13 August 2021

Tobacco and Male Infertility: the hard truths

Tobacco and Male Infertility: the hard truths
Medical Director
Cesar Diaz-Garcia
MD PhD Assoc Prof
IVI London


Chances are you already know that smoking is bad news for your health, but do you know about the toll it may be having on your fertility? For men in particular, the connection between  tobacco and infertility is hard to ignore. Tobacco smoking is one of the major factors leading to male infertility, with the habit being directly linked to low sperm counts, poor sperm motility and sub-optimum quality. However, it’s important to remember that for most men, a full sperm production cycle ( spermatogenesis ) takes around three months. What this means is that if you quit smoking today, in as soon as 90 days your sperm could be healthier, significantly increasing your chances of conceiving.

So, whether you’re thinking of starting a family and have concerns about your fertility or you’re currently investigating your fertility treatment options, there really never has been a better time to quit. In this article, we’ll take a closer look at just how harmful smoking can be to the chances of having a baby and why quitting smoking boosts male fertility levels.


The rise of infertility

It seems we’re fighting a rising tide of male infertility cases in the modern era. Research from IVI found that the number of men seeking fertility treatment rose from 12.4% in 2004 to 21.3% in 2017 , meaning around one in every five men in the UK could need help having a child. While it’s evident that male infertility is becoming a bigger issue, the reason why remains unclear. Fertility experts are unable to pinpoint the cause with certainty, but there are many educated guesses at what could be behind it. Along with poor diet, obesity and certain medications such an antidepressants, smoking is often cited.

Although infertility has been rising, smoking habits have been on the decline for a while now: in 2019, 14.1% of UK adults (or around 6.9 million people) classed themselves as smokers, compared to 14.7% in the previous year. Those aged between 25 and 34 years were the most likely to smoke, with 19% in that age group being a smoker. This statistic becomes significant when you consider people in this age group are also at peak fertility age and are the most likely to be thinking about starting a family.


The hard facts

Needing a helping hand in starting or adding to your family is not uncommon, but if you smoke, there’s an even higher risk that you’ll struggle to do so. If you smoke, it can take twice as long to get pregnant when compared to a non-smoker. If you’re in a hetero couple, the passing of time could make your situation even more difficult. Age is the single largest cause of female infertility, meaning your partner could be left facing potential fertility blocks which could have been avoided, depending on her age.

Male smokers can expect an average 23% decrease in sperm concentration – a figure that’s significant enough to warrant concern. Fortunately, smoking is an issue that’s easily addressed and it’s possible to reverse any damage to sperm in the long-term. While there are no guarantees, many men should see a significant boost to their fertility just by giving up smoking. If you find there are still underlying fertility issues, the fact you’re no longer putting those toxins into your body will help increase your chance of successful fertility treatment.

Quantity does matter. While smoking can lead to a reduced sperm count, decreased motility and poorly formed sperm, the effect of this is strongest in the heaviest of smokers. Heavy smokers, those who indulge in 20 or more every day, will see their fertility suffer the most.


Does smoking affect sperm DNA?

In short, the answer is yes. As well as high levels of known carcinogens, cigarettes also contain heavy metals like cadmium, lead and mercury. These heavy metals – particularly the latter two – have been linked in scientific research to have a negative impact on sperm and are among the most common causes of sperm damage.

Studies have also shown that smoking can lead to an increase in sperm DNA fragmentation. Men who have damaged sperm are more likely to experience problems with their fertility. This means smokers are more likely to have issues with fertilization, embryo development and an increased risk of miscarriage if their partner does conceive.

Not only does smoking have a negative impact on sperm, it is also a known contributor to erectile dysfunction. This condition can make getting pregnant significantly more challenging. The longer and heavier you smoke, the higher your risk of being affected by erectile dysfunction.

It should also be mentioned that second-hand smoke inhalation can lead to problems with female infertility, too: even passive exposure to smoke is known to disrupt the normal function of the ovaries.


Can I just cut down on smoking?

If you have been smoking for a longer period of time, quitting altogether can be extremely challenging. It is normal to want to start slowly. The positive news is that even reducing the amount you smoke can help to improve sperm quality. However, if you’re at the stage where you are already looking into fertility treatments or planning to have treatment soon, then cutting out cigarettes completely could be the best thing to maximize your chances of success. Men who smoke have a lower chance of successful IVF or ICSI procedure than their non-smoking peers: one small study found that the success rate for IVF-ICSI leapt from 22% to 38% if the male participant wasn’t a smoker.

In recent years, an easier pathway to quitting smoking tobacco has appeared in the rise of e-cigarettes and vaping, with many smokers choosing to exchange their old habit for a less dangerous alternative. New research investigating the effects of vaping on fertility is still ongoing. A recent study published by the Journal of Human Reproduction found that daily e-cigarettes cause the sperm count to drop , according to an analysis involving a cohort of 2008 men of reproductive age. Meanwhile, researchers at the University College of London found that certain ingredients added to vape flavor concentrates (e-liquids) diminish male fertility by negatively impacting sperm motility.If you are unable to quit or cut down on cigarettes, then switching to e-cigarettes is a less harmful choice for your fertility. However, the health risks that remain with e-cigarettes could mean that kicking the habit altogether is the most effective way to build your family sooner.


Making a change

Quitting smoking tobacco is an enormous challenge for most people – and even more so if you’re also suffering with the stress and anxiety of infertility. Understanding just how beneficial ditching the habit can be for both your health and your fertility can be a source of motivation: not only will your blood pressure drop in just half an hour, but your fertility will start to improve immediately. If you stop smoking today, by the time the next spermatogenesis cycle is complete, the sperm should be much healthier. 

If you are struggling to quit smoking, there is lots of help available, including the Better Health: Quit Smoking program offered by the NHS.

There are a number of free UK helplines available where you can speak to a smoking advisor.

  • In England, you can call the free Smokefree National Helpline on 0300 123 1044
  • In Scotland, you can call the free Smokeline on 0800 84 84 84
  • In Wales, you can call the free Help Me Quit helpline on 0800 085 2219
  • In Northern Ireland, you can call a provider in the town or city where you live – you can find telephone numbers on the Want2Stop website.


Your next steps

What’s next if you plan to quit smoking in order to undergo fertility treatment? We would always advise our patients to give up smoking several months prior to treatment. This ensures the sperm is as healthy as possible. Giving up smoking can improve your fertility, but it can also lead to a healthier lifestyle in which to raise your children. Contact us today to find out more about your first steps to fertility treatments.

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