1 / 28

Cigarette smoking and infertility

Cigarette smoking and infertility. de Mouzon Jacques, MD, MPH, INSERM U822, Le Kremlin-Bicêtre, France. Introduction. Cigarette smoking associated to many pathologies Cancer : Lung, Stomach, Bladder, etc. Cardiovascular disease, lung insufficiency, etc.

orien
Download Presentation

Cigarette smoking and infertility

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cigarette smoking and infertility de Mouzon Jacques, MD, MPH, INSERM U822, Le Kremlin-Bicêtre, France

  2. Introduction • Cigarette smoking associated to many pathologies • Cancer : Lung, Stomach, Bladder, etc. • Cardiovascular disease, lung insufficiency, etc. • First cause of preventable mortality in France (65000 deaths) • Among women, well established role in pregnancy • Pre-eclampsia,, Placenta praevia, Abruptio placentae • Fetus : birth weight (150-200g), small for gestational age • Increasing concern in human reproduction • For natural fertility (woman and man) • For ART • Several hypotheses for action mode

  3. I / Natural fertility

  4. Normal fertility • On average, • 85% of couples conceive within 12 months • 90 % within 18 months • What about cigarette smokers ?

  5. Diminution of probability to conceiveFrench study (Gefco) 1887 couples, planned pregnancies de Mouzon J, Spira A, Schwartz D. Int J Epidemiol 1988,17:378-384

  6. Increase in TTPEuropean study (7 countries) * TTP > 9,5 months % * * Cigarettes / day • General population : 3187 planned pregnancies • Maternity hospitals : 2587 planned pregnancies Infertility duration multiplied by : 1.2 pour 1 - 10 cigarettes (1.1-1.4) 1.5 pour > 10 (1.3-1.8) Bolumar F, Olsen J, Boldsen J et al. Am J Epidemiol 1996,143:578-587

  7. Increase in TTP (2)England(Avon county) % 8515 planned pregnancies Hull MGR, North K, Taylor H et al. Fertil Steril 2000,74:725-733

  8. Increased risk of TTP≥ 12 months Male and female smoking cigarettes 8515 planned pregnancies English study Hull MGR, North K, Taylor H et al. Fertil Steril 2000,74:725-733

  9. Male and female smokingCanadian study OR for fecundibility Ontario Farm Family Health Study:2607 planned pregnancies Woman +, Man +,Both man and woman ++ Curtis KM, Savitz DA, Arbuckle TE Am J Epidemiol 1997,146:32-41

  10. In utero exposition to smokingOdds-ratios for fecundibility Prospective study, CO stopping, 423 couples, multivariate analysis Jensen TK, Henriksen TB, HjollundNHI et al. Am J Epidemiol 1998,148:992-997

  11. In utero exposition to smoking Danish study (2) • Jensen et al, Int J Androl. 2006 • National cohort of twins born 1931 - 1952 • 1653 women / 1598 men, with TTP • Exposition in utero to cigarette smoking • Fecundibility Odds Ratios, whole cohort • Women : FOR = 0.81; 95% CI 0.67-0.99 • Men : FOR = 1.12; 95% CI 0.89-1.40 NS • Selection of twins of opposite sex • Women : FOR = 0.65; 95% CI 0.47-0.91 • Men : FOR = 0.97; 95% CI 0.60-1.55

  12. Cigarette smoking and female fertilityOther aspects • Increase in short / irregular cycles • Younger menopausal age (2 years) • Increase % of earlymenopauses (<40 yrs) • Related to level and duration of smoking • Multiplied by 3 fo 20 cig / day, 20 years • ± reversible Willett W, Stampfer MJ & Bain C et al. Cigarette smoking, relative weight, and menopause. Am J Epidemiol 1983,117: 651-8

  13. Cigarette smoking and male fertilitySemen • Künzle 2003, infertile smokersNon smokers p • n 655 1131 • Concentration : 68 (66)80 (75) 0.001 • Motility A : 37.1 (18.6)38.7 (17.7) 0.07 • Normal forms: 21.2 (14.6)23.7 (15.5) 0.001 • Trummer 2002, infertile: n=478 517 109 ExS • Round cells (106) : 3.5 (5.3) 2.7 (3.4)2.6 (3.4) 0.01 • Saleh 200212 Infert S21 Infert NS13 Donors NS Leucocytes (106) 1.8 (0.6-4.4)0.0 (0.0-0.4)0.1 (0.0-0.2) 0.01 S=Smokers; NS=Non Smokers; ExS= Ex Smokers

  14. II / Assisted Reproduction

  15. Woman cigarette Smoking and IVF. Retrospective cohort Van Voorhis BJ, Dawson JD, Stovall DW et al. Obstet Gynecol 1996;88:785-791

  16. Woman cigarette Smoking and IVF. Tubal infertility Smoking classified according to follicular cotinine (ng/ml) Sterzik K, Abt M, Strehler E et al. Human Reprod 1995,10:3213-3217

  17. Woman cigarette Smoking and oocyte quality Zenzes MT, Wang P, Casper RF (Human Reprod 1995,10:3213-3217

  18. Couple cigarette smoking and IVF failure OR N=221 Klonoff-Cohen H., Natarajan L., Marrs R., Yee B. Human Reprod 2001,16 :1382-1390

  19. Woman cigarette smoking and Pregnancy rate Belaisch-Allart J, El-Akoum ., Mayenga JM, et al. Fertil Steril 1996,66:679-689

  20. Woman passive cigarette smoking and Pregnancy rate All NS Neal MS, Hughes EG, Holloway AC et al.Hum Reprod 2005,20:2531-5

  21. Woman passive cigarette smoking and Pregnancy rate (2) • Cumulative embryo score • ** p<0.05 Neal MS, Hughes EG, Holloway AC et al.Hum Reprod 2005,20:2531-5

  22. Cigarette smoking and implantation: oocyte donation S.R.Soares, Human Reproduction 2006 785 oocyte donations, Valence, man no-smoker, transfer D3 2.1 embryos on average (identical in the groups) *: p<0.05

  23. Meta-analysis 1 (EG Hugues) • 13 studies on natural fertility (n=55000) • All odds-ratios or relative risks of fertility lower than 1 except 1 : from 0.3 to 1 • 7 studies on ART (n=1700) • All odds-ratios of fertility lower than 1 • Mean estimate, 0.57 (0.42-0.78) • Hugues EG, Brennan BG. Fertil Steril 1996,66:679-689

  24. Meta-analysis 2 (Augood) • 13 studies on natural fertility • Mean estimate of risk of infertility among smokers: OR =1.60(1.34-1.91) • Mean estimate of risk of TTP >1yr among smokers OR = 1.42(1.27-1.58) • 9 studies on ART Mean estimate of risk pregnancy among smokers OR = 0.66 (0.49-0.88) Augood C, Duckitt K, Templeton. Human Reprod 1998,13 :1532-1539

  25. Cigarette smoking and infertility Hypotheses • Nicotine • Hypothalamo-pituitary-ovarian axis • Early menopause, Estradiol, oocytes number • local : • cervical mucus, tubal motility, ciliary function • Other compounds :Cadmium (diploid oocytes ?) • Hypoxia: oxydative stress on follicle • Marker for tubal infertility • Van Voorhis BJ et al. Tubal infertility in IVF cohort : No smoker 34 %, Ex smoker 57 %, smoker 62 %. • Smoker more sexually active (ACSF)

  26. Conclusion (1) • Decreased fertility (natural and ART) • Probablecausal relationship • Relation dose-effect, duration-effect • Biological plausibility • Reversibility at stopping (±) • Some interesting points • In utero exposure • Probable maternal and paternal effect • Passive exposition

  27. Conclusion (2) • Methodological difficulties in measuring exposition • Questionnaires, but concealed exposures • Biological measurements (cotinine) , expensive • Difficulties to measure duration, level • Carbon monoxyde tester in expired air • No study with large sample in ART

  28. Conclusion (3)French epidemiological study • Objective: association smoking/ Result • Large cohort study (3500 couples) • 14 ART Centres • Measurement of carbon monoxyde • Both members of couples • Criteria • Sperm quality • Oocyte number and quality • Cycle result and pregnancy outcome

More Related