Tobacco use can undermine fertility, UN health agency warns

“For all people who plan pregnancies, our message is, ‘Stop smoking, improve your health, improve your reproductive health as well,’” said Dr Kerstin Schotte, Medical Officer with WHO’s Tobacco Free Initiative. 

WHO defines infertility as failing to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse – a condition that affects one in six people globally. 

In a new report summarizing all the evidence on a link between tobacco smoking and infertility, the agency cited decades of evidence that shows tobacco use is associated with infertility in women while also being harmful to sperm quality and sexual function in men.  

WHO also noted that second-hand smoke can affect fertility, meaning that people can face possible reproductive risks even if they do not smoke. 

The WHO publication also suggests that quitting can make a difference as women who smoked in the past but no longer do so may have a 25 per cent lower risk of infertility than those who continue to smoke tobacco. 

Not only a women’s issue 

WHO stressed that infertility is not solely a women’s issue.  A review of 44 studies involving more than 60,000 men found that smoking was linked to reproductive dysfunction, including semen abnormalities and sexual dysfunction. 

The evidence indicated that men who smoke were more likely to have erectile dysfunction, ejaculation problems and related issues such as absence of sperm in semen, poor sperm motility and abnormal sperm shape. 

“The evidence indicated that men who smoke were more likely to have erectile dysfunction, ejaculation problems, and related issues such as absence of sperm in semen, poor sperm motility and abnormal sperm shape,” the UN health agency said. 

Impact on fertility treatments 

Smoking can also reduce the success of fertility treatments. Earlier research from 21 studies linked cigarette smoking to fewer live births as well as pregnancies following assisted reproduction like invitro fertilization (IVF).    

The findings further suggest that cigarette smoking could reduce the chances of successful outcomes by roughly half. 

Hookah, e-cigarettes and second-hand smoke  

WHO also identified other possible risks of waterpipe smoking—also known as hookah or shisha— which may affect male fertility. 

While evidence on e-cigarettes (also known as vapes), waterpipes and smokeless tobacco and other new products is still emerging, WHO said that other tobacco and nicotine products may also pose reproductive risks and require further research. 

WHO also warned that exposure to second-hand tobacco smoke may increase infertility risk for women as it could lower the likelihood of conceiving each month they try. 

Reducing the risks 

The publication recommends that healthcare providers discuss the reproductive risks of tobacco use with individuals and couples planning a pregnancy.  

It also calls for evidence-based support to help people quit smoking, including the routine provision of brief cessation advice to tobacco users in all healthcare settings.