Key Details
WHO’s Tobacco and Infertility summarises research on smoking, tobacco exposure and reproductive health. Infertility has many possible causes; the estimates below describe associations with smoking, not the share of all infertility attributable to tobacco.
Women who smoke: A recent evidence review found approximately 1.4 times the infertility risk of women who do not smoke. WHO illustrates this as 21% risk among smokers if the comparable risk among non-smokers is 15%.
Second-hand smoke: Women exposed to other people’s tobacco smoke had an estimated 1.2 times higher riskin the studies reviewed.
Men’s reproductive health: Smoking is associated with poorer sperm characteristics and sexual dysfunction. Much of the evidence measures these outcomes rather than pregnancy rates directly.
After quitting: Women who formerly smoked may have a 25% lower infertility risk than current smokers. This comparison does not mean quitting guarantees pregnancy.
Other products: Evidence specific to e-cigarettes, waterpipes and smokeless tobacco remains less developed than the evidence on cigarette smoking.
Tobacco Exposure Matters for Both Partners
Infertility means not achieving pregnancy after 12 months or more of regular unprotected sexual intercourse. WHO estimates that about one in six people experience infertility during their lifetime — a figure for infertility from all causes, not for tobacco-related infertility.
The evidence is strongest for cigarette smoking and women’s fertility. Smoking is associated with a longer time to conceive and a higher risk of infertility. Exposure to second-hand smoke is also relevant, including when the woman does not smoke herself. For men, the reported links to sperm quality and sexual function make tobacco use a concern for couple-based fertility assessment, although evidence on resulting pregnancies is less direct.
Quitting Support Belongs in Reproductive Care
WHO recommends that healthcare providers inform people planning pregnancy about tobacco’s reproductive risks and offer evidence-based help to quit. Its existing guidance calls for brief cessation advice during routine healthcare visits and lifestyle advice for couples receiving infertility care. Counselling, quit lines, digital support and appropriate medicines can provide follow-up beyond the initial conversation.
Some studies also associate cigarette smoking with poorer outcomes from fertility treatment, but findings are not uniform. The practical message is to address tobacco exposure before and during treatment, without presenting cessation as a substitute for assessing other causes of infertility.
Evidence for Other Tobacco Products Needs More Work
The WHO summary notes possible reproductive risks from waterpipes, e-cigarettes and smokeless tobacco, but cautions that product-specific evidence is limited. Findings established for cigarette smoking should not simply be transferred to every product as though the research were equally strong.
Policy Relevance
India already has a National Tobacco Control Programme, including tobacco-cessation centres and quit-line services. The policy opportunity is to connect those existing services more consistently with pre-pregnancy advice and infertility care, so that clinicians ask about both partners’ tobacco use and second-hand exposure and can offer a practical route to quitting.
The WHO summary does not estimate tobacco-attributable infertility in India. Research on products used in different forms — including smokeless tobacco and bidis — would help tailor reproductive-health advice without overstating what the current evidence establishes.
Follow the Full WHO Brief Here: Tobacco and Infertility
India Programme Context: National Tobacco Control Programme