Tobacco use is linked to infertility in women as well as poorer sperm quality and sexual function in men, according to the latest World Health Organisation (WHO) report, which further warned that second-hand smoke may also affect fertility. Women who quit smoking may have a 25% lower infertility risk than continuing smokers, it said.
The report highlighted evidence that tobacco use is associated with potentially lower chances of success for some fertility treatments. It said that evidence on newer products, including e-cigarettes, waterpipes, and smokeless tobacco, is still emerging, stating that while evidence is strongest for cigarette smoking, other tobacco and nicotine products may also pose risks to fertility and require further research.
Globally, one in six people of reproductive age will experience infertility at some point in their lifetime. Infertility is defined as the failure to achieve pregnancy after 12 months or more of regular unprotected sex.
40% rise in risk
The publication cites decades of evidence showing that smoking can harm women’s reproductive health. A systematic review of studies conducted between 2000 and 2026 found that women who currently smoke tobacco have a 40% higher risk of infertility compared to those who do not smoke.
The publication also notes that women who smoked tobacco in the past but are not currently smoking may have a 25% lower risk of infertility compared with women who continue to smoke, suggesting that quitting tobacco can make a meaningful difference.
The WHO stressed that infertility is not only a women’s health issue. "A recent review of 44 studies involving more than 60,000 men found that smoking was associated with 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," it said.
Impact on treatments
For people using fertility treatment, tobacco smoking may reduce the chance of success. The publication cites earlier research from 21 studies, showing that cigarette smoking was linked to fewer live births and fewer pregnancies following assisted reproduction, such as in vitro fertilisation, with findings suggesting that the chances of successful outcomes may be roughly halved by cigarette smoking.
The WHO has recommended that healthcare providers inform individuals and couples planning a pregnancy about the reproductive risks of tobacco use and offer evidence-based support to help them quit. It also recommended that brief advice on quitting be consistently provided to all tobacco users in all healthcare settings.
