Effect of female nargile smoking on in vitro fertilization outcome

Abstract

Objective

Smoking is a significant health hazard that has been associated with poor reproductive outcome and reduced fertility in reproductive age women. The aim of this study was to assess the effect of nargile smoking on intra-cytoplasmic sperm injection (ICSI) outcome.

Study design

A prospective analysis of the outcomes of 297 women who underwent ICSI treatment at the ART Unit at the American University of Beirut Medical Center between January 1, and December 31, 2006 was done. The patients were divided into 3 groups based on their smoking status: cigarette smokers (n = 42), nargile smokers (n = 51) and non-smokers (n = 204).

Results

The mean age of nargile smokers was significantly lower than the other groups; however, the 3 groups were similar with respect to the cause of infertility, total dose of follicular stimulating hormone (FSH), number of oocytes and embryos obtained, and number and quality of embryos transferred. There was no significant difference in the clinical pregnancy rate between nargile smokers and non-smokers (51.0% vs 43.6%). However, cigarette smokers had a significantly lower clinical pregnancy rate compared to non-smokers (23.8% vs 43.6%, p = 0.0238). On multiple logistic regression analysis, factors that decreased the clinical pregnancy rates were cigarette smoking and maternal age.

Conclusion

Although this study did not find a deleterious effect of nargile smoking on ICSI outcome, the results need to be confirmed in prospective studies that would include larger number of women with more objective measures of nargile smoke exposure.

Introduction

Tobacco use is widely recognized as a significant health hazard, and smoking, in reproductive age women, has been associated with poor reproductive outcome and reduced fertility [1], [2], [3]. Epidemiological studies of spontaneous conception confirm that 38% of non-smokers conceive in their first cycle compared with 28% of smokers, who are 3.4 times more likely to have a 1-year delay to conceive [2]. This impaired fertility is postulated to result from interference with gametogenesis, fertilization, failure of implantation and subclinical loss after implantation [2], [4]. Smoking is also associated with an earlier age of onset of menopause possibly through exacerbating the steady decrease in ovarian reserve that occurs with advancing age [5], [6], [7].

Studies evaluating the effect of smoking on the outcome of assisted reproductive techniques have produced conflicting results. Some have shown that maternal smoking is associated with decreased fertilization rates [8], [9], [10], decreased numbers of oocytes [11], decreased pregnancy rates [3], [11], [12], [13], [14], and increased miscarriage rates [15]. In contrast, other studies reported no effect of smoking on fertilization [15], [16], [17] and pregnancy rates [7], [16], [17], [18].

While extensive research has been conducted on the effect of cigarette smoking on reproductive outcomes, little is known about nargile, hubble-bubble or water pipe smoking. Nargile smoking is another form of tobacco consumption that originated more than 400 years ago in Turkey, India, and Iran but whose use has spread rapidly worldwide, thus constituting a major part of the global tobacco use epidemic [19]. It involves the burning of a dark tobacco paste of the Nicotiana tabacum family (containing 2–4% nicotine and 1.5–2% protein nitrogen) that is usually lit by charcoal embers underneath a metallic tray connected to a water container through a metallic tube. Tobacco smoke is inhaled through a long, flexible tube that is connected to the water container.

Nargile smoke has harmful components similar to those found in cigarette smoke, namely carbon monoxide, heavy metals, potentially cancerous tar fractions, and nicotine [20]. In the few published studies, nargile smoking has been associated with oral cavity and lung cancers, coronary heart disease, reduced ventilator capacity, bronchitis, emphysema, obstructive airway diseases, and low birth weight [21], [22]. Data on the effect of nargile smoking on female fertility and assisted reproductive techniques (ART) outcome is not available. Only one study showed that Egyptian men who are regular nargile smokers were at 2.5 times increased risk of male infertility as opposed to non-smokers [23].

With the increasing habit of nargile smoking (exact prevalence is undetermined), especially among women in our society, this study was performed to assess the effect of female nargile smoking on the outcome of intra-cytoplasmic sperm injection (ICSI) procedures.