The Effects of Tobacco or Marijuana Use on Fertility

We know that cigarette smoking is a well-established, modifiable risk factor in pregnancy with complications including: preterm delivery, and growth restriction of the baby in utero. The American Society for Reproductive Medicine (ASRM), recently published a committee opinion on the use of tobacco or marijuana use and the impact they can have on fertility and reproduction.

An independent study demonstrated that in smokers, the prevalence of infertility is higher, the time to conception is increased, and the ability to conceive is lower as compared to non-smokers. The increase in delay to conception is correlated with an increasing number of daily cigarettes smoked. Active smoking by either partner had adverse effects, therefore nonsmokers with significant exposure to tobacco smoke may have reproductive consequences as great as those observed in smokers.

It was also found that in women who smoke, menopause occurs 1 to 4 years earlier. In one study, FSH levels were 66% higher and anti-müllerian hormone levels (AMH) had significantly lower concentrations in patients who were smokers. Additionally, women who undergo IVF stimulation appear to need a larger dose of hormone medications when comparing them to non-smoking women. Also, several independent studies demonstrated that smokers require nearly twice the number of IVF cycles as non-smokers.

Once pregnancy is achieved, cigarette smoking is associated with an increase in spontaneous miscarriage for those going through fertility treatment as well as for those who conceive naturally. There is also an increased risk of ectopic pregnancy that has been demonstrated in numerous studies. Interestingly, the risk of ectopic pregnancy decreases to the same level as never smokers 10 years after quitting.

E-cigarettes or vaping have been thought to be less harmful than traditional tobacco products, however, increasing data has demonstrated that they are harmful to reproductive health and use by pregnant women is not safe for unborn babies. First-line therapies for smoking cessation include varenicline and bupropion, and nicotine replacement therapy prior to conception.

The American College of Obstetrics and Gynecology (ACOG) and the American College of Pediatricians recommend against the use of marijuana prior to conception and pregnancy because of the risks to the baby. They do, however, acknowledge that supporting evidence is incomplete, and conflicting. The potential association between marijuana, fertility and IVF outcomes is also incomplete and does not show any consistent associations.

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Article By Dr. Andrea Peterson