smoking infertility

8/8/2019 Smoking Infertility

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BYBY

Mohammad A. EmamMohammad A. Emam

Prof. of Obstetrics andProf. of Obstetrics and

GynecologyGynecology

Mansoura Faculty of MedicineMansoura Faculty of Medicine

Mansoura integrated fertilityMansoura integrated fertility

center (MIFC)center (MIFC) EGYPTEGYPT

Smoking AndSmoking And InfertilityInfertility


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Smoking as a major healthproblem.

High prevalence ofsmoking among women intheir reproductive years

Unawareness of effect of

smoking on reproduction.Smokers may be active orpassive.

Introduction &RationaleIntroduction &Rationale


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Prevalence of SmokingPrevalence of Smoking30% of reproductive age womenand 35% of men are cigarette

smokers (Centers for Disease Control andPrevention 2001)

Nearly 30% of middle schoolchildren and over 63% of highschool students had triedsmoking (American Heart Associationstatistics 2001).


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Prevalence of SmokingPrevalence of Smoking con.con.

In Egypt:

20% of reproductive age

women and 35% of men are

cigarette smokers.

Shesha smokers are

increased among adolescentsteenage girls.


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Awareness of The HealthAwareness of The Health

Risks of SmokingRisks of SmokingQuestionnaire for 388 female hospitalemployees 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%).


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Awareness of The HealthAwareness of The Health

Risks of SmokingRisks of Smoking contcont

Few women are aware that smokingis associated with:

Osteoporosis (30%).

Early menopause (17%).

Spontaneous abortion (39%). Ectopic pregnancy (27%).

Cervical cancer (24%).

Infertility (22%).


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Smoking & ReproductionSmoking & Reproduction

More Than4

0PublishedStudies In

MedicalLiterature


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Smoking & Female InfertilitySmoking & 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.


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Smoking & Female InfertilitySmoking & Female Infertility con.con.

Women who quit smoking before or during

pregnancy reduce the risk for adverse

reproductive outcomes, including:Difficulties in becomingpregnant.

Infertility.

PROM.

Preterm delivery.

Low birth weight.

(Cochrene review,Lumelyet al,2003)


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Smoking & Male InfertilitySmoking & Male Infertility

(ASRM=AFS(ASRM=AFS 20012001))

Heavy smokingcontributes to:

Development of impotence(decrease blood flow to the penis)

Abnormal semenogram :Decreased sperm count,

alteration in motility , and increase

in the abnormal forms.


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SMOKERS & ARTSMOKERS & ARTA prospective cohort studyA prospective cohort study ((Zitzman etalZitzman etal20012001))::

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.


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How Smoking Affect Fertility?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 follicleIncrease ROS inside Graafian follicle

Affect meiotic maturation of humanAffect meiotic maturation of human

oocytesoocytes


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How Smoking Affect Fertility?How Smoking Affect Fertility? ConCon

Interfere with estrogen synthesis,

Endothelial abnormalities (atherogenic

and thrombotic problems).

Oocytes (pre-zygotic genetic damage)

sperm DNA damage (substances insmoke).


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Substances In SmokeSubstances In Smoke

(active and passive ):

> 4.000 chemical compounds,

43 carcinogens or poisons

> 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


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Updat at r al iUpdat at r al i

I cr as s th ris f asth a

duri th first 7 y ars f lif(Laurberg P, 2004)

I pair t f i di

Nutriti i Br ast-F d

I fants (Nohr, 2004).

Incr as d ris f r suddeninfant death syndr e

( ID ).


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Mansoura integratedFertility Center (MIFC)

RESEARCHE Egypt


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Could Female Passive SmokingCompromise The Outcome of

Assisted Fertilization?

( Middle East Fertility Society 10th

a\Annual Scientific Meeting Lebanon

,December 10-13,2003) o-76


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Could Cadmium Be The Culprit ofCould Cadmium Be The Culprit of

Defective Male ReproductionDefective Male Reproduction

Among Smokers?Among Smokers?

The Egyptian Journal OfDermatology and Venereology vol

22 ,N 2&3 2002


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ConclusionsConclusionsA high cadmium level is

observed in plasma of heavy

smokers which may cause a

direct cytotoxic effect on

spermatozoa, impairing their

functions.


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ConclusionsConclusions cont.cont.Smoking cessation may improve

fertility and success rates with

infertility treatment.Moreover it ishealthy for the growing fetus, and

will create a smoke-free

environment for an infant.

Smoking may be a forgottenexplanation for some cases of

unexplained infertility.


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ConclusionsConclusions cont.cont.It is not known how long

the damaging effects ofsmoking last after

quitting but Oneimportant investigationshowed that cessation ofsmoking forat least two

months beforeattempting IVFsignificantly improvedchances for conception.


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RecommendationsRecommendations1. 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 tocigarette smoke and the fertilization rate,are needed.

3. Further studies on the levels of reactiveoxygen species (ROS) in the follicular fluidin passive smokers are needed.


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OB& GYN, Mansoura FacultyofMedcine

Mansoura Integrated Fertility Center (MIFC)EGYPT

Telfax 0020502319922 & 0020502312299

Email. [email protected]

smoking infertility

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