Tobacco use impairs, alters, adversely affects or interferes with normal reproductive functions.
The agency has now urged governments to treat tobacco control as a core pillar of reproductive health, warning that smoking sharply raises infertility risks for both men and women.
Infertility affects one in six people of reproductive age worldwide, the WHO said. It noted that testing and treatment remain limited, often expensive and, in many settings, financially devastating.
The guidelines also make clear that infertility is no longer only a medical issue but also an equity issue.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said, “Infertility is one of the most overlooked public health challenges of our time and a major equity issue globally. Millions face this journey alone — priced out of care, pushed toward cheaper but unproven treatments, or forced to choose between their hopes of having children and their financial security.”
The report names tobacco use as one of the most consistent and powerful contributors.
This assertion draws heavily from decades of research on tobacco’s impact on reproduction. The review shows overwhelming evidence linking smoking to infertility in women.
“The review suggested that cigarette smoking impairs, alters, adversely affects or interferes with normal reproductive functions,” the report says.
“More recently, a review of three non-randomised studies reported that the odds of infertility in female smokers were 1.85 times the odds in non-smokers.”
In men, smoking is linked to lower semen quality, even among young or otherwise healthy men. The WHO guideline cites a major 2016 review which assessed the association between smoking and semen quality using the 2010 WHO laboratory manual for the examination and processing of human semen.
The findings are clear: “Smoking may be associated with a reduction in some semen parameters: semen volume; sperm count; sperm motility; and sperm morphology.”
The guidelines also warn that reductions in
semen parameters may be greater in moderate and heavy smokers. However, the report notes the scientific caution that “although some results were statistically
significant, it is not clear whether the magnitude of the reductions in semen
parameters is clinically relevant and whether the observed reductions affect
fertility.”
Because smoking is a modifiable risk factor, the WHO recommended that clinicians caring for anyone planning or attempting pregnancy should provide quick, targeted advice on quitting tobacco. The guideline states that brief advice lasting 30 seconds to three minutes should warn individuals that smoking increases infertility and reduces reproductive success.
This intervention is especially important in
countries like Kenya, where around 11 per cent of men use tobacco, according to
the latest Global Adult Tobacco Survey. Public health experts warn that younger
men are increasingly using new forms of tobacco, potentially creating a
future wave of preventable infertility.
The guidelines further describe the enormous financial pressures people face when seeking fertility care. The WHO says: “In some settings, even a single round of in vitro fertilisation (IVF) can cost double the average annual household income.”
Infertility affects an estimated 10 to 15 per cent of couples in Kenya, according to the Ministry of Health, but the cost of services often keeps care out of reach. A single cycle of IVF in Nairobi can cost more than Sh400,000, and the Social Health Authority and private insurance firm do not cover such fertility treatments.
The guideline recommends integrating fertility care into national health strategies and financing systems to reduce the burden on families.
WHO calls for countries to ensure ongoing psychosocial support, including counselling and mental health services, at every step of care. The document outlines clear clinical pathways for diagnosing infertility in both men and women, starting with simple tests and moving toward more specialised interventions when needed.
The report also calls for better prevention in schools, health facilities, and communities. This includes providing accurate information about fertility, age-related declines in conception rates, untreated sexually transmitted infections, and lifestyle risks such as tobacco use.
Dr Pascale Allotey, Director of WHO’s Sexual and Reproductive Health Department, underscores the social dimensions of the challenge. “The prevention and treatment of infertility must be grounded in gender equality and reproductive rights,” she said. “Empowering people to make informed choices about their reproductive lives is a health imperative and a matter of social justice,” she said.
