Does Smoking Make it Harder to Get Pregnant?

Reviewed by Dr. Lisa Czanko MD, MPH

You've decided to get pregnant! You’re working hard to get your body and life prepped for the baby by reading and listening to fertility podcasts. So far, you’re eating a healthy diet, exercising regularly, and taking those prenatal vitamins. You’ve cut way back on drinking alcohol too, but you still enjoy smoking a few cigarettes. Lately you’ve begun to wonder: is smoking while trying to conceive going to make it harder to get pregnant? Here’s what the science says.

Can smoking while trying to conceive make it harder to get pregnant?

There are several ways in which smoking might impact fertility. Smoking before pregnancy may damage the reproductive organs vital for pregnancy, like the fallopian tubes, cervix, and ovaries. Smoking can also lead to early menopause (when menstruation stops completely). There may also be a relationship between smoking and egg quality.

These decreases in fertility may not be able to be overcome by fertility treatments like in-vitro fertilization (IVF). 

However, if you’re trying to become pregnant, quitting smoking can improve your chances. Decreased fertility from smoking before pregnancy can usually be reversed within a year of cutting out cigarettes!

Can smoking make it harder to stay pregnant?

In some cases, yes. One study found that smoking while pregnant can increase the chance of an ectopic pregnancy, which is when an embryo implants outside of the uterus. This type of pregnancy cannot survive to full term and can also be life-threatening for the person carrying.

In addition to ectopic pregnancies, smoking while pregnant also increases the likelihood of having a miscarriage.

Does smoking impact the future fertility of the fetus?

When people smoke, it impacts the health of their future children too! Smoking can cause damage to the ovaries of the fetus. One study of 221 couples showed that people with prenatal exposure to their mother’s smoking had a harder time becoming pregnant themselves in comparison to people who did not have any smoking exposure. 

Does smoking affect semen too?

For people who have a biologically male partner, quitting smoking is important for them too. Studies have shown a decrease in sperm quality among people who smoke. One study showed a 23 percent decrease in sperm concentration and a 13 percent decrease in sperm movement among fertile smokers.

How else does smoking affect pregnancy?

You've seen the warnings, heard from friends and family, and maybe even tried to quit smoking while pregnant. You likely know that quitting is important, but do you know the science behind why? Here are just a few risks involved with smoking during pregnancy. 

Smoking during pregnancy can increase the risks of:

• Defects in the baby’s mouth and face
• Babies that do not grow to a normal weight during pregnancy
• Abnormalities in the placenta (the organ in the uterus that provides oxygen and nutrients to the baby)
• Risk of early leakage of the fluid within the uterus, which can increase the risk of infections and lead to  preterm delivery
• Increased risk of infant death during pregnancy and delivery

The good news is that people who quit smoking while trying to conceieve or during pregnancy can reduce the risk for these health outcomes.

For example, studies suggest that the infants of people who quit smoking by the end of the first trimester in pregnancy have weight and body measurements similar to infants of nonsmokers! 

What are the other health risks of smoking?

Cutting out smoking is a win-win-win for mom, partner, and baby. Smokers have an increased risk for several types of cancer as well as for heart and lung disease. The sooner someone can quit smoking, the better their chances are of avoiding these health problems and enjoying a long, healthy life with their new family.

How do you quit smoking?

Studies have shown that people are more likely to quit smoking during pregnancy than at any other time in their lives. And remember: decreased fertility from smoking while trying to conceive can be reversed within a year of quitting smoking. If you’re already pregnant, quitting now can still have a huge positive impact on your baby.

There are several over-the-counter and prescribed medications that have been shown to help people quit smoking. The CDC has many free resources including a toll-free quit line at 1-800-QUIT-NOW.

The desire to expand your family can be a big motivator for change! Talk to your doctor for more information about the best ways to successfully quit smoking while trying to conceieve.

Citations 

1. Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Hum Reprod. 1998;13(6):1532. 

2. Hughes EG, Brennan BG. Does cigarette smoking impair natural or assisted fecundity? Fertil Steril. 1996;66(5):679. 

3. Phipps WR, Cramer DW, Schiff I, Belisle S, Stillman R, Albrecht B, Gibson M, Berger MJ, Wilson E. The association between smoking and female infertility as influenced by cause of the infertility. Fertil Steril. 1987;48(3):377. 

4. Bouyer J, Coste J, Fernandez H, Job-Spira N. Tobacco and ectopic pregnancy. Arguments in favor of a causal relation. Rev Epidemiol Sante Publique. 1998;46(2):93. 

5. Adena MA, Gallagher HG. Cigarette smoking and the age at menopause. Ann Hum Biol. 1982 Mar;9(2):121-30.

6. Weinberg CR, Wilcox AJ, Baird DD. Reduced fecundability in women with prenatal exposure to cigarette smoking. Am J Epidemiol. 1989;129(5):1072. 

7. Vine MF. Smoking and male reproduction: a review. Int J Androl. 1996;19(6):323. 

8. ACOG Committee Opinion No. 807: Tobacco and Nicotine Cessation During Pregnancy. Obstet Gynecol 2020; 135(5):e221-9.

9. Centers for Disease Control. Smoking and Tobacco Use- 2001 Surgeon General’s Report Highlights: Tobacco Use and Reproductive Outcomes. July 27, 2015. Accessed February 4, 2022. ​​https://www.cdc.gov/tobacco/data_statistics/sgr/2001/highlights/outcomes/index.htm