Cigarette Smoking and IVF

Sérgio R. Soares; Marco A. Melo

Expert Rev of Obstet Gynecol. 2008;3(4):555-563.

Abstract and Introduction

Abstract

The goal of this article is to present a thorough review of the literature concerning the relationship between cigarette smoking and IVF cycle outcome, as well as the possible mechanisms through which tobacco constituents affect these cycles. Cigarette smoke affects spermatozoa structure and function; sperm DNA is damaged by tobacco compounds. Spermatozoa from smokers have reduced fertilizing capacity and embryos display lower implantation rates. Ovarian aging is accelerated in smokers and oocyte number and maturation are negatively affected by cigarette smoke. Clinical parameters of IVF cycle outcome are worse in female smokers. This is also the consequence of impaired uterine receptiveness.

Introduction

Cigarette smoking has been reported to affect reproductive function in many ways.^[1] Some of these effects may impair the likelihood of spontaneous pregnancy, while some others may even hamper IVF success probability.^[1] This text focuses on the possible mechanisms through which cigarette smoking may interfere with IVF cycle outcome.

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Cite this: Cigarette Smoking and IVF - Medscape - Jul 01, 2008.

Abstract and Introduction
The Male Gamete
Cigarette Smoking & Ovarian Function in IVF
Tobacco & Uterine Receptiveness
Expert Commentary
Five-year View
Sidebar: Key Issues
References

Sidebar: Key Issues

Cigarette smoke affects reproductive function in many ways. Some of the consequences of the exposure to this environmental toxicant may be overcome by assisted reproduction technology. Conversely, other effects are related to the quality of biologic material that is essential for a healthy pregnancy (i.e., sperm DNA quality, oocyte quality and uterine receptiveness).
Oxidative stress, determined by cigarette smoking, is associated with reduced sperm fertilizing capacity. In addition, sperm plasma membrane and sperm tail both display structural abnormalities in smokers. These abnormalities may impair sperm function or even affect its integrity.
Oxidative stress, determined by tobacco-smoke exposure, leads to structural alterations in sperm DNA. Increased incidences of DNA fragmentation, formation of DNA adducts and aneuploidies are seen in spermatozoa from smokers. DNA adducts are lesions that predispose to point mutations that may be transmitted to descendants and increase the incidence of diseases such as cancer.
Parameters of IVF cycles of couples with a male smoker show that fertilization rate, implantation rate and pregnancy rate are lower. Intracytoplasmic sperm injection may improve the fertilization rate in these cases, but compromised embryo quality and cycle outcome are still seen with sperm microinjection, most likely due to compromised DNA quality.
Cigarette smoking clearly affects ovarian function. Sex steroid production by granulosa cells and follicular maturation is impaired by toxicants present in tobacco smoke. The expansion of the oocyte-cumulus cell complex is inhibited in vitro by tobacco compounds. Smokers also display an increased incidence of abnormalities in oocyte nuclear maturation: abnormalities in the assembly of the meiotic spindle lead to an increased frequency of numerical chromosome abnormalities.
Studies analyzing the effect of female smoking on IVF showed a clear trend toward fewer mature oocytes, requirement of higher doses of gonadotrophin and a longer stimulation period. These cycles also displayed lower fertilization rate, fewer embryos per cycle and lower embryo score; implantation rate and pregnancy rate were reduced and miscarriage rate was increased; live-birth rate per cycle is reduced.
Cigarette smoking reduces uterine receptiveness. Smokers have a reduced pregnancy rate in oocyte donation cycles. Curiously, multiple pregnancy rates are also significantly increased in these women.
All the evidence available regarding the negative impact of cigarette smoke exposure on IVF cycle outcome, and even on the health of descendants, indicate that quitting a smoking habit should be seen by physicians and couples scheduling an assisted reproductive therapy treatment as a key step before the performance of treatment.

References

Papers of special note have been highlighted as: • of interest •• of considerable interest

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Cigarette Smoking and IVF

Abstract and Introduction

Abstract

Introduction

Tables

Authors and Disclosures

Authors and Disclosures

Sidebar

Sidebar: Key Issues

Sidebar

References

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