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Smoking And Infertility. BY Mohammad A. Emam Prof. of Obstetrics and Gynecology Mansoura Faculty of Medicine Mansoura integrated fertility center (MIFC) – EGYPT. Introduction &Rationale. Smoking as a major health problem.

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Smoking And Infertility


Mohammad A. Emam

Prof. of Obstetrics and Gynecology

Mansoura Faculty of Medicine

Mansoura integrated fertility center (MIFC) – EGYPT

introduction rationale
Introduction &Rationale
  • Smoking as a major health problem.
  • High prevalence of smoking among women in their reproductive years
  • Unawareness of effect of smoking on reproduction.
  • Smokers may be active or passive.
smoking as a health problem
Smoking as A Health Problem
  • Kills over 400,000 people every year (more than 1 in 6 people in the U.S.)
  • More lethal than AIDS, car accidents, homicides, suicides, drug overdose, and fires combined
  • Smoking Killed Five Million Worldwide in 2000
  • U.S. spends $50 billion each year on smoking-related costs.
prevalence of smoking
Prevalence of Smoking
  • 30% of reproductive age women and 35% of men are cigarette smokers (Centers for Disease Control and Prevention 2001)
  • Nearly 30% of middle school children and over 63% of high school students had tried smoking (American Heart Association statistics 2001).
prevalence of smoking con
Prevalence of Smoking con….
  • In Egypt:
    • 20% of reproductive age women and 35% of men are cigarette smokers.
    • Shesha smokers are increased among adolescents teenage girls.
awareness of the health risks of smoking
Awareness of The Health Risks of Smoking
  • Questionnaire for 388 female hospital employees including health care professional(Roth and Taylor 2001):

Most women are aware that smoking causes:

    • Respiratory disease (99%).
    • Lung cancer (99%).
    • Heart disease (96%).s
    • Pregnancy complications (91%).
awareness of the health risks of smoking cont
Awareness of The Health Risks of Smoking cont…
  • Few women are aware that smoking is associated with:
    • Osteoporosis (30%).
    • Early menopause (17%).
    • Spontaneous abortion (39%).
    • Ectopic pregnancy (27%).
    • Cervical cancer (24%).
  • Infertility (22%).
smoking reproduction
Smoking & Reproduction

More Than 40 Published Studies In Medical Literature

smoking female infertility
Smoking & Female Infertility
  • Meta analysis (21 studies) (Augood et all, 1998)
    • Smoking reduce the natural fertility
    • Earlier menopause (average 2 years).
    • Damage of ovarian reserve increase with smoking(the amount and the period of smoking ).
    • Increase in risks for ectopic pregnancy and spontaneous abortion.
smoking female infertility con
Smoking & Female Infertility con….
  • Women who quit smoking before or during pregnancy reduce the risk for adverse reproductive outcomes, including:
  • Difficulties in becoming pregnant.
  • Infertility.
  • PROM.
  • Preterm delivery.
  • Low birth weight.
      • (Cochrene review,Lumely et al,2003)
smoking male infertility asrm afs 2001
Smoking & Male Infertility (ASRM=AFS 2001)
  • Heavy smoking contributes to:
    • Development of impotence (decrease blood flow to the penis)
    • Abnormal semenogram :
      • Decreased sperm count, alteration in motility , and increase in the abnormal forms.
smokers art a prospective cohort study zitzman et al 2001
SMOKERS & ART A prospective cohort study (Zitzman et al 2001):
  • High basal and post ccserum FSH.
  • Weak ovarian response to stim.
  • Need higher doses of GN
  • Impaired fertilization and delayed conception, resulted from:
    • Interference with gametogenesis
    • Failure of implantation
    • Early miscarriage.
how smoking affect fertility
How Smoking Affect Fertility?
  • Maternal smoking affects:
    • In utro ovary of female fetuses
    • Reduced Semen Quality and Testis Size in Adulthood (Jensen ,2004)
  • Increase ROS inside Graafian follicle
  • Affect meiotic maturation of human oocytes
how smoking affect fertility con
How Smoking Affect Fertility? Con…
  • Interfere with estrogen synthesis,
  • Endothelial abnormalities (atherogenic and thrombotic problems).
  • Oocytes (pre-zygotic genetic damage)
  • sperm DNA damage (substances in smoke).
substances in smoke
(active and passive ):

> 4.000 chemical compounds,

43 carcinogens or poisons

> 300 polycyclic aromatic hydrocarbons.

methyl isocyanate(lethal poison).

bezene,( a potent toxicant)

Nicotine and its metabolites, cotinine

Polonium 210(a carcinogenic radioactive elem),


Substances In Smoke

Cigarette smoke

update maternal smoking
Update Maternal Smoking
  • Increases the risk of asthma during the first 7 years of life (Laurberg P, 2004)
  • Impairment of iodine Nutrition in Breast-Fed Infants (Nohr, 2004).
  • Increased risk for sudden infant death syndrome (SIDS).
could female passive smoking compromise the outcome of assisted fertilization
Could Female Passive Smoking Compromise The Outcome of Assisted Fertilization?

( Middle East Fertility Society 10 th a\Annual Scientific Meeting Lebanon ,December 10-13,2003) o-76

table 2 the outcome of icsi in passive smokers non smokers


Passive Smokers


Number of cases



Number of cycles








Mature follicles / Cycle






Oocytes retrived / cycle






Oocytes Metaphase II/ cycle






Oocytes fertilized/ cycle






/ Embryos grade Acycle






Clinical pregnancy rate (%)




Table-2: The Outcome of ICSI in Passive Smokers & Non Smokers
  • Female passive smoking could decrease the success rates of ICSI either through:
    • The negative effect on the egg and embryo quality via passive exposure to smoke (second hand exposure) .
    • And/or through the defective sperms of the male active smoker.
could cadmium be the culprit of defective male reproduction among smokers
Could Cadmium Be The Culprit of Defective Male Reproduction Among Smokers?

The Egyptian Journal Of Dermatology and Venereology vol 22 ,N 2&3 2002

  • A high cadmium level is observed in plasma of heavy smokers which may cause a direct cytotoxic effect on spermatozoa, impairing their functions.
conclusions cont
Conclusions cont….
  • Smoking cessation may improve fertility and success rates with infertility treatment.Moreover it is healthy for the growing fetus, and will create a smoke-free environment for an infant.
  • Smoking may be a forgotten explanation for some cases of unexplained infertility.
conclusions cont24
Conclusions cont….

It is not known how long the damaging effects of smoking last after quitting butOne important investigation showed that cessation of smoking for at least two months before attempting IVF significantly improved chances for conception.


1.The phasing out and banning of smoking in home should be an integral part of human infertility treatment.

2.Further studies to show the correlation between the duration of exposure to cigarette smoke and the fertilization rate, are needed.

3.Further studies on the levels of reactive oxygen species (ROS) in the follicular fluid in passive smokers are needed.


Thank you


OB& GYN, Mansoura Faculty of Medcine

Mansoura Integrated Fertility Center (MIFC) EGYPT

Telfax 0020502319922 & 0020502312299