Cigarette Smoking and IVF

Sérgio R. Soares; Marco A. Melo

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

Expert Commentary

The impact of cigarette smoking on human health is vast and complex. In the reproductive field, our knowledge has increased in the last few decades. Tobacco smoke exposure may negatively interfere with the probability of a spontaneous pregnancy and is also detrimental to pregnancy development. It is now known that many of the negative effects of tobacco constituents on reproductive function are of relevance in the context of IVF cycles.

Oxidative stress determined by tobacco constituents may damage every cellular component. The cellular membrane, microtubules, proteins and DNA may have their integrity compromised. The male gamete may have its IVF capacity affected and chromosome number and the DNA molecule integrity altered; therefore, the quality of embryos generated and their implantation potential are reduced in smokers. Sperm DNA damage is also associated with the risk of diseases, such as cancer, in the progeny of male smokers.

Tobacco constituents also affect the process of follicular and oocyte maturation in many aspects; steroidogenesis and follicle growth are affected by these substances. Ovarian aging is accelerated in smokers and ovarian response in IVF cycles tends to be poorer. The incidence of abnormalities in meiosis resumption is higher in female smokers and clinical outcomes of IVF cycles are worse.

Endometrial receptiveness is altered by tobacco smoke. Endometrial decidualization may be compromised in smokers. Paradoxically, the incidence of twin gestations is higher among heavy smokers, as if in a subset of smoking women endometrial receptiveness were increased; this fact needs further clarification.

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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

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