Cigarette Smoking and Semen Quality: A New Meta-analysis Examining the Effect of the 2010 World Health Organization Laboratory Methods for the Examination of Human Semen
Abstract
Objective Approximately 37% of men of reproductive age smoke cigarettes, with Europe having the highest tobacco use among all the World Health Organization (WHO) regions. Toxins from tobacco smoking can potentially affect sperm development and function, with a negative effect on semen parameters. Given the high prevalence of smoking and recent changes in the WHO laboratory methods for the examination of human semen, the role of this exposure in face of new WHO methods needs to be clarified. Evidence acquisition We conducted a systematic review, followed by a meta-analysis, to determine whether cigarette smoking affects human semen parameters. PubMed, Saint Joseph's University Discover, and Google Scholar were used to identify relevant studies published after release of the latest WHO methods for laboratory evaluation of human semen. Participants were from fertility/urologic clinics and andrology laboratories. The outcome measures were semen volume, sperm concentration, motility, and morphology, the parameters usually used in clinical settings to assess fertility. Evidence synthesis Twenty studies with 5865 participants were included in the meta-analysis. Exposure to cigarette smoking was associated with reduced sperm count (mean difference [MD]: -9.72×10 6 /ml; 95% confidence interval [CI], -13.32 to -6.12), motility (MD: -3.48%; 95% CI, -5.53 to -1.44), and morphology (MD: -1.37%; 95% CI, -2.63 to -0.11). Subgroup analyses indicated that effect size was higher in infertile m…
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Smoking has an adverse effect on semen quality in both fertile and sterile men and is associated with decreased sperm motility and count, particularly in moderate to heavy smokers.
“A meta-analysis of studies with a large population of 5865 men from 26 regions/countries reported that smoking has an adverse effect on semen quality in both fertile and sterile men and is associated with decreased sperm motility and count, particularly in moderate to heavy smokers [15].”
From Sperm concentration and semen volume increase after smoking cessation in infertile men (2022) · cites this paper as [15]
Cigarette smoking has a negative impact on semen quality.
“Furthermore, findings from a recent meta-analysis indicated that cigarette smoking has a negative impact on semen quality (Sharma et al., 2016).”
From Use of e-cigarettes associated with lower sperm counts in a cross-sectional study of young men from the general population (2020) · cites this paper as Sharma et al., 2016
Smoking negatively affects semen quality, impairing sperm concentration, motility, morphology, and volume.
“Several studies, including meta-analyses (Sharma et al. 2016, Bundhun et al. 2019), have consistently demonstrated that smoking negatively affects semen quality, impairing parameters such as sperm concentration, motility, morphology, and volume (Mostafa et al. 2018, Osadchuk et al. 2023).”
From Evaluating the effect of smoking and its cessation on semen parameters (2025) · cites this paper as Sharma et al. 2016
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Temporal trends in sperm count: a systematic review and meta-regression analysis
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Sperm concentration and semen volume increase after smoking cessation in infertile men
Kulaksiz, D., Toprak, T., Tokat, E., Yilmaz, M., Ramazanoglu, M. A., Garayev, A., Sulukaya, M., Degirmentepe, R. B., Allahverdiyev, E., Gul, M., et al. (2022) · International Journal of Impotence Research · doi:10.1038/s41443-022-00605-0 · Cited by 43 · see citing works
“A meta-analysis of studies with a large population of 5865 men from 26 regions/countries reported that smoking has an adverse effect on semen quality in both fertile and sterile men and is associated with decreased sperm motility and count, particularly in moderate to heavy smokers [15].”
BackgroundResultInfluentialEvaluating the effect of smoking and its cessation on semen parameters
Ragheb, A., Abdelbary, A., Massoud, A., Abd Elkhalek, M., & Elbatanony, A. (2025) · Reproduction and Fertility · doi:10.1530/raf-24-0135 · Cited by 3 · see citing works
- Authors
- Sharma, R., Harlev, A., Agarwal, A., & Esteves, S. C.
- Affiliations
- Saint Joseph's University (US)
- Ben-Gurion University of the Negev (IL)
- Cleveland Clinic (US)
- Androfert (BR)
- Corresponding author
- Agarwal, Ashok
- Venue
- European Urology
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 70
- Issue
- 4
- Pages
- 635-645
- ISSN
- 0302-2838 (ISSN-L)
- OpenAlex
- W2336537050
- Cited by
- 532
- References
- 5
- Citations by year
- 2026: 50 · 2025: 54 · 2024: 69 · 2023: 84 · 2022: 57 · 2021: 51 · 2020: 50 · 2019: 44 · 2018: 26 · 2017: 33 · 2016: 14
- FWCI
- 5.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Urology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
- Keywords
- cigarette smoking, semen quality, male infertility, sperm count, sperm motility, sperm morphology, semen volume, tobacco smoke exposure
- MeSH terms
- Cigarette Smoking, Humans, Male, Sperm Count, Sperm Motility, Spermatozoa, World Health Organization, Semen Analysis
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