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  • Title: [Cigarette smoking: male and female infertility].
    Author: Zavos PM.
    Journal: Fertil Contracept Sex; 1989 Feb; 17(2):133-8. PubMed ID: 12281878.
    Abstract:
    Despite problems of methodology, epidemiologic studies of women who smoke have clearly indicated that they suffer a lowering of fertility. Harmful effects are particularly noted in the periodicity of the menstrual cycle, tubal function and embryo transfer, development and viability of the ovocyte, age at menopause, and bone metabolism. Several epidemiologic studies have shown that the rate of infertility among women smoking is 21% vs. 14% among nonsmokers. Fertility declines significantly with daily cigarette consumption among women smoking 16 cigarettes a day or more. Nevertheless, in some cases such as tubal infertility, further research is needed to determine clearly whether there is a true causal mechanism or whether there is simply an association related to differences in the lifestyle of smoking women. In general, studies in women and animals confirm the possible alteration of physiological characteristics of the tubes in smokers, resulting in a disturbance of intratubal transport of the embryo, a premature or delayed arrival of the blastocyst in the uterus, and alterations of the immune system that could explain the epidemiologic association of smoking and lowered fertility. Studies in mice and rats have shown that smoking can destroy ovocytes, but observations in women have not been completely convincing. It has been concluded however that smoking can decrease the number of viability of ovocytes, ending in premature extinction of reproductive function and early menopause. Results of a small number of studies tend to demonstrate that compared to nonsmokers, smokers experience a greater frequency of secondary amenorrhea, increased vaginal bleeding, and a significant lowering of urinary estrogens in the luteal phase. Taken together, clinical reports on women and animal studies demonstrate the effect of nicotine and smoke on the basic hormonal homeostasis of women, an effect which can change the timing of cycles and reduce fertility. The risk of osteoporosis after menopause is known to be greater among smokers than nonsmokers, probably because of hormonal modifications caused by elements in cigarette smoke. Available data on effects of smoking on male fertility are inconclusive, but a certain number of studies have shown an increased incidence of morphologic anomalies and a lowering of mobility and density in the sperm of smokers. Fluctuations in the levels of androgens and gonadotropins have also been observed in men who smoke. The evidence suggests that all persons wishing to reproduce but especially those with fertility impairments should avoid smoking.
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