Smoking could significantly reduce a person’s chances of having a baby, with new evidence linking tobacco use to infertility in women, poor sperm quality and sexual dysfunction in men, as well as lower success rates for fertility treatment.
The World Health Organisation (WHO) has warned that these reproductive health risks may also extend to non-smokers exposed to second-hand tobacco smoke.
The warning comes as the global health body publishes a new summary of evidence on tobacco use and fertility.
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Infertility is already a major global health concern. About one in six people of reproductive age experience infertility during their lifetime. It is defined as the inability to achieve pregnancy after at least 12 months of regular, unprotected sex.
Research cited by the WHO indicates that smoking can have a significant impact on female fertility.
A systematic review of studies conducted between 2000 and 2026 found that women who currently smoke tobacco had a 40 per cent higher risk of infertility than women who did not smoke. The review also indicated that quitting smoking may reduce the risk.
Women who had smoked previously but had quit were found to have a 25 per cent lower risk of infertility than women who continued to smoke.
The WHO added that the impact of tobacco on fertility is not confined to women.
A review of 44 studies involving more than 60,000 men found that smoking was associated with a range of reproductive problems, including abnormal semen and sexual dysfunction.
Male smokers were more likely to experience erectile dysfunction and ejaculation problems. Smoking was also associated with reduced sperm motility, abnormal sperm shape, and the absence of sperm in semen.
These problems can make conception more difficult for couples trying to start a family.
For people turning to fertility treatment, smoking may further reduce their chances of success.
The WHO summary cites research involving 21 studies that found cigarette smoking was associated with fewer pregnancies and live births following assisted reproductive treatment, including in vitro fertilisation (IVF).
The evidence suggests that smoking could roughly halve the chances of a successful fertility treatment outcome. Waterpipe smoking, including hookah and shisha, may also affect male fertility.
People do not necessarily need to smoke themselves to be exposed to potential reproductive risks.
Women exposed to second-hand tobacco smoke may have a higher risk of infertility and a lower chance of becoming pregnant during each month they try to conceive.
The WHO said evidence on newer products, including e-cigarettes, waterpipes and smokeless tobacco, is still emerging.
While the evidence is strongest for conventional cigarettes, the organisation warned that other tobacco and nicotine products could also pose risks to fertility.
The WHO is urging healthcare professionals to speak to individuals and couples planning a pregnancy about the reproductive effects of tobacco use and provide evidence-based support to help them quit.
It also recommends that brief advice on quitting should be routinely offered to all tobacco users in healthcare settings.
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