Pakistan Journal of Medical Sciences


ISSN 1681-715X





Volume 23

October - December 2007 (Part-I)

Number  5


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The effect of cigarette smoking on
semen quality of infertile men

Tooba Mehrannia1


Objective: To evaluate the effects of cigarette smoking on semen quality of infertile men.

Methodology: Two hundred fourteen infertile men who had been smoking cigarette and one hundred thirty infertile non smokers’ men participated in this study. Seminal volume, sperm concentration, motility, viability, and morphology were examined.

Results: The quality of spermatozoa obtained from smokers were much lower than non-smokers (P<0.01). The sperm concentration, viability and forward progression were negatively correlated with cigarette smoking (P<0.01).

Conclusions: Smoking does affect the semen quality of infertile men.

KEYWORDS: Cigarette smoking, Male infertility, Semen quality.

Pak J Med Sci    October - December 2007 (Part-I)    Vol. 23 No. 5    717-719

1. Dr. Tooba Mehrannia, PhD
Infertility Center,
University of Kermanshah Medical Sciences,
Kermanshah – Iran.


Dr. Tooba Mehrannia, PhD

* Received for Publication: March 23, 2007
* Revision Received: April 9, 20007
* 2nd Revision Received: April 20, 2007
* Final Revision Accepted: August 12, 2007


Despite worldwide anti-smoking campaigns, cigarette smoking is very common. Experimental studies indicated that in rats exposed to smoking, serum levels of nicotine and cotinine were increased which adversely affected spermatogenesis and sperm fertilizing potential.1,2 However, in regard to the clinical studies on relationship between smoking and male reproduction, the literature results have been no conclusive. Cigarette smoking may be associated with sub-fertility in men and my result in decreased sperm concentration, lower sperm motility, and a reduced percentage of morphologically normal sperm.3,4 Some studies have reported that the association between man smoking and semen quality was stronger in healthy men than in the infertile population.5,6

The objective of this study was to evaluate the effects of cigarette on the sperm quality of men attending the infertility center.


Patients: This study was conducted in the academic university Hospitals. Men with age of 25-45 years, including one hundred thirty nonsmokers and two hundred fourteen smokers, with a history of infertility, who were able to provide an ejaculate, were consecutively evaluated. Subjects who participated in the study had never had urogenital or serious systemic disease. They never used any contraceptive. Their spouses were apparently fertile women as indicated by physical and laboratory examinations, seventy five fertile, non smoker men, with age of 25-40, who had children, served as the controls.

The smokers were categorized as mild (10 cigarettes per day), moderate (>10 and 20 cigarettes per day), and heavy smokers (>20 cigarettes per day). The smokers according to the duration of smoking were divided into short term, 1-10 years and long term, 11-20 years.

Semen Analysis: Semen samples were collected by masturbation in a clean specimen container after a sexual abstince for 3-6 days, allowed to liquefy and evaluated immediately thereafter according to WHO guidelines.7 Ejaculate volume, PH, and time to liquefaction were measured. The results of semen analyses were classified according to the nomenclature of semen viables.7

Normozoospermia was diagnosed when sperm concentration, motility and morphology were within the reference values. The reference value for sperm concentration was 20106 sperm/ml, for motility 50% sperm with forward progression (categories ‘a’ and ‘b’) or25% sperm with category ‘a’ movement, and for morphology 30% sperm with normal morphology respectively.

Statistics: Data were presented as mean as, if applicable, and the significance of differences were analyzed by t-test. Statistical analysis was performed by means of SPSS 7.5 for windows software packet. The significance of differences was set at P<0.05.


In all, three hundred forty four men were evaluated for infertility; of these, one hundred thirty were nonsmokers and two hundred fourteen smokers respectively. The semen volume acidity, and the sperm concentration, viability and forward progression (Grade) were much lower in the smokers than in the nonsmokers (p<0.01, Table-I). The semen parameters were much lower in the nonsmokers of infertile men than in the fertile men (P<0.01).

No significant differences in the results of semen quality were seen between mild, moderate and short term smokers and nonsmokers. Most semen parameters in the heavy and long term smokers are significantly lower than their corresponding values in the nonsmokers (P<0.05 or 0.01, Table-II).


The possible detrimental effects of cigarette smoking on male reproductive performance, and specifically on semen parameters, is of great interest and aviable data is quiet conclusive.8-12

In addition, because of the recent desire to better understand and treat infertility in men, it has become important to assess the possible side effects of cigarette smoking on male reproduction.11-13 Chemical agents or mutagens may affect male reproduction via direct effeet on the testes and their ability to produce sperm via the process known as spermatogenesis.13-16 Those mechanisms may involve the hormonal control of spermatogenesis or may directly affect the germ and sertoli cells within the somniferous tubules.11,13,17,18,19-21

Although there is some evidence to the contrary, a number of studies have shown higher incidences of abnormally shaped sperm cells as well as decreased motility and sperm concentration in men who smoke.9,11,16,22-26

In the current study, we investigated the effect of smoking on the semen quality of infertile men, particularly in heavy and long term smokers. The results indicated that smoking significantly reduced the ejaculate volume: Every smoker should be encouraged to stop smoking, especially if a pregnancy is planned. Cigarette smoke contains a lot of known toxins, which may have detrimental effects on fertility. Simply stopping smoking could prevent the toxins contained in cigarette smoke.


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