ABSTRACT
The global prevalence of infertility is estimated to be 9% [1] and between 50 and 80 million people worldwide are infertile [2]. Advanced age, diet, prescription medication use, preexisting health status, and infections are among the known risk factors for infertility; however, for many women, the cause of their infertility is unknown. Environmental toxicants and lifestyle factors are thought to adversely affect human fertility in part via impaired ovarian function [3-5]. Of the many environmental chemicals to which women are exposed, we have focused on cigarette smoking because it is the one activity that a woman chooses to engage in that is known to kill eggs, decreases fertility, and brings forward the age of menopause. The healthcare costs in 2008, in the United States, associated with cigarette smoking were 96 billion dollars [6] with secondhand cigarette smoke exposure adding another 10 billion dollars [7]. A well-documented general health hazard, cigarette smoke also has serious consequences for reproductive health in women. Indeed, compared to women who have never smoked or been exposed to cigarette smoke, cigarette smoking has been linked to longer time to pregnancy, earlier age at menopause, decreased follicle counts, and diminished response to ovulation induction [8-15]. Despite the documented adverse health effects of cigarette smoking on women’s reproductive health, the number of young women commencing smoking is increasing [16], suggesting that current smoking prevention strategies are ineffective in this population. Hence, women represent a growing population who are exposed to the single most preventable toxic exposure and documented health risk.
