1. More Than 60 Published Studies In Medical Literature SMOKING & REPRODUCTION

2. SMOKING & FEMALE INFERTILITY Meta analysis (25 studies) - Smoking reduce the natural fertility - Earlier menopause(average 2 years) Damage of ovarian reserve increase with smoking - Increase in risks for ectopic pregnancy and spontaneous abortion

3. SMOKING & FEMALE INFERTILITY Women who quit smoking before or during pregnancy reduce the risk for adverse reproductive outcomes,including Difficulties in becoming pregnant. - Infertility - PROM - Preterm delivery - Low birth weight

4. SMOKING & MALE INFERTILITY (ASRM=AFS 2001) Heavy smoking countributes to - Development of impotence Abnormal semenogram - Decreased spermy count alteration in motility and increase in the abnormal forms

5. SMOKERS & ART A prospective cohort study (Zitzman et al 2001)  High basal and post cc serum FSH  Weak ovarian response to stim  Need higher doses of GN  Impaired fertilization and delayed conception resulted from - Interference with gametogenesis - Failure of implantation - Early miscarriage

6. HOW SMOKING AFFECT FERTILITY  Maternal smoking affects - In utro ovary female fetuses - Reduced Semen Quality and Testis Size in Adulthood (Jensen 2004)  Increase ROS inside Graafian follicle  Affect meiotic maturation of human oocytes

7. HOW SMOKING AFFECT FETILITY  Interfere with estrogen synthesis  Endothelial abnormalities (atherogenic and thrombotic problems)  Oocytes (pre-zygotic genetic damage)  Sperm DNA damage (substances in smoke)

8. UPDATE METERNAL SMOKING  Increases the risk of asthma during the first 7 years of life(Laurberg P.2004)  Impairment of iodine Nutrition in Breast-Fed Infants (Nohr,2004)  Increased risk for sudden infant death syndrome (SIDS)

10. In their meta-analysis, Waylen et. al. evaluadet 17 studies end showed in aggregate significantly lower odds of live birth per cycle (OR 0.54,95% CI 0.30- 0.99), and significantly higher odds of spontaneous miscarriage (OR 2.65, 95% CI 1.53-5.30 ) in women who smoked. In their meta-analysis, Waylen et. al. evaluadet 17 studies end showed in aggregate significantly lower odds of live birth per cycle (OR 0.54,95% CI 0.30- 0.99), and significantly higher odds of spontaneous miscarriage (OR 2.65, 95% CI 1.53-5.30 ) in women who smoked. Human Reprod update 2009;15

11. Benedict et al measured cotinine, a nicotine metabolite, in follicular fluid collected during 3270 IVF treatment cycles from 1909 non- smoking women between 1994 and 2003 to examine the relationship between secondhand tobacco smoke exposure and implantation failure. They reported a 52% in- crease in the risk of implantation failure among women exposed to STS compared with those unexposed. They also found a 25% decrease in the odds for a live birth among STS-exposed women Hum Reprod 2011;26

12. The summary point is that women trying to get pregnant should stop smoking, but non-smoking women, too, should remove themselves from chronic exposure to secondhand smoke. Fertil Steril 2012;97