Dear Colleagues! This is Asrar Qureshi’s Blog Post #1311 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to pharmaveterans2017@gmail.com for publishing your contributions here.
Preamble
This blogpost takes some insights from a recent World Health Organization report. Link to the report at the end.
Tobacco and Fertility: The Hidden Reproductive Cost of Smoking
For decades, the dangers of tobacco have been associated primarily with cancer, heart disease, stroke and chronic respiratory illness. Yet a new warning from the World Health Organization (WHO) highlights another consequence that receives far less public attention: tobacco use can undermine fertility.
The finding is important because infertility is already a major global health concern. WHO estimates that approximately one in six people of reproductive age experience infertility during their lifetime. Against this backdrop, the evidence linking tobacco use with impaired reproductive health adds a powerful new dimension to tobacco-control and reproductive-health policies.
The issue is not simply whether people smoke. It is whether smoking and other forms of tobacco exposure can affect their ability to have the children they want. Increasingly, the evidence suggests that they can.
A preventable contributor to infertility
WHO’s new knowledge summary, published in September 2026, brings together decades of evidence on tobacco and infertility. One of its most striking findings concerns women: a systematic review of studies conducted between 2000 and 2026 found that women who currently smoke tobacco have approximately a 40% higher risk of infertility than women who do not smoke.
This does not mean that every smoker will become infertile, nor that tobacco is the only cause of infertility. Fertility is influenced by age, reproductive disorders, infections, genetics, environmental exposures, nutrition and many other factors. But the evidence establishes tobacco as a potentially important and preventable risk factor.
There is also encouraging evidence about quitting. WHO notes that women who previously smoked but had stopped had a 25% lower risk of infertility than women who continued smoking. Quitting, therefore, is not merely a long-term investment in cardiovascular or respiratory health. It may also improve reproductive prospects.
This is an important message for people who are planning a family: stopping tobacco use before trying to conceive is an investment in reproductive health.
Infertility is not a “women’s problem”
Perhaps one of the most important aspects of the WHO report is its emphasis on men.
Infertility is frequently perceived as primarily a female issue, particularly in societies where women may face disproportionate social pressure when a couple struggles to conceive. Scientifically, however, infertility can result from male, female or combined factors.
WHO cites a review of 44 studies involving more than 60,000 men, which found an association between smoking and reproductive dysfunction. Male smokers were more likely to experience problems involving semen quality and sexual function, including poor sperm motility, abnormal sperm shape, absence of sperm in semen, erectile dysfunction and ejaculation problems. Earlier scientific research has similarly associated smoking with reductions in semen volume, sperm count and some measures of sperm quality.
The implications are significant. A couple experiencing difficulty conceiving should not automatically assume that the woman is responsible. Both partners’ reproductive health matters, and tobacco use by either partner deserves attention.
The fertility-treatment dimension
The reproductive consequences of smoking become even more important for couples seeking assisted reproductive technologies such as in-vitro fertilization (IVF).
WHO reports that research involving 21 studies has linked cigarette smoking with fewer pregnancies and live births following assisted reproduction. The evidence suggests that smoking may substantially reduce the likelihood of successful outcomes.
This creates a troubling cycle. Infertility can already be emotionally exhausting and financially expensive, particularly in countries where fertility treatment is largely paid for privately. If smoking further reduces the probability of successful treatment, continued tobacco use may increase the number of treatment attempts, and therefore the financial, psychological and physical burden on couples.
Prevention is consequently not only a health strategy. It can also be an economic strategy.
Second-hand smoke: the risk that affects non-smokers
Perhaps less widely understood is that a person does not necessarily have to smoke to face reproductive risks.
WHO warns that exposure to second-hand tobacco smoke may increase infertility risk. For women exposed to second-hand smoke, research suggests a higher risk of infertility and a lower likelihood of conceiving during individual months of trying.
This gives tobacco control a wider meaning. Protecting people from tobacco is not simply about helping smokers quit. It is also about creating homes, workplaces, restaurants, public spaces and communities where people are not involuntarily exposed to tobacco smoke. In other words, the reproductive-health consequences of tobacco are partly a collective responsibility.
What about vaping, waterpipes and smokeless tobacco?
The tobacco landscape is changing. Cigarettes remain the strongest focus of the available evidence, but people increasingly use e-cigarettes, waterpipes, heated tobacco products, nicotine pouches and smokeless tobacco.
WHO stresses that evidence concerning the effects of newer products on fertility is still developing. That uncertainty should not be interpreted as proof of safety.
Waterpipe smoking, for example, is sometimes perceived as a safer or more socially acceptable alternative to cigarettes. But tobacco smoke remains tobacco smoke, and WHO has highlighted potential reproductive risks associated with waterpipe use as well.
Why this matters for Pakistan
The issue deserves particular attention in countries such as Pakistan, where tobacco use remains a significant public-health challenge.
WHO data indicate that approximately 19% of Pakistan’s population aged 15 years and older used tobacco in 2022, although more recent national efforts have produced encouraging reductions. Pakistan’s 2024 Global Adult Tobacco Survey reported a decline in tobacco consumption, with tobacco products still used by around 16% of people aged 15 and above.
This means millions of people remain potentially exposed to tobacco’s health consequences, including its reproductive consequences.
The fertility dimension is particularly relevant because Pakistan has a large young population and is undergoing a major demographic transition. Reproductive health, family planning, maternal health and the health of young adults are already important components of the country’s development agenda.
From treatment to prevention
The larger lesson is that infertility policy cannot focus exclusively on IVF clinics and medical treatment.
WHO describes infertility as a condition that can sometimes be prevented. Lifestyle risks, including tobacco use, are therefore part of the prevention agenda.
This is especially important in low- and middle-income countries, where access to sophisticated fertility treatment remains limited and often unaffordable. Preventing avoidable reproductive-health risks can be far more equitable than relying primarily on expensive treatments after infertility has developed.
A comprehensive approach should combine tobacco control with reproductive-health education, healthy lifestyles, prevention and treatment of sexually transmitted infections, maternal healthcare, fertility awareness and access to appropriate infertility services.
A message for individuals and policymakers
The WHO warning ultimately carries two complementary messages.
For individuals and couples, the message is straightforward: if you are planning to have children, quitting tobacco is one positive step you can take to protect your reproductive health. It is relevant to women and men alike, and it remains worthwhile even for people who have smoked for years.
For governments and health systems, the message is broader: tobacco control should be connected to the wider development agenda.
The emerging evidence gives tobacco control a new urgency: protecting people from tobacco is not only about helping them live longer. It is also about helping them preserve the possibility of the lives and families they hope to build.
Concluded.
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