Mohammad A. Emam

1
Smoking And Infertility

• BY
• Mohammad A. Emam
• Prof. of Obstetrics and Gynecology
• Mansoura Faculty of Medicine
• Mansoura integrated fertility center (MIFC)
  EGYPT

2
Introduction Rationale

• Smoking as a major health problem.
• High prevalence of smoking among women in their
  reproductive years
• Unawareness of effect of smoking on reproduction.
• Smokers may be active or passive.

3
Smoking as A Health Problem

• Kills over 400,000 people every year (more than 1
  in 6 people in the U.S.)
• More lethal than AIDS, car accidents, homicides,
  suicides, drug overdose, and fires combined
• Smoking Killed Five Million Worldwide in 2000
• U.S. spends 50 billion each year on
  smoking-related costs.

4
Prevalence of Smoking

• 30 of reproductive age women and 35 of men are
  cigarette smokers (Centers for Disease Control
  and Prevention 2001)
• Nearly 30 of middle school children and over 63
  of high school students had tried smoking
  (American Heart Association statistics 2001).

5
Prevalence of Smoking con.

• In Egypt
• 20 of reproductive age women and 35 of men are
  cigarette smokers.
• Shesha smokers are increased among adolescents
  teenage girls.

6
Awareness of The Health Risks of Smoking

• Questionnaire for 388 female hospital employees
  including health care professional (Roth and
  Taylor 2001)
• Most women are aware that smoking causes
• Respiratory disease (99).
• Lung cancer (99).
• Heart disease (96).s
• Pregnancy complications (91).

7
Awareness of The Health Risks of Smoking cont

• Few women are aware that smoking is associated
  with
• Osteoporosis (30).
• Early menopause (17).
• Spontaneous abortion (39).
• Ectopic pregnancy (27).
• Cervical cancer (24).

• Infertility (22).

8
Smoking Reproduction

• More Than 40 Published Studies In Medical
  Literature

9
Smoking Female Infertility

• Meta analysis (21 studies) (Augood et all, 1998)
• Smoking reduce the natural fertility
• Earlier menopause (average 2 years).
• Damage of ovarian reserve increase with
  smoking(the amount and the period of smoking ).
• Increase in risks for ectopic pregnancy and
  spontaneous abortion.

10
Smoking Female Infertility con.

• Women who quit smoking before or during pregnancy
  reduce the risk for adverse reproductive
  outcomes, including

• Difficulties in becoming pregnant.
• Infertility.
• PROM.
• Preterm delivery.
• Low birth weight.
• (Cochrene review,Lumely et al,2003)

11
Smoking Male Infertility (ASRMAFS 2001)

• Heavy smoking contributes to
• Development of impotence (decrease blood flow to
  the penis)
• Abnormal semenogram
• Decreased sperm count, alteration in motility ,
  and increase in the abnormal forms.

12
SMOKERS ART A prospective cohort study
(Zitzman et al 2001)

• High basal and post cc serum FSH.
• Weak ovarian response to stim.
• Need higher doses of GN
• Impaired fertilization and delayed conception,
  resulted from
• Interference with gametogenesis
• Failure of implantation
• Early miscarriage.

13
How Smoking Affect Fertility?

• Maternal smoking affects
• In utro ovary of female fetuses
• Reduced Semen Quality and Testis Size in
  Adulthood (Jensen ,2004)
• Increase ROS inside Graafian follicle
• Affect meiotic maturation of human oocytes

14
How Smoking Affect Fertility? Con

• Interfere with estrogen synthesis,
• Endothelial abnormalities (atherogenic and
  thrombotic problems).
• Oocytes (pre-zygotic genetic damage)
• sperm DNA damage (substances in smoke).

15
Substances In Smoke

• (active and passive )
• gt 4.000 chemical compounds,
• 43 carcinogens or poisons
• gt 300 polycyclic aromatic hydrocarbons.
• methyl isocyanate( lethal poison).
• bezene,( a potent toxicant)
• Nicotine and its metabolites, cotinine
• Polonium 210 (a carcinogenic radioactive elem),
• Cadmium

Cigarette smoke
16
Update Maternal Smoking

• Increases the risk of asthma during the first 7
  years of life (Laurberg P, 2004)
• Impairment of iodine Nutrition in Breast-Fed
  Infants (Nohr, 2004).
• Increased risk for sudden infant death syndrome
  (SIDS).

17
Mansoura integrated Fertility Center (MIFC)
RESEARCHE Egypt
18
Could Female Passive Smoking Compromise The
Outcome of Assisted Fertilization?

• ( Middle East Fertility Society 10 th a\Annual
  Scientific Meeting Lebanon ,December 10-13,2003)
  o-76

19
Table-2 The Outcome of ICSI in Passive Smokers
Non Smokers
20
Conclusion

• Female passive smoking could decrease the success
  rates of ICSI either through
• The negative effect on the egg and embryo quality
  via passive exposure to smoke (second hand
  exposure) .
• And/or through the defective sperms of the male
  active smoker.

21
Could Cadmium Be The Culprit of Defective Male
Reproduction Among Smokers?

• The Egyptian Journal Of Dermatology and
  Venereology vol 22 ,N 23 2002

22
Conclusions

• A high cadmium level is observed in plasma of
  heavy smokers which may cause a direct cytotoxic
  effect on spermatozoa, impairing their functions.

23
Conclusions cont.

• Smoking cessation may improve fertility and
  success rates with infertility treatment.Moreover
  it is healthy for the growing fetus, and will
  create a smoke-free environment for an infant.
• Smoking may be a forgotten explanation for some
  cases of unexplained infertility.

24
Conclusions cont.

• It is not known how long the damaging effects of
  smoking last after quitting but One important
  investigation showed that cessation of smoking
  for at least two months before attempting IVF
  significantly improved chances for conception.

25
Recommendations

• 1. The phasing out and banning of smoking in home
  should be an integral part of human infertility
  treatment.
• 2. Further studies to show the correlation
  between the duration of exposure to cigarette
  smoke and the fertilization rate, are needed.
• 3. Further studies on the levels of reactive
  oxygen species (ROS) in the follicular fluid in
  passive smokers are needed.

26
Thank you
Prof. MOHAMMAD EMAM
OB GYN, Mansoura Faculty of Medcine Mansoura
Integrated Fertility Center (MIFC) EGYPT Telfax
0020502319922 0020502312299 Email.
mae335_at_hotmail.com