The alarmingly increasing trend of smoking among men and women of reproductive age remains a source of worry. Smoking has long been associated with numerous health hazards, including but not confined to its negative impact on both male and female fertility and fecundity. Infertility rates in male and female smokers are double in comparison to their non-smoking counterparts. Couples in which either of the partners is a smoker face delay in conceiving compared to non-smoking couples. The increased daily number of cigarettes consumed is directly proportional to the delay in conception. Moreover, passive smoke exposure alone poses a somewhat lower impact than active smoking by either partner.

Smoking cessation by both partners is therefore recommended before attempts at conception, whether individually or with assistance.

Smoking and female fertility

Smoking affects the female reproductive system structurally as well as functionally.

• It influences ovarian hormone production, thus disturbing the reproductive hormonal balance required for conception.
• Moreover, the fallopian tube functionality and integrity are changed. Fallopian tube blockage is a fairly common happening that hinders the process of fertilization (the union of male sperm and female egg) and can lead to ectopic pregnancy (obstetric emergency).
• Smoking is responsible for damaging the eggs in ovaries by decreasing their number, altering ovarian DNA, and causing premature ovarian aging, which in turn can lead to early menopause.
• Increased incidence of reproductive tract cancers like cervical cancer has also been reported in female smokers.
• Increased risk of miscarriage by possibly interfering with the uterine receptivity and lessening the likelihood of implantation.

Not only does smoking reduce fertility, but it also constitutes tremendous harm during pregnancy, inclusive of spontaneous abortion, placenta previa, IUGR (intrauterine growth retardation), low birth weight, premature rupture of membranes, premature delivery, and perinatal death.

Smoking and male fertility

Negative out-turns of smoking on male fertility have been evident, with studies demonstrating its effect on semen quality parameters. It does so by:

• Decreasing sperm synthesis and sperm motility, changing sperm morphology and functionality through oxidative stress and DNA damage to sperms.
• Disturbing the hypothalamic-pituitary axis and thus affecting male hormonal balance.
• Significantly reducing the function of accessory sex glands.
• Increasing the risk of erectile dysfunction, which further lowers the chances of conception.
• Increasing incidence of prostatic cancer in male smokers.
• In utero, exposure to tobacco smoke of a male offspring by a smoking mother can also adversely affect seminal quality.

Smoking and assisted conception

Assisted conception refers to treatments designed to help couples wishing to conceive. It includes pharmacological treatment with medication like ovulation induction drugs (such as Clomid), as well as assisted reproductive technology (ART) procedures which generally refer to invasive techniques, including IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection).

Tobacco smoking also reduces the chances of successfully assisted fertility treatments. This may be due to the fact that smoking females are far more likely to miscarry in comparison to non-smoking women. Not only does smoking affect the favorable outcome of assisted procedures, but the toxins in tobacco smoke also interact with ovulation induction drugs requiring a higher dosage.

Some studies have shown smoking in males affected the rate of conception with negative clinical outcomes of the success of ICSI and IVF.

Failure of such methods can take a jibe at the mental health of the hopeful patients as well as be very costly to their pockets.

An insight from mamahood

In conclusion, even though smoking is not the sole contributor to infertility, couples wishing to conceive should have a sense of responsibility to their future generations and quit smoking before trying, as smoking can affect the fertility of both gender groups and can have a lasting impact on the mental health of the couple by increasing stress, frustration as well as threatening the physical health of the smoker.

Smoking cessation is not an easy task, so there should be no reluctance to consult your primary physician. Prenatal counseling can also greatly improve the chances of conception.