Upload
ccn-mina
View
220
Download
0
Embed Size (px)
Citation preview
8/8/2019 Smoking Infertility
1/26
BYBY
Mohammad A. EmamMohammad A. Emam
Prof. of Obstetrics andProf. of Obstetrics and
GynecologyGynecology
Mansoura Faculty of MedicineMansoura Faculty of Medicine
Mansoura integrated fertilityMansoura integrated fertility
center (MIFC)center (MIFC) EGYPTEGYPT
Smoking AndSmoking And InfertilityInfertility
8/8/2019 Smoking Infertility
2/26
Smoking as a major healthproblem.
High prevalence ofsmoking among women intheir reproductive years
Unawareness of effect of
smoking on reproduction.Smokers may be active orpassive.
Introduction &RationaleIntroduction &Rationale
8/8/2019 Smoking Infertility
3/26
8/8/2019 Smoking Infertility
4/26
Prevalence of SmokingPrevalence of Smoking30% of reproductive age womenand 35% of men are cigarette
smokers (Centers for Disease Control andPrevention 2001)
Nearly 30% of middle schoolchildren and over 63% of highschool students had triedsmoking (American Heart Associationstatistics 2001).
8/8/2019 Smoking Infertility
5/26
Prevalence of SmokingPrevalence of Smoking con.con.
In Egypt:
20% of reproductive age
women and 35% of men are
cigarette smokers.
Shesha smokers are
increased among adolescentsteenage girls.
8/8/2019 Smoking Infertility
6/26
Awareness of The HealthAwareness of The Health
Risks of SmokingRisks of SmokingQuestionnaire for 388 female hospitalemployees including health care
professional (Roth and Taylor 2001):Most women are aware that smoking
causes: Respiratory disease (99%).
Lung cancer (99%).
Heart disease (96%).s
Pregnancy complications (91%).
8/8/2019 Smoking Infertility
7/26
Awareness of The HealthAwareness of The Health
Risks of SmokingRisks of Smoking contcont
Few women are aware that smokingis associated with:
Osteoporosis (30%).
Early menopause (17%).
Spontaneous abortion (39%). Ectopic pregnancy (27%).
Cervical cancer (24%).
Infertility (22%).
8/8/2019 Smoking Infertility
8/26
Smoking & ReproductionSmoking & Reproduction
More Than4
0PublishedStudies In
MedicalLiterature
8/8/2019 Smoking Infertility
9/26
Smoking & Female InfertilitySmoking & Female Infertility
Meta analysis (21 studies) (Augood et all, 1998)
Smoking reduce the natural fertility
Earlier menopause (average 2 years).
Damage of ovarian reserve increase with
smoking(the amount and the period of smoking ). Increase in risks for ectopic pregnancy and
spontaneous abortion.
8/8/2019 Smoking Infertility
10/26
Smoking & Female InfertilitySmoking & Female Infertility con.con.
Women who quit smoking before or during
pregnancy reduce the risk for adverse
reproductive outcomes, including:Difficulties in becomingpregnant.
Infertility.
PROM.
Preterm delivery.
Low birth weight.
(Cochrene review,Lumelyet al,2003)
8/8/2019 Smoking Infertility
11/26
Smoking & Male InfertilitySmoking & Male Infertility
(ASRM=AFS(ASRM=AFS 20012001))
Heavy smokingcontributes to:
Development of impotence(decrease blood flow to the penis)
Abnormal semenogram :Decreased sperm count,
alteration in motility , and increase
in the abnormal forms.
8/8/2019 Smoking Infertility
12/26
SMOKERS & ARTSMOKERS & ARTA prospective cohort studyA prospective cohort study ((Zitzman etalZitzman etal20012001))::
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.
8/8/2019 Smoking Infertility
13/26
How Smoking Affect Fertility?How Smoking Affect Fertility?
Maternal smoking affects:
In utro ovary of female fetuses
Reduced Semen Quality and Testis Size in
Adulthood (Jensen ,2004)
Increase ROS inside Graafian follicleIncrease ROS inside Graafian follicle
Affect meiotic maturation of humanAffect meiotic maturation of human
oocytesoocytes
8/8/2019 Smoking Infertility
14/26
How Smoking Affect Fertility?How Smoking Affect Fertility? ConCon
Interfere with estrogen synthesis,
Endothelial abnormalities (atherogenic
and thrombotic problems).
Oocytes (pre-zygotic genetic damage)
sperm DNA damage (substances insmoke).
8/8/2019 Smoking Infertility
15/26
Substances In SmokeSubstances In Smoke
(active and passive ):
> 4.000 chemical compounds,
43 carcinogens or poisons
> 300 polycyclic aromatic hydrocarbons.
methyl isocyanate( lethal poison).
bezene,( a potent toxicant)
Nicotine and its metabolites, cotinine
Polonium 210 (a carcinogenic radioactive elem),
Cadmium
Cigarette
smoke
8/8/2019 Smoking Infertility
16/26
Updat at r al iUpdat at r al i
I cr as s th ris f asth a
duri th first 7 y ars f lif(Laurberg P, 2004)
I pair t f i di
Nutriti i Br ast-F d
I fants (Nohr, 2004).
Incr as d ris f r suddeninfant death syndr e
( ID ).
8/8/2019 Smoking Infertility
17/26
Theimage cannotbe displayed.Your computer may nothaveenough memory toopen theimage,or the imagemay havebeen corrupted. Restartyour computer,and then open thefileagain.If thered x stillappears,you may havetodeletethe imageand then insertit again.
Mansoura integratedFertility Center (MIFC)
RESEARCHE Egypt
8/8/2019 Smoking Infertility
18/26
Could Female Passive SmokingCompromise The Outcome of
Assisted Fertilization?
( Middle East Fertility Society 10th
a\Annual Scientific Meeting Lebanon
,December 10-13,2003) o-76
8/8/2019 Smoking Infertility
19/26
8/8/2019 Smoking Infertility
20/26
8/8/2019 Smoking Infertility
21/26
Could Cadmium Be The Culprit ofCould Cadmium Be The Culprit of
Defective Male ReproductionDefective Male Reproduction
Among Smokers?Among Smokers?
The Egyptian Journal OfDermatology and Venereology vol
22 ,N 2&3 2002
8/8/2019 Smoking Infertility
22/26
ConclusionsConclusionsA high cadmium level is
observed in plasma of heavy
smokers which may cause a
direct cytotoxic effect on
spermatozoa, impairing their
functions.
8/8/2019 Smoking Infertility
23/26
ConclusionsConclusions cont.cont.Smoking cessation may improve
fertility and success rates with
infertility treatment.Moreover it ishealthy for the growing fetus, and
will create a smoke-free
environment for an infant.
Smoking may be a forgottenexplanation for some cases of
unexplained infertility.
8/8/2019 Smoking Infertility
24/26
ConclusionsConclusions cont.cont.It is not known how long
the damaging effects ofsmoking last after
quitting but Oneimportant investigationshowed that cessation ofsmoking forat least two
months beforeattempting IVFsignificantly improvedchances for conception.
8/8/2019 Smoking Infertility
25/26
RecommendationsRecommendations1. The phasing out and banning of smoking
in home should be an integral part of
human infertility treatment.2. Further studies to show the correlation
between the duration of exposure tocigarette smoke and the fertilization rate,are needed.
3. Further studies on the levels of reactiveoxygen species (ROS) in the follicular fluidin passive smokers are needed.
8/8/2019 Smoking Infertility
26/26
OB& GYN, Mansoura FacultyofMedcine
Mansoura Integrated Fertility Center (MIFC)EGYPT
Telfax 0020502319922 & 0020502312299
Email. [email protected]