For many couples, the path to pregnancy is filled with frustration and heartbreak. Couples may spend months or years working with doctors on medical and nonmedical ways to get pregnant. Many health factors that impact infertility may be out of the couple’s control.
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The good news? There are several lifestyle and environmental factors that you can control, including diet, exercise, alcohol use and smoking. In fact, quitting smoking is one of the best natural ways to boost fertility. Women who stop smoking double their chances of getting pregnant each month.
Sadly, most people aren’t aware of the reproductive risks of smoking. Only about 22% of people understand that smoking is a risk factor for infertility. And only 17% are familiar with its connection to early menopause.
For couples struggling with infertility, knowledge is power. To help these couples improve their chances of getting pregnant, fertility specialists Sarah Vij, MD, and Cynthia Austin, MD, explain how smoking impacts fertility for both men and women while providing practical suggestions for protecting the health of an unborn baby — from the beginning.
Q: How common is smoking today, especially among couples of childbearing age?
Drs. Vij and Austin: According to the Centers for Disease Control and Prevention, almost 38 million American adults smoke. Cigarette smoking is especially high among men between the ages of 25 and 64. In fact, the World Health Organization reports that about 46% of men age 20 to 39 are smokers.
Although it varies by region, about 20% women of childbearing age in the U.S. smoke. Each year, almost half a million babies in the U.S. are exposed to cigarette smoke.
Q: How much does smoking impact men’s fertility?
Dr. Vij: There’s more inflammation in the semen of men who smoke. This can weaken the sperm and make pregnancy more difficult to achieve.
Cigarettes contain toxic levels of carcinogens (cancer-causing substances) and mutagenic substances. They also contain heavy metals (like cadmium and lead), which are shown to be the primary agents of sperm damage.
Studies show that smoking can lead to DNA damage in sperm. Some evidence shows that men with elevated sperm with DNA damage may have reduced fertility and higher miscarriage rates.
In addition, smoking is a risk factor for erectile dysfunction (ED), which can make getting pregnant a challenge. According to the Journal of Andrology, men are about twice as likely to have ED if they smoke. After adjusting for other risk factors, men who smoke more than 20 cigarettes a day are 1.5 times more likely to have ED than men who don’t.
Q: And how does smoking affect women’s fertility?
Dr. Austin: Active smoking has been associated with:
Once a woman becomes pregnant, smoking increases the risk of miscarriage. Especially for women who conceive using in vitro fertilization, smoking can be a serious threat to such a precious pregnancy.
Later in pregnancy, smoking can cause birth defects, growth restrictions and maternal high blood pressure.
Q: When it comes to affecting your fertility, does it matter how many cigarettes you smoke?
Dr. Vij: Medical evidence shows that the more you smoke, the worse it is for a man’s sperm count, sperm concentrations, motility (how they swim) and shape (main parameters of semen test). It has been shown that 20 cigarettes a day is much worse for fertility than the occasional cigarette.
When it comes to quitting smoking, don’t approach it with an ‘all or nothing’ attitude. If totally quitting isn’t realistic, cutting down can make a meaningful difference in fertility. There are always health benefits tied to reducing the amount of cigarettes you smoke.
It’s important to remember that no amount of cigarette smoking has been determined to be safe for pregnancy.
Q: What about the impact of secondhand smoke?
Dr. Austin: Exposure to secondhand smoke in the household is bad for female fertility. Even if a person doesn’t smoke in the home, smoke can still be present on the hair and clothing of the smoker and harm other members of the household.
Once a woman gets pregnant, secondhand smoke can increase the risk of miscarriage, low birth weight and learning disabilities. There’s abundant evidence that shows that smoke exposure to a newborn baby can lead to respiratory infections, asthma and sudden infant death syndrome.
Q: Are there any common myths about smoking and fertility that we should discuss?
Drs. Vij and Austin: Many of the misconceptions about smoking and fertility involve the psychological component of the addiction. Knowing the facts can keep you well-informed and healthy at all stages of pregnancy.
MYTH 1: I’ll just stop smoking once I get pregnant to protect my unborn child.
Dr. Austin: You really need to stop smoking as soon as possible — ideally several months before you would plan to get pregnant. Medical evidence proves that smoking is dangerous at every point along the continuum of pregnancy.
MYTH 2: Vaping and e-cigarettes are safe alternatives to smoking.
Dr. Vij: Smoking alternatives still contain toxic chemicals that can harm sperm. Nicotine itself has also been shown to be harmful.
MYTH 3: Smoking after sex is relaxing and can help promote pregnancy.
Dr. Austin: The chemical compounds in cigarettes aren’t actually relaxing and have a bad effect on the blood vessels feeding the reproductive system. Smoking in no way helps you get pregnant.
MYTH 4: I’ve tried to quit so many times before. Pregnancy won’t be enough reason for me to quit.
Dr. Austin: Don’t give up! On average, female smokers have tried to quit three other times before they’re finally able to kick the habit. Each time you try, your chances of success go up.
Q: What are the biggest challenges involved with quitting smoking while coping with infertility?
Dr. Vij: Infertility is an incredibly stressful situation for couples to deal with, and stress is a huge driver for smoking. So it’s important to find other ways to cope with stress that don’t harm reproductive health.
Doctors can provide assistance in helping men and women quit smoking. There are several medications that have proven to be effective in helping people quit, including bupropion (Wellbutrin®) and varenicline (Chantix®). To get started, schedule an appointment with your doctor and ask for help.
Q: Once you quit smoking, how long does it take to improve reproductive health?
Dr. Austin: The good news is that many health benefits are visible within weeks or months of quitting. But some effects aren’t seen for a year after quitting. So, of course, the sooner you quit, the better.
For women, the positive effects of quitting smoking can be detected in the eggs in three months. Since it takes 90 days to produce the egg that will be released during your cycle, the egg that you ovulate in three months is starting to be made now.
Dr. Vij: For men, the cycle of spermatogenesis (the creation and development of new sperm) is three months. Any change you make in lifestyle, medication or surgery will generally take three months to impact sperm health. After quitting, it’s best to wait three months before testing sperm quality.
Q: What’s the best advice you can give smoking couples struggling with infertility?
Dr. Vij: If you’re struggling to get pregnant, educate yourself and your family about how fertility is impacted by smoking. We find that couples are the most successful when they tackle smoking cessation together.
Smoking is a very serious risk factor for heart disease and cancer. If you want to be around to see your kids grow up, now is the time to quit. Plus, it’s a lot harder for an older adult to quit smoking.
Dr. Austin: Your ultimate goal should be to create a healthy, stable environment for your child. Do it from day one to give your baby the best possible start — before they are even conceived.
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