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Cited by 154Sperm and Testicular FunctionSmoking Behavior and CessationReproductive Health and Technologies

Tobacco smoking and semen quality in infertile males: a systematic review and meta-analysis

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Bundhun, Pravesh Kumar, Janoo, Girish, Bhurtu, Akash, Teeluck, Abhishek Rishikesh, Soogund, Mohammad Zafooruddin Sani, Pursun, Manish, Huang, Feng·2019·BMC Public Health
DOI 10.1186/s12889-018-6319-3PMC PMC6325781
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Abstract

BACKGROUND: Nowadays, the total number of couples visiting an infertility clinic is on the rise. Tobacco smoking is considered one of the major factors leading to male infertility. In this study, we aimed to systematically investigate the impact of tobacco smoking on semen quality in infertile male participants. METHODS: Online databases (Cochrane Central database of Randomized Controlled Trials and the databases of MEDLINE and EMBASE respectively) were searched for relevant English publications that satisfied the inclusion and exclusion criteria of this analysis. The clinical endpoints which were assessed included semen parameters (oligozoospermia, asthenozoospermia, teratozoospermia, and azoospermia), morphological defects of spermatozoa and the hormones involved in reproduction. RevMan 5.3 software was used to analyze the data whereby mean difference (MD) and risk ratios (RR) with 95% confidence intervals (CI) were generated to represent the results. RESULTS: Sixteen studies with a total number of 10,823 infertile male participants (5257 smokers and 5566 non-smokers) were included. Results of this analysis showed oligozoospermia to be significantly higher in smokers (RR: 1.29, 95% CI: 1.05-1.59; P = 0.02). Morphological defect of spermatozoa (MD: 2.44, 95% CI: 0.99-3.89; P = 0.001) was also significantly higher in smokers whereby significant head (MD: 1.76, 95% CI: 0.32-3.20; P = 0.02), neck (MD: 1.97, 95% CI: 0.75-3.18; P = 0.002) and tail (MD: 1.29, 95% CI: 0.35-2.22; P = 0.007) defects were observed. However, smoking did not affected the pH (MD: 0.04, 95% CI: [- 0.03-0.11]; P = 0.30) and motility (RR: 1.42, 95% CI: 0.97-2.09; P = 0.07) of spermatozoa. Additionally, tobacco smoking did not cause any dis-balance in hormones which were involved in reproduction. CONCLUSIONS: In conclusion, with reference to the clinical endpoints which were studied in this analysis, tobacco smoking was associated with a lower sperm count and an increase in the number of morphological defects of spermatozoa. However, the pH and motility of spermatozoa as well as the production of hormones which were involved in reproduction were not affected in this population of infertile males.

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  • Some studies showed that heavy smoking is correlated with lower sperm quality, including teratozoospermia, and incidence of cytoplasmic droplets in sperm.

    “Some studies showed that heavy smoking is correlated with lower sperm quality, including teratozoospermia, and incidence of cytoplasmic droplets in sperm (55-57).”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [55]

    The Discussion reports lower sperm count and more morphological defects among smokers, supporting the general claim of poorer semen quality. But the Results section, “Oligozoospermia and teratozoospermia,” finds no significant difference in teratozoospermia between smokers and non-smokers (P = 0.10). The paper does not establish these findings specifically for heavy smokers or report an increased incidence of cytoplasmic droplets; a study on cytoplasm retention appears in its References. (LLM, conf=0.88)

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  • There are conflicting findings on the association between smoking and sperm morphology.

    “There are conflicting findings on the association between smoking and sperm morphology.”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [55]

    The Results report mixed morphology-related outcomes in infertile men: teratozoospermia was not significantly different between smokers and non-smokers, while abnormal sperm form and specific defects were significantly higher in smokers (Table 4; page unavailable). This supports the idea of mixed findings, but the paper does not explicitly describe conflicting findings across studies on the same morphology measure. (LLM, conf=0.79)

    Experimental — accuracy not yet measured

  • 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 Bundhun et al. 2019

    The Abstract Results and Discussion report lower sperm count and more morphological defects among infertile male smokers, supporting the broad claim that smoking harms semen quality. But this meta-analysis found no significant effect on motility, and its listed endpoints do not include semen volume. The findings are also specific to infertile males. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 46

  1. [1]Corrao MA Guindon GE Cokkinides V Sharma N Building the evidence base for global tobacco control Bull World Health Organ 2000 78 7 884 890 10994261 PMC2560810
  2. [2]Rojewski AM, Zuromski KL, Toll BA. Strategies for smoking cessation among high risk populations to prevent lung cancer. Expert Rev Respir Med. 2016 Dec 13:1–3. PMC5555417 27910714
  3. [3]Xu X Chen C Abdullah AS Sharma M Liu H Zhao Y Knowledge about and sources of smoking-related knowledge, and influencing factors among male urban secondary school students in Chongqing China Springerplus 2016 5 1 1879 27833838 PMC5081986
  4. [4]Patel A Sharma PS Narayan P Nair BV Narayanakurup D Pai PJ Distress in infertile males in Manipal-India: a clinic based study J Reprod Infertil 2016 17 4 213 220 27921000 PMC5124340
  5. [5]Practice Committee of American Society for Reproductive Medicine Definitions of infertility and recurrent pregnancy loss: a committee opinion Fertil Steril 2013 99 1 63 23095139
  6. [6]Daumler D Chan P Lo KC Takefman J Zelkowitz P Men's knowledge of their own fertility: a population-based survey examining the awareness of factors that are associated with male infertility Hum Reprod 2016 31 12 2781 2790 27816924 PMC5193328
  7. [7]Kovac JR Pastuszak AW Lamb DJ The use of genomics, proteomics, and metabolomics in identifying biomarkers of male infertility Fertil Steril 2013 99 4 998 1007 23415969 PMC3652543
  8. [8]Liberati A Altman DG Tetzlaff J The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcareinterventions: explanation and elaboration BMJ 2009 339 b2700 19622552 PMC2714672
  9. [9]Julian P T Higgins, Statistician, Simon G Thompson, director, Jonathan J Deeks, senior medical statistician, and, Douglas G Altman, professor of statistics in medicine. Measuring inconsistency in meta-analyses. BMJ 2003 Sep 6; 327(7414): 557–560. PMC192859 12958120
  10. [10]Al-Turki HA Effect of smoking on reproductive hormones and semen parameters of infertile Saudi Arabians Urol Ann 2015 7 1 63 66 25657547 PMC4310120
  11. [11]Al-Turki HA A 5-year analysis of semen parameters in Saudi Arabian men attending infertility clinics J Int Med Res 2016 44 3 656 661 27036147 PMC5536693
  12. [12]Anifandis G Bounartzi T Messini CI Dafopoulos K Sotiriou S Messinis IE The impact of cigarette smoking and alcohol consumption on sperm parameters and sperm DNAfragmentation (SDF) measured by Halosperm (®) Arch Gynecol Obstet 2014 290 4 777 782 24840110
  13. [13]Caserta D Bordi G Di Segni N D'Ambrosio A Mallozzi M Moscarini M The influence of cigarette smoking on a population of infertile men and women Arch Gynecol Obstet 2013 287 4 813 818 23183716
  14. [14]Cui X Jing X Wu X Wang Z Li Q Potential effect of smoking on semen quality through DNA damage and the downregulation of Chk1 in sperm Mol Med Rep 2016 14 1 753 761 27221653 PMC4918538
  15. [15]Gaur DS Talekar M Pathak VP Effect of cigarette smoking on semen quality of infertile men Singap Med J 2007 48 2 119 123 17304390
  16. [16]Meri ZB Irshid IB Migdadi M Irshid AB Mhanna SA Does cigarette smoking affect seminal fluid parameters? A comparative study Oman Med J 2013 28 1 12 15 23386938 PMC3562984
  17. [17]Mitra A Chakraborty B Mukhopadhay D Pal M Mukherjee S Banerjee S Chaudhuri K Effect of smoking on semen quality, FSH, testosterone level, and CAG repeat length in androgen receptorgene of infertile men in an Indian city Syst Biol Reprod Med 2012 58 5 255 262 22578234
  18. [18]Trummer H Habermann H Haas J Pummer K The impact of cigarette smoking on human semen parameters and hormones Hum Reprod 2002 17 6 1554 1559 12042277
  19. [19]Mostafa T Tawadrous G Roaia MM Amer MK Kader RA Aziz A Effect of smoking on seminal plasma ascorbic acid in infertile and fertile males Andrologia 2006 38 6 221 224 17081174
  20. [20]Osser S Beckman-Ramirez A Liedholm P Semen quality of smoking and non-smoking men in infertile couples in a Swedish population Acta Obstet Gynecol Scand 1992 71 3 215 218 1317645
  21. [21]Yu B Qi Y Liu D Gao X Chen H Bai C Huang Z Cigarette smoking is associated with abnormal histone-to-protamine transition in human sperm Fertil Steril 2014 101 1 51 57.e1 24112532
  22. [22]Zhang ZH Zhu HB Li LL Yu Y Zhang HG Liu RZ Decline of semen quality and increase of leukocytes with cigarette smoking in infertile men Iran J Reprod Med 2013 11 7 589 596 24639795 PMC3941345
  23. [23]Zhang M Zhang QS Zheng HS Wang XY Feng SQ Tian WJ Fan HT Clinical, demographic and psychological characteristics of infertile male smokers in Northeast China J Int Med Res 2016 44 1 75 80 26647076 PMC5536574
  24. [24]Dikshit RK Buch JG Mansuri SM Effect of tobacco consumption on semen quality of a population of hypofertile males Fertil Steril 1987 48 2 334 336 3609347
  25. [25]R K Mueller MD Hänggi W Birkhäuser MH Drescher H Bersinger NA Semen quality of male smokers and nonsmokers in infertile couples Fertil Steril 2003 79 2 287 291 12568836
  26. [26]Sharma R Harlev A Agarwal A Esteves SC 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 Eur Urol 2016 70 4 635 645 27113031
  27. [27]Lingappa HA Govindashetty AM Puttaveerachary AK Manchaiah S Krishnamurthy A Bashir S Doddaiah N Evaluation of effect of cigarette smoking on vital seminal parameters which influence fertility J Clin Diagn Res 2015 9 7 EC13 EC15 26393133 PMC4572965
  28. [28]Davar R Sekhavat L Naserzadeh N Semen parameters of non-infertile smoker and non-smoker men J Med Life 2012 5 4 465 468 23346252 PMC3539834
  29. [29]Elshal MF El-Sayed IH Elsaied MA El-Masry SA Kumosani TA Sperm head defects and disturbances in spermatozoal chromatin and DNA integrities in idiopathicinfertile subjects: association with cigarette smoking Clin Biochem 2009 42 7–8 589 594 19094977
  30. [30]Liu RZ Gao JC Zhang HG Wang RX Zhang ZH Liu XY Seminal plasma zinc level may be associated with the effect of cigarette smoking on sperm parameters J Int Med Res 2010 38 3 923 928 20819428
  31. [31]Mak V Jarvi K Buckspan M Freeman M Hechter S Zini A Smoking is associated with the retention of cytoplasm by human spermatozoa Urology 2000 56 3 463 466 10962316
  32. [32]Harlev A Agarwal A Gunes SO Shetty A du Plessis SS Smoking and male infertility: an evidence-based review World J Mens Health 2015 33 3 143 160 26770934 PMC4709430
  33. [33]Zenzes MT Smoking and reproduction: gene damage to human gametes and embryos Hum Reprod Update 2000 6 2 122 131 10782570
  34. [34]Pacifici R Altieri I Gandini L Lenzi A Pichini S Rosa M Zuccaro P Dondero F Nicotine, cotinine, and trans-3-hydroxycotinine levels in seminal plasma of smokers: effects on sperm parameters Ther Drug Monit 1993 15 5 358 363 8249041
  35. [35]Condorelli RA La Vignera S Duca Y Zanghi GN Calogero AE Nicotine receptors as a possible marker for smoking-related sperm damage Protein Pept Lett 2018 25 5 451 454 29651935
  36. [36]Chen X Xu W Miao M Zhu Z Dai J Chen Z Fang P Wu J Nie D Wang L Wang Z Qiao Z Shi H Alteration of sperm protein profile induced by cigarette smoking Acta Biochim Biophys Sin Shanghai 2015 47 7 504 515 26063603
  37. [37]Kumosani TA Elshal MF Al-Jonaid AA Abduljabar HS The influence of smoking on semen quality, seminal microelements and Ca2+-ATPase activity among infertile and fertile men Clin Biochem 2008 41 14–15 1199 1203 18708043
  38. [38]Colagar AH Jorsaraee GA Marzony ET Cigarette smoking and the risk of male infertility Pak J Biol Sci 2007 10 21 3870 3874 19090244
  39. [39]Hassa H Yildirim A Can C Turgut M Tanir HM Senses T Sahinmutlu F Effect of smoking on semen parameters of men attending an infertility clinic Clin Exp Obstet Gynecol 2006 33 1 19 22 16761532
  40. [40]Dunphy BC Barratt CL von Tongelen BP Cooke ID Male cigarette smoking and fecundity in couples attending an infertility clinic Andrologia 1991 23 3 223 225 1741486
  41. [43]Kazemzadeh Z, Manzari ZS, Pouresmail Z. Nursing interventions for smoking cessation in hospitalized patients: a systematic review. Int Nurs Rev. 2016. 27933638
  42. [44]Wang TW Kenemer B Tynan MA Singh T King B Consumption of combustible and smokeless tobacco - United States, 2000-2015 MMWR Morb Mortal Wkly Rep 2016 65 48 1357 1363 27932780 PMC5584068
  43. [45]Sozańska B Pearce N Błaszczyk M A B Cullinan P Changes in the prevalence of cigarette smoking and quitting smoking determinants in adult inhabitants of rural areas in Poland between 2003 and 2012 Public Health 2016 141 178 184 27931996
  44. [46]Lopez E The efficacy of smoking cessation interventions via social media Am J Public Health 2017 107 1 e9 27925804 PMC5308145
  45. [47]Keskin MZ Budak S Gubari S Durmaz K Yoldas M Celik O Aksoy EE Ilbey YO Do cigarette and alcohol affect semen analysis? Arch Ital Urol Androl 2016 88 1 56 59 27072177
  46. [48]Gerhard I Lenhard K Eggert-Kruse W Runnebaum B Clinical data which influence semen parameters in infertile men Hum Reprod 1992 7 6 830 837 1323572

Cited by

Sorted by citations

Authors
Bundhun, P. K., Janoo, G., Bhurtu, A., Teeluck, A. R., Soogund, M. Z. S., Pursun, M., & Huang, F.
Affiliations
  • First Affiliated Hospital of GuangXi Medical University (CN)
  • Guangxi Medical University (CN)
Corresponding author
Huang, Feng
ORCID
Huang, Feng
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2019-01-08
Volume
19
Issue
1
Pages
36-36
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-018-6319-3
PMC
PMC6325781
OpenAlex
W2947093263
Cited by
154
References
2
Citations by year
2026: 21 · 2025: 15 · 2024: 18 · 2023: 36 · 2022: 20 · 2021: 21 · 2020: 15 · 2019: 8
FWCI
2.25
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Natural Science Foundation of China (81560046, 81760057)
  • Natural Science Foundation of Guangxi Province (2016GXNSFAA380002)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
Keywords
smoking, male infertility, semen quality, oligozoospermia, asthenozoospermia, teratozoospermia, azoospermia, sperm morphology, sperm motility, semen pH, reproductive hormones, testosterone, luteinizing hormone, follicle-stimulating hormone, estradiol, smoking cessation, infertility treatment outcomes, assisted reproduction outcomes
MeSH terms
Tobacco Smoking, Humans, Infertility, Male, Male, Randomized Controlled Trials as Topic, Semen Analysis

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