Tobacco use impairs, alters, adversely affects or interferes with normal reproductive functions.
Tobacco use is emerging as a silent but
powerful cause of infertility worldwide, the World Health Organization warns in
its first-ever global guidelines on preventing and treating the condition.
The agency has now urged governments to treat
tobacco control as a core pillar of reproductive health, warning that smoking
sharply raises infertility risks for both men and women.
Infertility affects one in six people of
reproductive age worldwide, the WHO said. It noted that testing and treatment remain
limited, often expensive and, in many settings, financially devastating.
The guidelines also make clear that infertility is
no longer only a medical issue but also an equity issue.
WHO Director-General Dr Tedros Adhanom
Ghebreyesus said, “Infertility is one of the most overlooked public health
challenges of our time and a major equity issue globally. Millions face this
journey alone — priced out of care, pushed toward cheaper but unproven
treatments, or forced to choose between their hopes of having children and
their financial security.”
The report names tobacco use as one
of the most consistent and powerful contributors.
This assertion draws heavily from decades of
research on tobacco’s impact on reproduction. The review shows overwhelming evidence
linking smoking to infertility in women.
“The review suggested that cigarette smoking
impairs, alters, adversely affects or interferes with normal reproductive
functions,” the report says.
“More recently, a review of three
non-randomised studies reported that the odds of infertility in female smokers
were 1.85 times the odds in non-smokers.”
In men, smoking is linked to lower semen
quality, even among young or otherwise healthy men. The WHO guideline cites a
major 2016 review which assessed the association between smoking and semen
quality using the 2010 WHO laboratory manual for the examination and processing
of human semen.
The findings are clear: “Smoking may be
associated with a reduction in some semen parameters: semen volume; sperm
count; sperm motility; and sperm morphology.”
The guidelines also warn that reductions in
semen parameters may be greater in moderate and heavy smokers. However, the report notes the scientific caution that “although some results were statistically
significant, it is not clear whether the magnitude of the reductions in semen
parameters is clinically relevant and whether the observed reductions affect
fertility.”
Because smoking is a modifiable risk factor, the WHO recommended that clinicians caring for anyone planning or attempting
pregnancy should provide quick, targeted advice on quitting tobacco. The
guideline states that brief advice lasting 30 seconds to three minutes should
warn individuals that smoking increases infertility and reduces reproductive
success.
This intervention is especially important in
countries like Kenya, where around 11 per cent of men use tobacco, according to
the latest Global Adult Tobacco Survey. Public health experts warn that younger
men are increasingly using new forms of tobacco, potentially creating a
future wave of preventable infertility.
The guidelines further describe the enormous
financial pressures people face when seeking fertility care. The WHO says: “In
some settings, even a single round of in vitro fertilisation (IVF) can cost
double the average annual household income.”
Infertility affects an estimated 10 to 15 per cent of couples in Kenya, according to the Ministry of Health, but the cost
of services often keeps care out of reach. A single cycle of IVF in Nairobi can
cost more than Sh400,000, and the Social Health Authority and private insurance
firm do not cover such fertility treatments.
The guideline recommends integrating fertility
care into national health strategies and financing systems to reduce the burden
on families.
WHO calls for countries to ensure ongoing
psychosocial support, including counselling and mental health services, at
every step of care. The document outlines clear clinical pathways for
diagnosing infertility in both men and women, starting with simple tests and
moving toward more specialised interventions when needed.
The report also calls for better prevention in
schools, health facilities, and communities. This includes providing accurate
information about fertility, age-related declines in conception rates,
untreated sexually transmitted infections, and lifestyle risks such as tobacco
use.
Dr Pascale Allotey, Director of WHO’s Sexual
and Reproductive Health Department, underscores the social dimensions of the
challenge. “The prevention and treatment of infertility must be grounded in
gender equality and reproductive rights,” she said. “Empowering people to make
informed choices about their reproductive lives is a health imperative and a
matter of social justice,” she said.