The Effect of Patient Smoking Habit on the Outcome of IVF and GIFT Treatment

Abstract

EDITORIAL COMMENT: This paper provides strong evidence that infertile women who are smokers achieve significantly fewer successful pregnancies with treatment. This is yet another reason to advise smokers to conquer the habit, although worry about reproductive failure (perhaps the most potent of all anxieties) may result in increased difficulty in giving up this variety of drug addiction ‐ unfortunately this is likely to particularly apply to heavy smokers. The morality/legality of withholding treatment from patients who request it, is questionable, even when they persist with habits that lessen their chances of success, yet insist that expensive modern technology (IVF‐ ET, GIFT) be made available to them. When patients pay for their treatment and are counselled regarding the chances of success or failure of the method, the problem is different, but remains. Some gynaecologists refuse to operate on patients for cure of stress incontinence of urine if they continue to smoke or remain grossly overweight. Some IVF units will not accept patients over 40 years of age or those whose command of English precludes ready understanding of complicated treatment regimens. How should we react when we see couples who request referral for treatment of infertility when we judge that a baby would be very unlucky to have such parents? We agree with the authors' conclusion that vigorous attempts to convince infertile couples to stop smoking should be made well before they embark upon an assisted reproduction programme. A more important conclusion, if larger studies confirm these findings, is that the general public should be informed about the harmful effects of smoking on the reproductive process. Another comment is that infertile couples, smokers or not, often need counselling, especially when repeated treatment has failed; a clergyman, who was researching an address he was giving on IVF ‐ ET, once told the editor that he considered that there was inadequate counselling of infertile couples to accept their infertility!