3.6 Reproductive health and smoking

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3.0 Background

3.1 Tobacco—a leading preventable cause of death and disease

3.2 Cardiovascular diseases

3.3 Lung cancer

3.4 Respiratory diseases

3.5 Other cancers caused by or associated with smoking

3.6 Reproductive health and smoking

3.7 Pregnancy and smoking

3.8 Infant health and smoking

3.9 Increased susceptibility to infection in smokers

3.10 Eye diseases

3.11 Dental diseases

3.12 Gastrointestinal diseases

3.13 Bone density and risk of fractures

3.14 Effects of smoking on the skin

3.15 Smoking and complications in medical treatment

3.16 Smoking and diabetes

3.17 Poorer levels of general health

3.18 Smoking, motor vehicle crashes and other injuries

3.19 Burns and fires caused by tobacco use

3.20 Tobacco poisoning

3.21 Health effects for younger smokers

3.22 Genetic influences on tobacco-caused disease

3.23 Smoking, dementia and cognitive decline

3.24 Lung disease, smoking and occupational exposures

3.25 Air pollution, cigarette smoking and ill health

3.26 Health effects of smoking brands that claim to deliver lower levels of tar, nicotine and carbon monoxide

3.27 Health effects of smoking tobacco in other forms

3.28 Health 'benefits' of smoking?

3.29 Morbidity (ill health) attributable to tobacco-caused disease

3.30 Deaths attributable to tobacco by disease category

3.31 Morbidity and mortality due to tobacco-caused disease and socioeconomic disadvantage

3.32 Health effects of smoking other substances

3.33 Health effects of chewing tobacco, and of other smokeless tobacco products

3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking

3.35 Health benefits of cessation

3.36 The global tobacco pandemic

Acknowledgments

References

3.6.1 Women

3.6.1.1 Fertility

Women who smoke experience a reduced rate of fertility—overall, female smokers are on average twice as likely to be infertile as non-smokers. Reduced fertility is evident both in female smokers who never been pregnant (primary infertility) and those who have had one or more prior pregnancies (secondary infertility).5

Smokers may also be less likely to respond to infertility treatments such as in vitro fertilisation (IVF), showing lower rates for successful fertilisation, implantation and ongoing pregnancy.15 Smokers are also more likely to have shorter menstrual cycles and are at higher risk of not ovulating regularly (anovulation), which may also reduce fertility.

Toxins in cigarette smoke may affect the early stages of fertilisation and implantation, as well as post-fertilisation cell division,5 possibly through endocrine disruption.39 Increased levels of tobacco use elevate the risk of experiencing fertility problems.5

Smoking also has a range of adverse effects on both mother and unborn baby during pregnancy, outlined in Section 3.7 below.

3.6.1.2 Smoking and the oral contraceptive pill

As noted previously, smoking is an important cause of coronary heart disease, increasing disease risk by two- to fourfold.13 Usage of the 'combined' oral contraceptive pill (which contains the hormone oestrogen) is also known to increase the risk of myocardial infarction by twofold.40 The interaction between smoking and the pill is synergistic, meaning that when the risk factors are combined, the risk of disease is multiplicative rather than additive. Women who both take the oral contraceptive pill and smoke have 20 times the risk of developing coronary heart disease.41 Heavier smokers have a higher risk for disease.15

Although more recent 'lower dose' versions of the pill may be associated with a lesser risk of developing coronary heart disease, there is still substantial evidence that disease risk is elevated in smokers.15 There is insufficient evidence to evaluate the risk profile of the currently-used 'third generation' pills (containing 30 µg or less of ethynyl estradiol and either gestodene or desogestrel) combined with smoking,15, 40 but clinicians are advised to be wary when prescribing oral contraceptives to smokers aged in their mid-30s and to exercise extreme caution40 or avoid using them altogether in smokers aged over 40.15

In past decades the risk of stroke, particularly subarachnoid haemorrhage, has been significantly higher among smokers using the contraceptive pill. However research published since the 1990s following women using lower dose pills is conflicting, some research showing increased risk, while other studies have shown no substantial effect.15

There is some evidence that suggests that the combined contraceptive pill has a higher failure rate in smokers than in non-smokers.41

3.6.1.3 Menstruation and menopause

Some studies suggest that smoking may alter menstrual function by increasing the risks for dysmenorrhea (painful menstruation), secondary amenorrhea (lack of menses among women who have ever had menstrual periods), and menstrual irregularity.5, 41

Women smokers reach natural menopause on average two years earlier than do non-smokers and may also experience more menopausal symptoms such as hot flushes and insomnia.15, 41

3.6.2 Men

3.6.2.1 Sperm production

Smoking may be associated with having a lower sperm count and volume, and an increased likelihood of sperm abnormality. However these findings are not conclusive and it is not known at this stage what, if any, implications they may hold for male fertility. Further research is required to rule out other possible influences such as workplace exposures to toxins and health behaviours such as caffeine, alcohol and other drug use.5

3.6.2.2 Erectile dysfunction

Erectile dysfunction is the persistent inability to attain and maintain penile erection adequate for satisfactory sexual performance.5, 41 Australian research has shown that one in 10 men aged between 16 and 59 has experienced erectile difficulties, the risk increasing with age.42 Smoking is a risk factor for experiencing erectile dysfunction. Smokers of up to 20 cigarettes a day are 24% more likely to report having experienced erectile problems, and heavier smokers are 40% more likely to report having had erectile difficulties than non-smokers.42 The probable mechanisms are nicotine in tobacco smoke, which reduces blood flow to the penis by constricting the arteries, and long-term damage to the blood vessels within erectile tissue.5, 41

Individuals with diabetes, coronary artery disease or high blood pressure are more likely to experience erectile dysfunction. Males with these conditions who smoke as well increase their risk of impotence.41

3.6.2.3 Less success following assisted fertility techniques

Couples undergoing fertility treatment may be less likely to conceive if the male partner is a smoker. Programs for IVF and intracytoplasmic sperm injection (the actual injection of a sperm into an ovum, rather than simple combination of the two) appear to have a poorer success rate among women whose partners smoke.41