Smoking Is a Potential Cause of Infertility and Delayed Conception: WHO Report

According to a 2026 World Health Organization (WHO) report, cigarette smoking is linked to infertility in both women and men. Second-hand smoke exposure may also affect fertility. The WHO recommends that people planning a pregnancy should be informed about the reproductive risks of tobacco and offered evidence-based support to quit.

How Common Is Infertility?

Infertility is defined as being unable to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. It is a global health issue, with about one in six people experiencing infertility at some point in their reproductive lives.

Infertility can have female, male, or combined causes. The WHO report notes that about 30% of cases are linked to female factors alone, around 18% to male factors alone, and about 26% involve both partners. In roughly 10% of cases, no clear cause is identified during routine investigations.

Lifestyle factors, including smoking, second-hand smoke exposure, unhealthy diet, physical inactivity, and excessive alcohol use, may also affect reproductive health.

Smoking Can Reduce Female Fertility

Second-hand smoke exposure may reduce the number and quality of eggs in women, which can negatively affect fertility.

The connection between smoking and female fertility has been studied for decades. Research has consistently found that women who smoke have a higher risk of infertility than non-smokers.

The WHO summary reports that a recent review of studies found the risk of infertility to be about 1.4 times higher among women who currently smoke. Smoking has also been associated with taking longer to conceive and a greater risk of both primary infertility and secondary infertility.

Also Read: Infertility vs Recurrent Miscarriage: Why Treating Them the Same Way Doesn’t Work

According to Dr Shalu Gupta, Senior Clinical Director - Department of Fertility at Cloudnine Group of Hospitals, Sector 47, Gurugram, “Smoking also accelerates follicular depletion, which may contribute to an earlier onset of menopause compared with women who do not smoke. Regular exposure to second-hand smoke may also affect reproductive health and potentially influence the chances of success with fertility treatments such as IVF.”

This means smoking can affect women who are trying for their first baby as well as those who are attempting to conceive again.

Even Passive Smoking May Matter

You do not necessarily have to smoke yourself to be exposed to tobacco-related reproductive risks.

The WHO review found an association between passive smoking and infertility in women.

“While passive smoking may not directly cause infertility in every individual, regular exposure to tobacco smoke can affect reproductive health and have significant implications during pregnancy, including ectopic pregnancy, miscarriage, preterm birth, pre-eclampsia, foetal growth restriction, low birth weight, stillbirth, placental complications and neonatal complications,” shares Dr Gupta.

Women exposed to second-hand smoke were also found to have a lower chance of conceiving in each month they were trying.

Also Read: Does Smoking in Pregnancy Increase Childhood Cancer Risk? An Oncologist Explains

What About Male Fertility?

Smoking can affect male reproductive health as well. Research has linked cigarette smoking with problems involving semen, sperm, and sexual function.

A review involving more than 60,000 men found smoking was associated with reproductive dysfunction. Smokers were more likely to experience problems such as erectile dysfunction and ejaculation difficulties. Smoking has also been associated with azoospermia, which means an absence of sperm in semen, as well as poor sperm movement and abnormal sperm shape.

These changes can reduce the chances of conception and contribute to infertility.

Is Vaping Or Hookah Safer For Fertility?

It is important not to assume that alternatives to cigarettes are harmless for reproductive health.

Research on e-cigarettes and fertility is still more limited than research on conventional cigarette smoking. However, the WHO summary notes that one study involving more than 4,500 women found ever-use of e-cigarettes was associated with a 20% reduction in fecundability, or the probability of becoming pregnant during a menstrual cycle.

There is also evidence suggesting that waterpipe or hookah smoking may affect fertility. In men, studies have linked waterpipe smoking with measures of poorer sperm quality, including lower semen volume, reduced sperm motility, and fewer normally shaped sperm. However, the WHO says more high-quality research is needed to establish these effects firmly.

Smoking May Also Affect Fertility Treatment

The effects of tobacco use may continue to matter when couples seek medical help for infertility.

Fertility treatments can include medicines to induce ovulation, surgery, IVF and other forms of medically assisted reproduction. Research reviewed by the WHO found cigarette smoking was associated with fewer pregnancies and live births following assisted reproduction in some studies.

However, the evidence is not completely consistent. A smaller, more recent study found no difference in fertilisation or pregnancy rates between people who did and did not smoke cigarettes, e-cigarettes or use waterpipes.

Can Quitting Smoking Improve Fertility?

Stopping smoking is one modifiable step that may improve reproductive prospects. The WHO summary reports that women who had smoked in the past but were no longer smoking had a lower risk of infertility than women who continued to smoke.

“For couples planning a pregnancy or undergoing fertility treatment, avoiding tobacco smoke is an important step towards protecting reproductive health. This means not only quitting smoking but also maintaining a smoke-free environment at home and avoiding regular exposure to cigarette smoke,” suggests Dr Gupta.

Every healthy choice matters on the fertility journey. Creating a smoke-free environment is one simple yet important step couples can take to protect their reproductive health and support their chances of building a family.

Final Word

Summing up, Dr Gupta highlights that it is important to remember that fertility depends on multiple factors. Exposure to second-hand smoke does not necessarily mean a couple will experience infertility or IVF failure. However, reducing preventable risk factors can be beneficial when trying to conceive.

If you are planning a pregnancy, quitting tobacco and avoiding passive smoking can be an important step towards protecting reproductive health. The WHO recommends that healthcare professionals routinely provide brief advice to tobacco users and support them with evidence-based quitting approaches, including counselling, digital programmes and approved treatments where appropriate.