Purpose: Smoking is known to be deleterious on female fertility and in vitro fertilization (IVF) outcome, probably partly through ovarian reserve alteration. Recently, anti-Müllerian hormone (AMH) and antral follicle count (AFC) have been shown to be the most accurate ovarian reserve markers. Here, we compared ovarian reserve markers in women undergoing IVF according to smoking status and stimulation regimen.
Methods: AFC, AMH, basal FSH, LH and estradiol, and IVF outcome were compared in 277 women undergoing IVF. Smoking status and ovarian stimulation protocol (i.e. agonists or antagonists) were recorded.
Results: Active smoking women had lower AMH and modified follicles' size repartition in AFC compared to non-smokers. They also experienced poorer IVF outcome with decreased ovarian response and lower pregnancy rate. This remained true in both antagonist and agonist stimulation protocol groups.
Conclusion: Active smoking in infertile women is associated with ovarian reserve alteration, as reflected by AFC modification and decreased serum AMH, and leads to poor prognosis in ART cycles, whatever the stimulation protocol used. Infertile women should be strongly discouraged from smoking before they start IVF cycles.