RCOG World Congress 2025

The impact of e-cigarette use on ovarian reserve and outcomes of assisted reproductive technology. A systematic review.

BACKGROUND

The negative impact of cigarette smoking on female ovarian reserve is well established.

Endocrine disruptor chemicals are linked to reduced female and male fertility (1).

Smoking has been shown to reduce ovarian reserve and result in an earlier age of menopause (2).

Less is known about the impact of vaping (e-cigarette use) but emerging evidence is concerning.

The number of young people vaping is increasing and 1 in 5 women of childbearing age are estimated to vape (3).

METHODS

PRISMA guidelines were followed, study was registered on PROSPERO (CRD42024590117).

Time frame for studies: 2019-2025, searches in Sept 2024 and repeated

Databases searched: PubMed, the Cochrane database, EMBASE and CINAHL and conference abstracts from BFS, ASRM and ESHRE

Search terms: ‘vaping’ or ‘e-cigarette’, ‘Ovarian reserve’, ‘infertility’ or ‘subfertility’, ‘fecundability’ and ‘Pregnancy rate’ or ‘ART outcomes’.

Inclusion criteria: Experimental or observational studies including human female participants, vaping as exposure and objective measurements of ovarian reserve and results of ART as outcomes.

Exclusion criteria: animal studies, male only participants, review/opinion articles

The ROBINS-E tool for risk of bias assessment was used.

AIMS

The aim of this systematic review was to review the literature on the impact of vaping (e-cigarette use) on ovarian reserve and outcomes of assisted reproductive technology (ART), including in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).

RESULTS

The initial search included 213 studies. Three studies met the inclusion criteria.

One study involved a retrospective review of Anti-Müllerian hormone (AMH) levels in > 20,000 healthy women of reproductive age and observed a 8% reduction in AMH levels in current vapers and 5% reduction in occasional vapers compared to non-vapers (4).

Two of the studies were prospective observational studies on outcomes of intracytoplasmic sperm injection (ICSI) for infertile couples, comparing smokers/vapers to non-smokers(5,6).

One study reported significantly lower AMH levels fertilisation rates but neither study reported a difference in clinical outcomes.

CONCLUSIONS

Vaping appears to reduce ovarian reserve.

A greater reduction in ovarian reserve was observed in ‘current’ vapers than ‘occasional’ vapers suggesting the reduction may be dose dependent but the threshold for harm and whether the effect is reversible is unclear.

Whether vaping impacts on the success of ART is yet to be empirically proven.

REFERENCES

1.Silva ABP, Carreiró F, Ramos F, Sanches-Silva A. The role of endocrine disruptors in female infertility. Mol Biol Rep. 2023;50(8):7069-88.

2.Plante BJ, Cooper GS, Baird DD, Steiner AZ. The impact of smoking on antimüllerian hormone levels in women aged 38 to 50 years. Menopause. 2010;17(3):571-

3.Jackson SE, Brown J, Notley C, Shahab L, Cox S. Characterising smoking and nicotine use behaviours among women of reproductive age: a 10-year population study in England. BMC Med. 2024;22(1):99.

4.Esther Wainwright BND, Sofia Rodrigues Vaz, Tharni Vasavan, Natalie Getreu,, O'Neill H. The effect of vaping on hormonal ovarian reserve markers in women of reproductive age in the United Kingdom. Human Fertility. 2025;28:334-5.

5.Galanti F, Licata E, Paciotti G, Gallo M, Riccio S, Miriello D, et al. Impact of different typologies of smoking on ovarian reserve and oocyte quality in women performing ICSI cycles: an observational prospective study. Eur Rev Med Pharmacol Sci. 2023;27(11):5190-9.

6.Trapphoff T, Ontrup C, Krug S, Dieterle S. Consumption of hookahs, e-cigarettes, and classic cigarettes and the impact on medically assisted reproduction treatment. Sci Rep. 2024;14(1):9597.

RCOG World Congress 2025

The impact of vaping on ovarian reserve and fertility. A systematic review.

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