A new World Health Organization knowledge summary has brought renewed attention to the connection between tobacco use and difficulties in conceiving. The document synthesises decades of research and finds that smoking is associated with a significantly higher risk of infertility in women, as well as semen abnormalities and sexual dysfunction in men. Importantly, it also indicates that quitting can reduce some of that risk, offering a practical message for people planning a pregnancy.
Higher Risk of Infertility in Women Who Smoke
The WHO summary cites a systematic review of studies conducted between 2000 and 2026. According to the findings, women who currently smoke tobacco face a 40 percent higher risk of infertility compared with women who do not smoke. Infertility is defined as the inability to achieve pregnancy after 12 months or more of regular unprotected intercourse.
To put the figure in perspective, if the baseline risk of infertility among non-smoking women is around 15 percent, the corresponding risk among current smokers rises to approximately 21 percent. The association does not mean that every woman who smokes will experience infertility, nor that tobacco is the sole cause in every case. It does, however, identify smoking as a clear and modifiable risk factor for reproductive health.
The review also examined women who had smoked in the past but were no longer smoking. These former smokers showed a 25 percent lower risk of infertility compared with women who continued to smoke. The comparison suggests that stopping tobacco use can produce a meaningful improvement in reproductive prospects.
Effects on Male Reproductive Health
The WHO publication emphasises that infertility is not solely a women’s health issue. A separate review of 44 studies involving more than 60,000 men found consistent associations between smoking and reproductive dysfunction. The problems identified fall into two broad categories: abnormalities in semen quality and difficulties with sexual function.
Men who smoke were more likely to experience erectile dysfunction and ejaculation problems. The evidence also linked smoking to specific semen parameters that can impair the ability to achieve pregnancy. These include the absence of sperm in the semen, reduced sperm motility, and a higher proportion of abnormally shaped sperm. Such changes can interfere with the sperm’s capacity to reach and fertilise an egg.
Because sperm production is a continuous process that takes roughly three months, improvements in semen quality may become noticeable within a relatively short period after a man stops smoking. This biological timeline reinforces the potential benefit of cessation for couples trying to conceive.
Second-Hand Smoke and Fertility Treatments
The summary notes that exposure to second-hand tobacco smoke may also elevate infertility risk. Women exposed to passive smoking appear to face a higher likelihood of infertility and a reduced chance of conceiving in any given menstrual cycle. This finding expands the relevance of smoke-free environments beyond the individual smoker to partners and household members.
For couples undergoing assisted reproductive technologies, the picture is similarly concerning. Earlier research synthesised in the WHO document indicates that cigarette smoking is associated with lower rates of pregnancy and live birth following treatments such as in-vitro fertilisation. Some analyses suggest that the chance of successful outcomes may be substantially reduced among smokers.
Emerging Evidence on Other Tobacco and Nicotine Products
While the strongest evidence concerns conventional cigarette smoking, the WHO summary acknowledges that research on newer or alternative products remains limited. These include e-cigarettes, waterpipes and smokeless tobacco. Preliminary findings raise the possibility of adverse effects on fertility parameters, but the agency stresses that more rigorous studies are needed before firm conclusions can be drawn. In the meantime, a precautionary approach is warranted.
The Case for Quitting
One of the clearest practical takeaways from the knowledge summary is that cessation can make a difference. The lower infertility risk observed among former smokers compared with continuing smokers points to a reversible component of tobacco’s impact on reproductive health. For men, the relatively rapid turnover of sperm production offers a concrete window in which improvements can occur after quitting.
Healthcare providers are encouraged to discuss these risks with individuals and couples who are planning a pregnancy. Brief advice on cessation, delivered routinely in clinical settings, combined with evidence-based support such as counselling or pharmacotherapy where appropriate, can help people stop smoking. Integrating reproductive-health messaging into tobacco-control efforts, and vice versa, strengthens the overall public-health response.
Broader Public-Health Implications
Infertility affects a substantial proportion of people of reproductive age worldwide. Many factors contribute to it, including age, underlying medical conditions, environmental exposures and lifestyle. Tobacco use stands out because it is both harmful and modifiable. Addressing smoking therefore represents one of the more actionable steps couples can take while pursuing conception.
The WHO summary serves as both a synthesis of existing science and an advocacy tool. By consolidating evidence across multiple studies and populations, it provides clinicians, policymakers and the public with a clear reference point. It also underscores the value of smoke-free policies and cessation services not only for reducing cancer, cardiovascular and respiratory disease, but also for protecting reproductive potential.
A Practical Message for Couples
For people who smoke and are hoping to have a child, the evidence supports a straightforward recommendation: stopping tobacco use improves the odds. The benefit is not guaranteed in every individual case, and infertility can arise from many causes. Yet the consistent direction of the research—higher risk among current smokers, lower risk among those who have quit, and measurable effects on both female and male reproductive parameters—makes cessation a rational priority.
Partners who do not smoke themselves can still be affected by second-hand exposure, reinforcing the value of a completely smoke-free home. Couples already engaged in fertility treatment may find that quitting supports better outcomes from the medical interventions they are undertaking.
The WHO knowledge summary does not claim that tobacco is the only or even the primary cause of infertility in most cases. It does establish that smoking is a significant and avoidable contributor. In a field where many risk factors are difficult or impossible to change, the opportunity to reduce risk through cessation stands out as both scientifically grounded and practically achievable.
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