Practice Committee of the American Society for Reproductive Medicine (2024). Tobacco or marijuana use and infertility: a committee opinion. Fertility and Sterility, 121(4), 589-603. https://doi.org/10.1016/j.fertnstert.2023.12.029
Practice Committee of the American Society for Reproductive Medicine. Tobacco or marijuana use and infertility: a committee opinion. Fertility and Sterility. 2024;121(4):589-603. doi:10.1016/j.fertnstert.2023.12.029
Practice Committee of the American Society for Reproductive Medicine. "Tobacco or marijuana use and infertility: a committee opinion." Fertility and Sterility, vol. 121, no. 4, 2024, pp. 589-603.
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RRM Academy Synopsis
Tobacco use is linked to lower fertility; marijuana evidence is mixed
A 2024 committee opinion finds good evidence that smoking in women is linked to lower fertility, more miscarriage and more ectopic pregnancy. Early data suggest vaping harms reproductive health. Current data do not support it as a safe alternative to cigarettes. The committee found no consistent link between marijuana and fertility.
Key Findings
A meta-analysis of 12 studies (10,928 exposed and 19,179 unexposed women) gave an overall odds ratio for infertility in smokers versus nonsmokers of 1.60 (95% CI 1.34–1.91).
Two 2018 meta-analyses of IVF cycles found a lower chance of live birth per cycle in smokers (OR 0.59, 95% CI 0.44–0.79) and more miscarriage (OR 2.22, 95% CI 1.10–4.48).
Smoking is associated with menopause 1–4 years earlier. Among 284 women aged 38 to 50, AMH levels were 44% lower in current smokers than in women who had not smoked.
In 4,194 North American pregnancy planners (485 exposed), marijuana use less than weekly gave an adjusted fecundability ratio of 0.99 (95% CI 0.85–1.16); weekly or more often gave 0.98 (95% CI 0.80–1.20).
One human study has examined vaping and fecundability. It suggested lower fecundability, though vaping alone was hard to separate from joint use with cigarettes.
Interpretation
The document is a committee opinion that summarizes published research, and the available studies are observational. The committee rates the evidence linking tobacco to women's fecundity and IVF outcomes as good and the evidence on semen parameters as fair. It names the small number of exposed participants as a hindrance in the marijuana studies. Vaping evidence comes mostly from animals.
RRM Context
Restorative reproductive medicine looks for modifiable exposures in both partners when finding the root cause of infertility. The committee's summary says smokers need almost double the IVF attempts that nonsmokers need. It adds that assisted reproduction may fail to offset smoking's effect on natural fecundity, and much of that effect may reverse within a year of quitting.
Our editorial summary of this paper, not the article's abstract.
Abstract
In the United States, approximately 21% of adults report some form of tobacco use, although 18% report marijuana use. Although the negative impact of tobacco use in pregnancy is well documented, the impact of tobacco and marijuana on fertility and reproduction is less clear. This committee opinion reviews the potential deleterious effects of tobacco, nicotine, and marijuana use on conception, ovarian follicular dynamics, sperm parameters, gamete mutations, early pregnancy, and assisted reproductive technology outcomes. It also reviews the current status of tobacco smoking cessation strategies. This document replaces the 2018 American Society for Reproductive Medicine Practice Committee document entitled Smoking and Infertility: a committee opinion (Fertil Steril 2018).
Clinical Guidelines and Standards › Guidelines by Clinical Area › Fertility and Infertility Guidelines · Lifestyle and Environment › Substances › Tobacco and Nicotine
DOI 10.1016/j.fertnstert.2023.12.029 10.1016/j.fertnstert.2023.12.029 Practice Committee of the American Society for Reproductive Medicine et al. 2024, Practice Committee of the American Society for Reproductive Medicine 2024
