Tobacco use can undermine fertility, UN health agency warns

WHO Confirms Tobacco’s Role in Reproductive Harm Across a New Evidence Review

Provpnmatrix.com – One in six people worldwide struggles to conceive after a full year of trying, and the World Health Organization has now laid out the strongest consolidated case yet that tobacco use is a significant contributor to that burden. In a publication released on Tuesday, the UN health agency summarized decades of research linking cigarette smoking, waterpipe use, and passive smoke exposure to diminished fertility in both women and men. The report does not merely restate old associations; it frames tobacco as a modifiable risk factor that clinicians should address whenever a couple is planning a pregnancy.

What the data show for women

For female smokers, the numbers are stark. The WHO document states that women who currently smoke face a 40 per cent elevated risk of infertility relative to women who have never smoked. Infertility, as the agency defines it, means the inability to achieve a clinical pregnancy after twelve months or more of regular, unprotected intercourse. That threshold captures a condition now touching roughly 150 million couples globally, making any preventable contributor to the problem a matter of public-health urgency.

The publication also highlights a hopeful counterpoint: women who once smoked but have since quit appear to carry a 25 per cent lower infertility risk than those who continue using tobacco. In other words, cessation is not merely a general health benefit—it translates into a measurable reproductive advantage.

“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.

The male side of the equation

WHO was explicit that infertility is not exclusively a women’s issue. A systematic review of 44 studies encompassing more than 60,000 men found consistent associations between cigarette smoking and a range of reproductive dysfunctions. These included semen abnormalities—such as absent sperm, reduced motility, and irregular morphology—as well as broader 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 UN health agency said.

For couples undergoing evaluation, this means that a partner’s smoking habit can independently compromise the chances of conception even when the female partner’s reproductive parameters are within normal ranges. Clinicians assessing unexplained infertility should therefore take a thorough tobacco-use history from both partners.

Passive exposure and the broader smoke environment

The report extends its scope beyond the smoker. Second-hand tobacco smoke, the agency notes, can impair fertility in non-smokers by lowering the probability of conception in any given menstrual cycle. A woman who does not light a cigarette herself may still face elevated reproductive risk if she shares a household or workplace with regular smokers. This finding reinforces existing public-health measures aimed at smoke-free indoor environments and underscores why tobacco-control policies have a direct bearing on population-level fertility outcomes.

Assisted reproduction and treatment success

Tobacco use also erodes the effectiveness of fertility treatments. Drawing on 21 prior studies, the WHO publication links cigarette smoking to fewer live births and fewer achieved pregnancies following assisted-reproduction technologies such as in-vitro fertilization (IVF). The magnitude of the effect is substantial: the evidence suggests that smoking could cut the odds of a successful treatment cycle by approximately half. For couples already investing time, money, and emotional energy in IVF or intrauterine insemination, quitting before treatment begins may represent one of the highest-yield lifestyle changes available.

Waterpipes, e-cigarettes, and emerging products

The agency did not limit its analysis to combustible cigarettes. Waterpipe smoking—commonly called hookah or shisha—was flagged as carrying possible risks to male fertility, though the evidence base remains thinner than for conventional cigarettes. For electronic cigarettes (vapes), smokeless tobacco, and other newer nicotine-delivery products, WHO acknowledged that research is still emerging. The organization cautioned that these products may also pose reproductive risks and called for further investigation before they can be considered safe in the context of fertility planning.

Clinical recommendations and what couples should do

The publication closes with practical guidance for the healthcare system. Providers who see individuals or couples planning a pregnancy are urged to initiate a conversation about the reproductive risks of tobacco use, including second-hand exposure. Beyond advice, WHO calls for evidence-based cessation support to be routinely available in every clinical setting—brief, structured quit-smoking counselling should be a standard component of preconception care, not an afterthought.

The timing of the release matters. With global smoking prevalence still above one billion adults and assisted-reproduction clinics reporting rising demand, the WHO’s consolidated evidence review arrives at a moment when both patients and clinicians need a clear, citable statement of how tobacco intersects with reproductive health. The message distilled from hundreds of studies is unambiguous: tobacco use, whether active or passive, whether in cigarette form or in newer product formats, is a recognized and modifiable threat to the ability to conceive and carry a pregnancy to term.