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J Assist Reprod Genet (2009) 26:421424 DOI 10.1007/s10815-009-9330-x
LIFESTYLE FACTORS
Influence of smoking on outcome of COH and IUI in subfertile couples
Jacob Farhi & Raoul Orvieto
Received: 15 April 2009 /Accepted: 17 July 2009 /Published online: 15 September 2009 # Springer Science + Business Media, LLC 2009
AbstractAim To evaluate the influence of smoking on the outcome of COH and IUI in subfertile couples.
Patients and methods We reviewed the medical files of all consecutive women, age 35 years, attending our infertility clinics over an eigth-year period. Data on patient age, smoking habits, and variable related to infertility-treatment were collected from the files.
Results A total of 2,318 cases were evaluated: 1,803 in non-smoking patients (n=679) and 515 in smokers (n=206). The smokers used significantly more gonadotropin ampoules and gained a thinner endometrium on the day of hCG adminis-
tration than the nonsmokers (p<0.016 for both). There were no between-groups differences in patient age, duration of gonadotropin stimulation, number of follicle >14 mm in diameter, or E2 levels on the day of hCG administration. Conclusion Smokers undergoing COH with IUI required a significantly higher gonadotropin dosage than nonsmokers in order to achieved a comparable pregnancy rate.
Keywords Smoking . COH . IUI . Infertility. Pregnancy rate
Introduction
Lifestyle and environmental factors are well-known contributors to reproductive failure. Therefore, clinicians suggest that they be identified and corrected during preconception counseling of infertile couples prior to initiation of treatment.
Cigarette smoking, with its widely recognized deleterious health effects, accounts for an estimated 13% of causes of female infertility [1]. The underlying mechanism is presumed to involve a toxic effect of the various tobacco chemicals on follicular development, gamete mutagenesis or inhibition of granulose cell aromatase. This, in turn, leads to accelerated follicular depletion, reduced fecundity, increased miscarriages, and accelerated onset of menopause [24].
Cigarette smoking also has a significant negative effect on the clinical outcome of assisted reproduction treatment (ART). Several meta-analyses and reviews have investigated the effect of smoking in patients undergoing IVF treatment [57]. They all found that compared to nonsmokers, smokers required a higher mean gonadotropin doses for ovarian stimulation, and had lower peak E2 levels, fewer oocytes retrieved, lower fertilization and implantation rates, and lower pregnancy and live-birth rates. Moreover, smokers required...