smoking is strongly
associated with an increased risk of spontaneous
miscarriage and possibly ectopic pregnancy as well.
Pregnant smokers are more likely to have low birth weight
babies and premature birth. The incidence of sudden
infant death syndrome (SIDS) also increases in households
where someone smokes.

Impact of cigarette smoking on assisted reproductive
therapy outcomes: Nearly twice as many in vitro
fertilization (IVF) attempts are required to conceive in
smokers than in nonsmokers. Studies of IVF have
reported that female smokers require higher doses of
gonadotropins to stimulate their ovaries, have lower peak
estradiol levels, fewer oocytes obtained, more canceled
cycles, lower implantation rates, and undergo more cycles
with failed fertilization than nonsmokers. Miscarriage
rates are also increased. The adverse effect of cigarette
smoking is more noticeable in older women. Overall, the
reduction in natural fertility associated with smoking may
not be overcome by assisted reproductive technologies.

Impact of cigarette smoking on reproduction in men:
Men who smoke cigarettes have a lower sperm count and
motility and increased abnormalities in sperm shape and
function. The effect of smoking on male fertility,
however, is more difficult to discern because it is difficult
to create studies to address that question. Although the
effects of cigarette smoking on male fertility remain
inconclusive, the harmful effect of passive smoke on the
fertility of female partners and the evidence that smoking
adversely affects sperm quality suggest that smoking in
men should be regarded as an infertility risk factor.

Smoking cessation as a treatment issue in couples
undergoing fertility therapy: One important investigation
showed that cessation of smoking for at least two months
before attempting IVF significantly improved chances for
conception. Although long-term cigarette smoking can
have an irreversible effect on ovarian function, the harmful
effect on treatment outcome may, in part, be reversed if
smoking is discontinued prior to entering into fertility
therapy.

Summary: The best available scientific data indicate that
cigarette smoking strongly contributes to infertility.
Smoking should be discouraged for both male and female
partners in couples with a history of infertility or recurrent
miscarriage. Smoking cessation may improve natural
fertility and success rates with infertility treatment.