A number of comprehensive reviews of the literature have been published, summarizing the cumulative data supporting an association between cigarette smoking and diminished female fecundity. In addition, evidence linking cigarette smoking to diminished fertility in the male has been reviewed.Active smoking was associated with failure to conceive within 6 or 12 months with increase delay correlated to increase number of cigarettes smoked per day. The percentage of women experiencing conception delay for over 12 months was 54% higher for smokers compared to nonsmokers. Exposure to passive smoke further increased the odds against a woman conceiving within 6 months. The investigators studied data from nearly 15,000 pregnancies.Cooper et al. also found a diminished ovarian reserve based on markedly statistically significant higher mean basal FSH levels, particularly in younger women smokers. Smokers also required more gonadotropins for ovarian stimulation in vitro fertilization cycles, had a higher number of canceled cycles, fewer oocytes retrieved in those cycles not canceled, more cycles with failed fertilization and a lower overall clinical pregnancy rate. This is one of several studies documenting diminished success in Assisted Reproduction among smokers compared to non-smokers.Zenzes documented cotinine, a major metabolite of nicotine, to be found in dose dependent concentrations relative to the number of cigarettes smoked in 100% of the follicular fluids of infertility patients undergoing in vitro fertilization oocyte retrieval. Besides, 84% of women reporting themselves as non-smokers and with a nonsmoking partner also had detectable levels of cotinine in their follicular fluids. Also, many nonsmokers are regularly exposed by inhalation of ‘sidestream’ smoke from burning cigarettes and/or from ‘passive’ smoke exhaled by smokers.smoking is clearly associated with an increase in spontaneous miscarriage, with bacterial vaginosis (which is associated with late pregnancy miscarriage), with preterm labor and with delivery of low birth weight infants at added risk of neonatal morbidity and mortality. To the adverse effects of cigarette smoking on female fertility and pregnancy outcome must also be added the adverse effects of cigarette smoking by males on their pathologically increased sperm DNA fragmentation is one of the causes of repeated assisted reproduction failures in the ICSI era. Several studies have demonstrated that sperm DNA integrity correlates with pregnancy outcome in in vitro fertilization. Therefore, sperm DNA fragmentation should be included in the evaluation of the infertile male. Assessment of sperm DNA damage appears own fertility and on their partners through passive and sidestream smoke Several studies over many years have evaluated the effect of smoking on semen parameters, especially density, motility and morphology. These studies collectively demonstrate a reduction in sperm density, motility and possibly morphology. The reduction in sperm count averaged 22%, and showed a dose response, with increased cigarette smoking correlating to a greater reduction in sperm count.Women who smoke have decreased fertility. The risk of spontaneous abortion is higher for pregnant women who smoke. Babies born to smokers weigh, on average, 200 grams less than babies born to comparable women who do not smoke, with low birth weight being an important predictor of infant mortality.