World No Tobacco Day 2025: Expert Explains How Tobacco Use Affects Fertility In Men And Women

Infertility is increasingly affecting both young individuals and couples at an alarming rate. While certain medical conditions and genetic factors play a role, shifts in lifestyle have emerged as a major contributor to this trend. Although some causes lie beyond one's control, many lifestyle-related factors-such as the use of tobacco in any form-are within our influence. Tobacco consumption significantly hampers fertility and has a negative impact on reproductive health in both men and women.

Impact on female fertility

Here's how smoking affects ovarian function:

Hormonal disruption: In the body, hormone regulation is a delicate process where the secretion of one hormone influences others. The chemicals present in tobacco products, like cigarettes, interfere with the normal functioning of glands that produce reproductive hormones-namely the thyroid, hypothalamus, pituitary, and adrenal glands. This interference raises levels of cortisol (the stress hormone) and testosterone (typically a male hormone) in women, both of which are linked to reduced fertility. Simultaneously, essential hormones such as estrogen, progesterone, Anti-Mullerian Hormone (AMH), and prolactin decline, all of which play vital roles in female fertility.

Ovarian and menstrual disorders: The hormonal imbalances caused by smoking are known to lead to various ovarian and menstrual irregularities. For instance, increased testosterone levels in women are often associated with polycystic ovary syndrome (PCOS), a condition marked by disrupted ovulation and menstrual cycles, which complicates natural conception. Reduced levels of estrogen and progesterone further contribute to irregular menstrual cycles. Moreover, a drop in AMH levels suggests a reduced reserve of healthy eggs, as smoking damages the genetic composition of gametes.

Early onset of menopause: Menopause, the natural end of menstrual cycles that usually occurs in women during their late 40s or 50s, marks the depletion of viable eggs for ovulation. Smoking speeds up the deterioration of egg quality and quantity in the ovaries, often leading to premature menopause. Once menopause occurs, the possibility of natural pregnancy ceases.

Impact on pregnancy

Smoking affects both the initial stages of conceiving a baby and the progression of pregnancy.

• Pregnancy-related risks: Women who smoke are more prone to complications such as ectopic pregnancies (where the embryo implants outside the uterus), miscarriages, and spontaneous abortions.
• Foetal development concerns: The carbon monoxide present in cigarette smoke can harm the developing foetal central nervous system (CNS). Smoking during pregnancy also impairs growth within the womb, heightening the risk of premature delivery. Furthermore, it can negatively affect the formation of the foetus's lungs and brain.
• Genetic abnormalities and birth defects: Smoking negatively affects the quality of a woman's eggs, which can lead to fertilised eggs carrying genetic disorders such as Down syndrome, Turner syndrome, and Klinefelter syndrome. Women who smoke during pregnancy are also at greater risk of giving birth to babies with congenital defects like cleft lip and/or cleft palate.
• Postnatal complications: Babies born to mothers who smoke often have lower birth weights, even if carried to full term. As they grow, these children face an increased risk of developing chronic health conditions, including obesity, diabetes, asthma, and cardiovascular disease.

According to the American Society for Reproductive Medicine, women who use tobacco are twice as likely to experience infertility compared to non-smokers. They also have a higher incidence of ectopic pregnancies and preterm births. Tobacco use not only harms the health of women but also has serious consequences for their future children. Smoking during pregnancy can hinder foetal growth and lead to long-term health issues in children, such as asthma, heart disease, obesity, and diabetes.

Impact on male fertility:

In men, smoking impairs both the genetic integrity and physical structure of sperm, and can also lead to erectile dysfunction, making it more difficult to conceive. The Journal of Andrology reports that men who smoke are twice as likely to experience erectile dysfunction. Furthermore, smoking has been linked to sperm DNA damage and increased miscarriage risk. Tobacco products introduce cancer-causing chemicals and heavy metals like cadmium and lead into the body, both of which are known to harm sperm health.

The need to quit tobacco

Given these serious risks, it is crucial for couples to either reduce or completely quit tobacco use-not only for their own health but also for the well-being of the children they hope to have. Temporary alternatives such as nicotine gum, patches, or prescribed medications can support the quitting process and significantly improve fertility.

However, even with lifestyle changes, natural conception may still be difficult for some. In such cases, assisted reproductive technologies (ART) like in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) can offer potential solutions. It's important to note, however, that the effectiveness of ART treatments can also be affected by the extent of tobacco-related damage to one's reproductive health.

(Dr Kshitiz Murdia is an IVF specialist. He is also the CEO and co-founder of Indira IVF)

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