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The Effects of Smoking on ovarian Function and Fertility During Assisted Reproduction Cycles

VAN VOORHIS, BRADLEY J. MD; DAWSON, JEFFREY D. ScD; STOVALL, DALE W. MD; SPARKS, AMY E. T. PhD; SYROP, CRAIG H. MD
Obstetrics & Gynecology: November 1996
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Objective To investigate the effects of cigarette smoking on ovarian function and fertility in women undergoing assisted reproduction cycles.

Methods We assessed the effects of smoking on ovarian function and fertility in a cohort of 499 women. Questionnaires were designed to quantify past smoking exposure and to determine whether the woman was smoking during the treatment cycle. Ovarian function characteristics and pregnancy rates were compared among current smokers, past smokers, and nonsmokers.

Results Compared with nonsmokers, both current and past smokers have reduced gonadotropin-stimulated ovarian function. A history of increasing tobacco exposure was associated with decreasing serum estradiol concentrations, numbers of retrieved oocytes, and numbers of embryos. On average, for every 10 pack-years of cigarette smoking, 2.5 fewer mature oocytes and 2.0 fewer embryos were obtained. Women who smoked during their treatment cycle had approximately a 50% reduction in implantation rate and ongoing pregnancy rate compared with women who had never smoked. Women who quit smoking before their treatment cycle had the same pregnancy rate as nonsmokers.

Conclusion Cigarette smoking is associated with a prolonged and dose-dependent adverse effect on ovarian function. Smoking appears to have a more transient toxic effect on fertility, because current smokers, but not past smokers, had a markedly reduced pregnancy rate after treatment cycles compared with nonsmokers. Women should quit smoking before assisted reproduction cycles.

Address reprint requests to: Bradley J. Van Voorhis, MD, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, 1A 52242-1080.

© 1996 The American College of Obstetricians and Gynecologists